Functional Outcomes and Quality of Life for Patients With Cachexia and Solid Tumour Cancers: Findings of a Systematic Literature Review.

Abstract / Summary

Cachexia, a complex multifactorial syndrome characterized by loss of skeletal muscle mass, is common in cancer and impacts treatment response, quality of life (QoL) and survival. No effective therapy is currently available. This report summarizes findings from the literature on the relationship between cachexia and physical function, activities of daily living and health-related QoL in patients with solid tumours. We conducted a systematic literature review by searching Embase, MEDLINE and Cochrane Library publications from 2018-2023 for relevant studies. After screening and data extraction, a narrative synthesis was performed to identify QoL and functional outcomes in relation to cachexia. Forty publications representing 37 unique studies and 52 053 patients were identified, with 35 (94.6%) observational studies and two (5.4%) post hoc analyses of randomized trials ranging in sample size from 38 to approximately 17 000 patients. Mean/median patient age ranged from 45 to 79.6 years. Across the 40 publications, 11 different definitions of cachexia or body weight loss were used (with the most common, the Fearon et al. 2011 International Consensus criteria, used in 18 publications [45.0%]), revealing an overall lack of consensus on the most suitable diagnostic criteria for cachexia. Nineteen outcome types were reported, including physical function measures in 31 studies (77.5%), health-related QoL in 24 studies (60.0%), performance status in 16 studies (40.0%), pain and fatigue in 15 studies (37.5%) each, depression or anxiety in nine studies (22.5%) and activities of daily living in six studies (15.0%). Eleven outcome types were exclusively evaluated in univariate analysis; eight were evaluated in multivariate analysis. Many studies identified statistically significantly worse physical function, activities of daily living or health-related QoL in patients with cachexia or body weight loss compared with patients without these conditions. Of studies assessing physical function measures, 80.6% (25/31) identified a statistically significant association with cachexia or body weight loss in at least one outcome; for studies assessing health-related QoL, this was 91.7% (22/24); for performance status, 87.5% (14/16); for pain, 78.6% (11/14); for fatigue, 73.3% (11/15); for depression or anxiety, 55.6% (5/9); and for activities of daily living, 100% (6/6). This systematic literature review provides insights into functional outcomes and health-related QoL in predominantly real-world populations with cancer cachexia and can inform selection of cachexia clinical trial endpoints that reflect clinical benefits to patients. However, the wide range of methods, physical function metrics and patient-reported outcomes instruments used across studies support a call for standardization.

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