University Researchers Develop Tool to Diagnose Serious Weight Loss in Patients with MS, Cancer

Researchers at McGill University Health Centre (MUHC) in Canada developed a new tool to diagnose cachexia — also called wasting syndrome. It’s characterized by weight loss, muscle atrophy, fatigue, weakness, and a significant loss of appetite in someone who is not trying to lose weight, mainly in cancer patients. The tool may also be used in cachexia resulting from chronic diseases such as multiple sclerosis (MS).

The study, “Use of routinely available clinical, nutritional, and functional criteria to classify cachexia in advanced cancer patients,” was published in the journal Clinical Nutrition.

Cachexia is highly prevalent in patients with cancer and chronic diseases, and it is responsible for about one-third of deaths in cancer patients. Due to the heterogeneous features of cancer cachexia, its identification and classification are a challenge to physicians.

Patients with cachexia often do not respond well to treatments and are often hospitalized. They generally have a poor overall quality of life and experience pain and fatigue. It also becomes more difficult for them to perform regular daily activities. Cachexia, at least in more advanced stages, cannot be fully cured by eating more or by taking nutritional supplements.

“We are losing many cancer patients, not because of their cancer, but because their bodies have undergone important metabolic changes. In other words, they have simply stopped functioning correctly. In severe stages of cachexia, weight loss becomes very important and nutrients can no longer be absorbed or used properly by cancer patients,” Dr. Antonio Vigano, lead author of the study and firector of the Cancer Rehabilitation Program and Cachexia Clinic at MUHC, said in a news release.

“Cachexia gets worse with time and the longer we wait to address it, the harder it is to treat,” Vigano added. “Effectively diagnosing cachexia when still in its early stages can make an enormous difference for a cancer patient’s prognosis and quality of life. In order to save more lives, we need practical and accessible tools that can be effectively used by clinicians in their routine practice to identify patients with cachexia.”

The tool the researchers developed to diagnose cachexia in advanced cancer patients includes five clinical criteria that can be used to stage patients and predict important clinical, nutritional, and functional outcomes. The criteria include:

• Biochemistry (high C-reactive protein or leukocytes, or hypoalbuminemia, or anemia);
• Food intake (normal/decreased);
• Moderate weight loss (less than 5 percent); or
• Significant weight loss (more than 5 percent in past six months);
• Performance evaluated through a score of Eastern Cooperative Oncology Group Performance Status of 3 or more.

Vigano’s team at the McGill Nutrition and Performance Laboratory is also taking part in studies for cachexia therapies. But these therapies will only be useful if clinicians are able to properly diagnose cachexia and understand the severity of each case, he said.

“Research is still needed to understand all the causes of cachexia,” Vigano said. “Unless we can talk the same language in terms of what type of patients we are treating and the severity of their condition, it is often very difficult to make substantial progress.”

The team hopes this diagnostic tool can be applied to cancer patients and chronic disease patients, including MS, tuberculosis, chronic obstructive pulmonary disease (COPD), acquired immunodeficiency syndrome (AIDS), and chronic heart failure.