The Harry R Horvitz Center for Palliative Medicine, Department of Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA.
Support Care Cancer. 2010 Feb;18(2):265-72. doi: 10.1007/s00520-009-0772-6.
Controversy exists as what constitutes the cancer anorexia-cachexia syndrome (CACS), and whether it truly is a distinct clinical disorder. In this study, we aimed to: (1) assess if CACS is a distinct clinical disorder, (2) identify the symptoms characteristic of CACS, (3) evaluate CACS impact on patient outcomes (symptom burden and survival time from referral).
Consecutive patients referred to palliative medicine were assessed by 38-symptom questionnaire. Demographics, Eastern Cooperative Oncology Group (ECOG), disease and extent, and survival were recorded. CACS, defined as anorexia plus weight loss (>10% of pre-illness weight). For analysis, patients were divided into four groups: (1) group CACS; (2) group A (only anorexia, NO >10% pre-illness weight loss); (3) group WL (weight loss >10% pre-illness weight only but NO anorexia); and (4) group N (NO weight loss >10% pre-illness weight and NO anorexia). Symptoms present in > or =5%, and patients with complete data were analyzed.
Four hundred eighty-four patients had complete data, metastatic cancer, and 26 symptoms present in > or =5%. Groups had significantly different ECOG, symptom burden, and survival. Significantly different symptom prevalence between groups: dry mouth,*early satiety,*constipation,*nausea,*taste changes,*vomiting,*dysphagia,*fatigue,*weak,*lack of energy, insomnia, dyspnea, depression, hoarseness, and anxiety. The nine symptoms with asterisk were CACS specific. Symptom Burden: CACS independently predicted greatest burden. Survival: Group N had significantly longer survival.
CACS appeared to be a distinct disorder with unique clinical characteristics in our advanced cancer population. Nine other symptoms constituted CACS. CACS independently predicted higher symptom burden. CACS absence predicted longer survival. More evidence is needed to better characterize this syndrome and generate a valid CACS consensus. A comprehensive validated CACS assessment instrument is required.
癌症恶病质厌食症综合征（CACS）的构成以及它是否确实是一种独特的临床疾病存在争议。在这项研究中，我们旨在：（1）评估 CACS 是否是一种独特的临床疾病，（2）确定 CACS 的特征症状，（3）评估 CACS 对患者预后（症状负担和从转介到死亡的时间）的影响。
连续转介至姑息医学的患者通过 38 项症状问卷进行评估。记录人口统计学、东部合作肿瘤学组（ECOG）、疾病和程度以及生存情况。CACS 定义为厌食症加体重减轻（> 10%的疾病前体重）。为了分析，患者被分为四组：（1）CACS 组；（2）A 组（仅厌食症，无> 10%的疾病前体重减轻）；（3）WL 组（体重减轻> 10%的疾病前体重，但无厌食症）；和（4）N 组（无> 10%的疾病前体重减轻和无厌食症）。分析时，选择症状出现率> =5%且有完整数据的患者。
484 例患者有完整数据，转移性癌症和 26 项症状出现率> =5%。各组的 ECOG、症状负担和生存情况均有显著差异。各组之间的症状发生率存在显著差异：口干，*早饱，*便秘，*恶心，*口味改变，*呕吐，*吞咽困难，*疲劳，*虚弱，*乏力，失眠，呼吸困难，抑郁，声音嘶哑和焦虑。带有星号的九个症状是 CACS 特有的。症状负担：CACS 独立预测最大负担。生存：N 组的生存时间显著更长。
在我们的晚期癌症患者中，CACS 似乎是一种独特的疾病，具有独特的临床特征。其他九个症状构成了 CACS。CACS 独立预测更高的症状负担。CACS 缺失预测更长的生存时间。需要更多的证据来更好地描述这种综合征并产生有效的 CACS 共识。需要一种全面的经过验证的 CACS 评估工具。
