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Poster Discussion session - Supportive and palliative care 1

4101 - A prospective study examining cachexia predictors in patients with incurable cancer.


20 Oct 2018


Poster Discussion session - Supportive and palliative care 1


End-of-Life Care

Tumour Site


Ola Magne Vagnildhaug


Annals of Oncology (2018) 29 (suppl_8): viii548-viii556. 10.1093/annonc/mdy295


O.M. Vagnildhaug1, C. Brunelli2, M.J. Hjermstad3, F. Strasser4, V. Baracos5, A. Wilcock6, M. Nabal7, S. Kaasa3, B. Laird8, T.S. Solheim1

Author affiliations

  • 1 The Cancer Clinic & European Palliative Care Research Centre (prc), Department Of Clinical And Molecular Medicine, St. Olav's hospital & NTNU, Norwegian University of Science and Technology, NO-7491 - Trondheim/NO
  • 2 Palliative Care, Pain Therapy And Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan/IT
  • 3 European Palliative Care Research Centre, Institute Of Clinical Medicine And Department Of Oncology, University of Oslo and Oslo University Hospital, 424 - Oslo/NO
  • 4 Oncological Palliative Medicine, Kantonsspital St. Gallen, 9007 - St. Gallen/CH
  • 5 Department Of Oncology, University of Alberta Cross Cancer Institute, T6G 1Z2 - Edmonton/CA
  • 6 Hayward House, Nottingham University Hospital NHS Trust, Nottingham/GB
  • 7 Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova de Lleida, Lleida/ES
  • 8 Edinburgh Cancer Research Uk Centre, University of Edinburgh, Edinburgh/GB


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Abstract 4101


A predictive model of cachexia development would help identify those at greatest risk for early therapeutic intervention. The aims of this study were to identify predictors of cachexia development and to use these to create and evaluate the accuracy of a predictive model.


A secondary analysis of an international, prospective, observational multicentre study was conducted. Patients with incurable cancer and without cachexia, who attended a palliative care unit were amenable to the analysis. Cachexia was defined as weight loss (WL) >5% (6 months) or WL > 2% and body mass index<20kg/m2. Disease related, demographic and patient reported markers were evaluated as possible predictors with Cox analysis. The predictor “cancer type” was divided into high risk (pancreatic or gastric cancer), low risk (sarcoma, breast or hematologic cancer) or neutral risk (all others). A classification and regression tree analysis was used to create a model based on optimal combinations and cut-offs of significant predictors for cachexia development, and accuracy was evaluated with receiver operating characteristic curve analysis.


628 patients, 57% female, were included in the analysis. Median (IQR) age was 65 (17) years and Karnofsky performance status 70 (10). Median (IQR) follow-up was 109 (108) days, and 159 (25%) patients developed cachexia. Initial WL, cancer type, appetite and chronic obstructive pulmonary disease were significant predictors (p ≤ 0.04). A four-level model was created with each level carrying an increasing risk of cachexia development. Level 1-patients (WL < 3%, low risk cancer type and no or little appetite loss) had a relative hazard ratio (RHR) of 0.27 of cachexia development, while level 4-patients (WL 3-5%) had a RHR of 4.9. Accuracy of cachexia predictions at 3 months was 76%, and a risk level ≥3 (1-3% WL and neutral risk cancer type OR < 3% weight loss and high risk cancer type) yielded a sensitivity of 46% and a specificity of 90% of cachexia development.


Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia. Patients with a risk level ≥3 have a high risk of cachexia development, and should be targeted for therapeutic intervention.

Clinical trial identification

Legal entity responsible for the study

European Palliative Care Research Centre, NTNU-Norwegian University of Science and Technology.


The European Palliative Care Research Centre, funded by Helsinn, The Norwegian Cancer Society, Joint Research Council at NTNU.

Editorial Acknowledgement


F. Strasser: Punctual advisorships (boards, expert meetings): Danone, Grünenthal, Helsinn, ISIS Global, Mundipharma, Novartis, Novelpharm, Obexia, Ono Pharmaceutical, Psioxus Therapeutics, PrIME Oncology, Sunstone Captial, Vifor; Unrestricted industry grants for clinical research: Celgene, Fresenius, Helsinn; Participation in a clinical cachexia trial lead by Novartis. All financial support was given to the institution. B. Laird: Honoraria: Helsinn. All other authors have declared no conflicts of interest.

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