in patients with advanced cancer
in patients with advanced cancer in palliative care in a reference
center in Brazil. Our results support that the stages of cachexia
based on this simple and objective classification were associated
with the main domains related to the cancer cachexia syndrome.
Our findings confirm the Malonyl Coenzyme A suggested by Douglas and
McMillan  that mGPS can help in the assessment of cachexia
In the present study, 36.2% of the sample had at least one
altered criterion (albumin or CRP) and 26.4% fulfilled both lab-
oratory altered criteria, named RCa. Bye et al.  using the
mGPS framework in a group of patients with inoperable
pancreatic cancer receiving palliative chemotherapy (n ¼ 20)
demonstrated a 65% prevalence of NCa, 5% of Un, 25% of PCa and
10% of RCa. The median survival rate reported by the authors
was of 45.5 weeks. The disagreement between our reports
should be justified by differences in the clinical profile, sample
size, current medical situation and median OS. Gray and
Axelsson  in a cohort study of patients enrolled in a
specialized palliative home care found a prevalence of cachexia
(define as CRP >10 mg/L and albumin <30 g/L) of 85% in the
0e30 days prior to death and 66% in the 31e60 days prior to
death. In addition, these authors demonstrated that the majority
of the sample (75%) had fulfilled the criteria within 0e120 days
prior to death. Accordingly, the prevalence of cachexia seems to
increase as death approaches.
Our results demonstrated that the cachexia framework allowed
to capture alterations in clinical and functional features (nutritional
risk, WL, symptoms, laboratory biomarkers, muscle mass, HGS, and
performance status) according to the cachexia stage progression.
Others have also related the elevated CRP with cachexia domains,
like WL , skeletal muscle loss, strength impairment, physical
function  and other symptoms [19,20].
Weight change is an important prognostic factor in advanced
cancer. Furthermore, progressive WL is the most reported pheno-
type of cancer cachexia . According to our results, RCa patients
exhibited significantly higher WL than the NCa patients. Previous
studies report inflammation as the major cause of WL in cancer
patients and present the concentration of albumin and CRP as the
best predictors of WL [21,22]. Takaioshi et al.  described
increased WL rate as an independent predictor of poor OS and
progression-free survival, and mGPS and CRP concentrations were
significantly correlated with WL in this study. Likewise, Dean et al.
 described that 34% of the WL observed was determined by
elevated CRP concentration.
Irrespective of functionality markers, the RCa patients had
poorer HGS, fatigue and functionality. Corroborating these findings,
Wallengren et al.  evaluated different diagnostic criteria for
cachexia in palliative cancer patients and demonstrated that
elevated CRP and reduced albumin were associated with fatigue,
low grip strength and short walking distance. Similarly, Kilgour
et al.  showed that lower HGS percentiles were associated with
reduced serum albumin values.
We also observed that the patients in advanced stages of
cachexia exhibited higher nutritional impact symptoms burden. In
a cohort of ovarian cancer patients it was shown that the highest
mGPS values were associated with greater nausea, pain, dyspnea,
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