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  • in patients with advanced cancer

    2022-09-13

    74 in patients with advanced cancer in palliative care in a reference 75 center in Brazil. Our results support that the stages of cachexia 76 based on this simple and objective classification were associated 77 with the main domains related to the cancer cachexia syndrome. 78 Our findings confirm the Malonyl Coenzyme A suggested by Douglas and 79 McMillan [10] that mGPS can help in the assessment of cachexia 80 progress. 81 In the present study, 36.2% of the sample had at least one 82 altered criterion (albumin or CRP) and 26.4% fulfilled both lab- 83 oratory altered criteria, named RCa. Bye et al. [17] using the 84 mGPS framework in a group of patients with inoperable 85 pancreatic cancer receiving palliative chemotherapy (n ΒΌ 20) 86 demonstrated a 65% prevalence of NCa, 5% of Un, 25% of PCa and 87 10% of RCa. The median survival rate reported by the authors 88 was of 45.5 weeks. The disagreement between our reports 89 should be justified by differences in the clinical profile, sample 90 size, current medical situation and median OS. Gray and 91 Axelsson [18] in a cohort study of patients enrolled in a 92 specialized palliative home care found a prevalence of cachexia 93 (define as CRP >10 mg/L and albumin <30 g/L) of 85% in the 94 0e30 days prior to death and 66% in the 31e60 days prior to 95 death. In addition, these authors demonstrated that the majority 96 of the sample (75%) had fulfilled the criteria within 0e120 days 97 prior to death. Accordingly, the prevalence of cachexia seems to 98 increase as death approaches. 99 Our results demonstrated that the cachexia framework allowed 100 to capture alterations in clinical and functional features (nutritional 101 risk, WL, symptoms, laboratory biomarkers, muscle mass, HGS, and 102 performance status) according to the cachexia stage progression. 103 Others have also related the elevated CRP with cachexia domains, 104 like WL [7], skeletal muscle loss, strength impairment, physical 105 function [19] and other symptoms [19,20]. 106 Weight change is an important prognostic factor in advanced 107 cancer. Furthermore, progressive WL is the most reported pheno- 108 type of cancer cachexia [4]. According to our results, RCa patients 109 exhibited significantly higher WL than the NCa patients. Previous 110 studies report inflammation as the major cause of WL in cancer 111 patients and present the concentration of albumin and CRP as the 112 best predictors of WL [21,22]. Takaioshi et al. [21] described 113 increased WL rate as an independent predictor of poor OS and 114 progression-free survival, and mGPS and CRP concentrations were 115 significantly correlated with WL in this study. Likewise, Dean et al. 116 [22] described that 34% of the WL observed was determined by 117 elevated CRP concentration. 118 Irrespective of functionality markers, the RCa patients had 119 poorer HGS, fatigue and functionality. Corroborating these findings, 120 Wallengren et al. [2] evaluated different diagnostic criteria for 121 cachexia in palliative cancer patients and demonstrated that 122 elevated CRP and reduced albumin were associated with fatigue, 123 low grip strength and short walking distance. Similarly, Kilgour 124 et al. [23] showed that lower HGS percentiles were associated with 125 reduced serum albumin values. 126 We also observed that the patients in advanced stages of 127 cachexia exhibited higher nutritional impact symptoms burden. In 128 a cohort of ovarian cancer patients it was shown that the highest 129 mGPS values were associated with greater nausea, pain, dyspnea, 130
    Please cite this article as: Alves da Silva G et al., Clinical utility of the modified Glasgow Prognostic Score to classify cachexia in patients with advanced cancer in palliative care, Clinical Nutrition, https://doi.org/10.1016/j.clnu.2019.07.002