Quality of life and survival survey of cancer cachexia in advanced non-small cell lung cancer patients-Japan nutrition and QOL survey in patients with advanced non-small cell lung cancer study

Abstract

Purpose: Although cancer cachexia is mainly characterized by persistent loss of body weight (BW), usually in response to a malignancy, the pathophysiology of cachexia remains unresolved. To elucidate the relationship between the loss of BW and other related clinical factors, we conducted a nationwide, multi-institutional, prospective, observational study in patients with advanced non-small cell lung cancer (NSCLC).

Methods: Treatment-naïve stage IV NSCLC patients with an Eastern Cooperative Oncology Group performance status (PS) of 0-2 were eligible. BW, handgrip strength (HGS), quality of life (QOL), Karnofsky Performance Scale (KPS), biochemical parameters, and survival were evaluated at baseline and every 4 weeks for 1 year. The relationship between BW loss and other factors was examined by linear regression analysis. Estimated survival curves were drawn by the Kaplan-Meier method and applied by the log-rank test. Clinical factors associated with cancer cachexia were identified through principal component analysis. The generalized estimating equation approach was used to analyze the deterioration of QOL resulting from the progression of cachexia.

Results: A total of 406 patients were analyzed. BW loss was significantly associated with worsening of QOL, HGS, KPS, and biochemical parameters. The incidence of BW loss was observed throughout the study period. Overall survival was significantly shorter in patients as BW loss progressed. BW loss, decrease in HGS, anorexia, and fatigue were identified as core factors of cachexia that contributed to the deterioration of QOL.

Conclusion: BW loss most likely deteriorated QOL and shortened survival in patients with advanced NSCLC and should be closely monitored.

Keywords: Body weight loss; Handgrip strength; Karnofsky Performance Scale; Non-small cell lung cancer; Quality of life.

Fig. 1

Relationship between body weight loss and change of MDASI-J score. Increase in score change indicates worsening of quality of life (QOL). Four hundred six patients were divided into four groups equally according to percentage of body weight (BW) loss from baseline. First quartile includes patients with BW loss ≤2.3 %; second quartile, BW loss 2.3 % ≤6.1 %; third quartile, BW loss 6.1 % ≤10.9 %; and fourth quartile, BW loss >10.9 %. QOL was evaluated and scored using MDASI-J questionnaire. Regression coefficient was −0.0291 (P = 0.0002) with linear regression analysis. MDASI-J, the Japanese version of the M.D. Anderson Symptom Inventory

Fig. 2

Overall survival curves according to the percentage of body weight loss The overall survival curve was drawn using the Kaplan-Meier method: first quartile, body weight (BW) loss ≤2.3 %; second quartile, BW loss 2.3 % ≤6.1 %; third quartile, BW loss 6.1 % ≤10.9 %; and fourth quartile, BW loss >10.9 %. Q quartile, HR hazard ratio