Abstract 1509P
Background
Cachexia appears in many terminal cancer patients and often shifts to refractory cachexia. The purpose of this study was; 1) to identify cachexia patients among the patients judged to have refractory cachexia and 2) to evaluate the impact of appropriate nutritional support for cachexia patients on survival.
Methods
Study subjects were terminal cancer patients who were admitted for terminal care and were judged to have had refractory cachexia in the last 6 years. We retrospectively examined the following Methods: 1) based on prognostic prediction using Palliative Performance Scale (PPS) and Palliative Performance Index (PPI), and biochemical markers (albumin (Alb), transthyretin (TTR), etc.), we distinguished cachexia from refractory cachexia, and 2) we evaluated the change of PPS, PPI, Alb, TTR and survival period of cachexia patients after nutritional support.
Results
Out of 223 patients who were considered to have refractory cachexia on admission, 26 patients improved their general status after palliating symptoms and hydration therapy. We judged them not refractory cachexia but cachexia. We administered nutritional support for these patients and observed significant improvement in several indices (Alb 2.1→3.0, TTR 8.3→21.6, PPS 24→61, p=0.01). When PPS, Alb and TTR were maintained, we judged that nutritional support was effective (Effective group; n=17). When PPS< 50, PPI>6, deterioration of TTR occurred, we judged the transition to refractory cachexia and ceased nutritional support (Non-effective group; n=9). In Effective group, PPS was significantly higher 2 weeks later (P=0.01), and TTR and Alb were significantly higher 3 weeks later (p=0.003, 0.04). Survival period was significantly longer in Effective group (51 vs 23 days, P=0.003).
Conclusions
PPS and TTR were considered to be useful indices for the differential diagnosis of cachexia and refractory cachexia at the terminal stage of cancer, and for the judgement of the indication of nutritional therapy. Change of PPS was the fastest and most useful index for assessing the adequacy of nutritional intervention for cachexia patients. Appropriate nutritional intervention based on these findings may lead to improvements in general condition and prognosis.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.