Abstract
Cancer cachexia (CC) is a syndrome characterized by wasting of lean body mass and
fat, often driven by decreased food intake, hypermetabolism, and inflammation resulting
in decreased lifespan and quality of life. Classification of cancer cachexia has improved,
but few clinically relevant diagnostic tools exist for its early identification and
characterization. The abridged Patient-Generated Subjective Global Assessment (aPG-SGA)
is a modification of the original Patient-Generated Subjective Global Assessment,
and consists of a four-part questionnaire that scores patients' weight history, food
intake, appetite, and performance status. The purpose of this study was to determine
whether the aPG-SGA is associated with both features and clinical sequelae of cancer
cachexia. In this prospective cohort study, 207 advanced lung and gastrointestinal
cancer patients completed the following tests: aPG-SGA, Edmonton Symptom Assessment
System, handgrip strength, a complete blood count, albumin, apolipoprotein A and B,
and C-reactive protein. Ninety-four participants with good performance status as assessed
by the Eastern Cooperative Oncology Group Performance Status completed additional
questionnaires and underwent body composition testing. Of these, 68 patients tested
for quadriceps strength and completed a 3-day food recall. Multivariable regression
models revealed that higher aPG-SGA scores (≥9 vs 0 to 1) are significantly associated
(P<0.05) with the following: unfavorable biological markers of cancer cachexia, such
as higher white blood cell counts (10.0 vs 6.7×109/L; lower hemoglobin (115.6 vs 127.7 g/L), elevated C-reactive protein (42.7 vs 18.2
mg/L [406.7 vs 173.3 nmol/L]); decreased anthropometric and physical measures, such
as body mass index (22.5 vs 27.1); fat mass (14.4 vs 26.0 kg), handgrip (24.7 vs 34.9
kg) and leg strength; an average 12% greater length of hospital stay; a dose reduction
in chemotherapy; and increased mortality. Given its association with the main features
of cancer cachexia and its ease of use, the aPG-SGA appears to be a useful tool for
detecting and predicting outcomes of cancer cachexia. Additional research is required
to determine what impact the aPG-SGA has on quality of care when used in the clinical
setting.
Keywords
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Biography
A. L. Vigano is director, McGill Nutrition and Performance Laboratory, Montreal, Quebec, Canada, and assistant professor and attending physician, Division of Palliative Care, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
Biography
J. di Tomasso is a clinical dietitian, Department of Clinical Nutrition, McGill University Health Centre, Montreal, Quebec, Canada.
Biography
R. D. Kilgour is associate director, McGill Nutrition and Performance Laboratory, and a professor and chair of the Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.
Biography
B. Trutschnigg is a graduate student, McGill Nutrition and Performance Laboratory, Montreal, Quebec, Canada.
Biography
E. Lucar is a research assistant, McGill Nutrition and Performance Laboratory, Montreal, Quebec, Canada.
Biography
J. A. Morais is associate director, McGill Nutrition and Performance Laboratory, and an associate professor and director, Division of Geriatric Medicine, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.
Biography
M. Borod is chief, Division of Palliative Care, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
Article info
Publication history
Published online: January 24, 2014
Accepted:
September 24,
2013
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT We acknowledge the support of the Canadian Foundation for Innovation New Opportunities Award; Canadian Institute for Health Research Operating Grant; McGill University Health Centre Research Institute; Fonds de la recherche en santé du Québec Senior clinical-scientist award; Canada Graduate Scholarships-Canadian Institute for Health Research Master's Award; Fonds de la recherche en santé du Québec Master's Training Award; and Cedars Cancer Institute, Henry R. Shibata fellowship.
Identification
Copyright
© 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
