Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 23:14:1362244.
doi: 10.3389/fonc.2024.1362244. eCollection 2024.

Leveraging real-world data to predict cancer cachexia stage, quality of life, and survival in a racially and ethnically diverse multi-institutional cohort of treatment-naïve patients with pancreatic ductal adenocarcinoma

Jennifer B Permuth  1   2 , Margaret A Park  2   3 , Dung-Tsa Chen  3 , Toni Basinski  2 , Benjamin D Powers  2   4 , Clement K Gwede  5 , Kaleena B Dezsi  1 , Maria Gomez  1   2 , Shraddha L Vyas  1   6 , Tiago Biachi  2 , Elena M Cortizas  7 , Sylvia Crowder  5 , Maria Genilo-Delgado  2 , B Lee Green  5 , Anna Greene  3 , Christopher Gregg  8 , Sarah E Hoffe  2 , Kun Jiang  9 , Bora Kim  2 , Vanitha Vasudevan  10 , Jeronimo Garcialopez De Llano  10 , Anjana A Menon  2 , Qianxing Mo  3 , Lina M MorenoUrazan  2 , Shaffer Mok  2 , Nathan Parker  5 , Sahana Rajasekhara  11 , Ghulam Rasool  12 , Andrew Sinnamon  5 , Lauren Sparks  13 , Paul A Stewart  3 , Kenneth Tardif  14 , Alexandra F Tassielli  2 , Jamie K Teer  3 , Dan Viet Tran  7 , Kea L Turner  5 , Susan T Vadaparampil  5   15 , Christopher J Whelan  16 , Wade G Douglas  17 , Vic Velanovich  18 , Andreas Karachristos  18 , Adrian Legaspi  10 , Kenneth Meredith  19 , Manual A Molina-Vega  20 , Kevin L Huguet  14 , Juan P Arnoletti  21 , Mark Bloomston  22 , Jose Trevino  23   24 , Nipun B Merchant  25 , Jose M Pimiento  2 , Pamela J Hodul  2 , Mokenge Malafa  2 , Jason Fleming  2 , Sarah M Judge  26 , Daniel K Jeong  11 , Andrew Judge  26
Affiliations

Leveraging real-world data to predict cancer cachexia stage, quality of life, and survival in a racially and ethnically diverse multi-institutional cohort of treatment-naïve patients with pancreatic ductal adenocarcinoma

Jennifer B Permuth et al. Front Oncol. .

Abstract

Introduction: Cancer-associated cachexia (CC) is a progressive syndrome characterized by unintentional weight loss, muscle atrophy, fatigue, and poor outcomes that affects most patients with pancreatic ductal adenocarcinoma (PDAC). The ability to identify and classify CC stage along its continuum early in the disease process is challenging but critical for management.

Objectives: The main objective of this study was to determine the prevalence of CC stage overall and by sex and race and ethnicity among treatment-naïve PDAC cases using clinical, nutritional, and functional criteria. Secondary objectives included identifying the prevalence and predictors of higher symptom burden, supportive care needs, and quality of life (QoL), and examining their influence on overall survival (OS).

Materials and methods: A population-based multi-institutional prospective cohort study of patients with PDAC was conducted between 2018 and 2021 by the Florida Pancreas Collaborative. Leveraging patient-reported data and laboratory values, participants were classified at baseline into four stages [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca), and refractory cachexia (RCa)]. Multivariate regression, Kaplan Meier analyses, and Cox regression were conducted to evaluate associations.

Results: CC stage was estimated for 309 PDAC cases (156 females, 153 males). The overall prevalence of NCa, PCa, Ca, and RCa was 12.9%, 24.6%, 54.1%, and 8.4%, respectively. CC prevalence across all CC stages was highest for males and racial and ethnic minorities. Criteria differentiated NCa cases from other groups, but did not distinguish PCa from Ca. The most frequently reported symptoms included weight loss, fatigue, pain, anxiety, and depression, with pain significantly worsening over time. The greatest supportive care needs included emotional and physical domains. Males, Black people, and those with RCa had the worst OS.

Conclusions: Using clinical, nutritional, and functional criteria, nearly one-quarter of the PDAC cases in our diverse, multi-institutional cohort had PCa and 62.5% had Ca or RCa at the time of diagnosis. The PCa estimate is higher than that reported in prior studies. We recommend these criteria be used to aid in CC classification, monitoring, and management of all incident PDAC cases. Findings also highlight the recommendation for continued emotional support, assistance in alleviating pain, and supportive care needs throughout the PDAC treatment journey.

Keywords: cancer-associated cachexia; health-related quality of life; longitudinal prospective cohort; pancreatic adenocarcinoma; racial and ethnic disparities.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
EORTC and PAN-26 heath-related quality of life (HRQoL) variables differ significantly based on cachexia stage at baseline. (A) Bar graph depicting mean of the EORTC QLQ30 scaled to 100 and colored by either EORTC domain (if a multi-item domain) or single-item (if item is part of a single-item domain). (B) Bar graph depicting mean scaled EORTC QLQ 30 domain and the overall QoL and health rating stratified by cachexia stage. Brackets indicate p<0.05 between RCa and all other categories (ANOVA). (C) Frequency of scores (“not at all”, “a little”, “quite a bit”, very much”) at baseline for the PAN-26 HRQoL questionnaire. (D) Frequency of scores of the 5 PAN-26 variables which were found to be significantly different by cachexia stage at baseline.
Figure 2
Figure 2
Overall survival is significantly different by race and ethnicity and cachexia stage. Kaplan-Meier survival curves were plotted and stratified by (A) sex, (B) race and ethnicity, (C) cachexia stage (Vigano criteria) or (D) cachexia stage (Fearon criteria).
Figure 3
Figure 3
Cox proportional hazards models showing the association between key covariates and overall survival in the FPC cohort. Forest plots for the (A) preliminary (full) cox survival model (without the treatment variable) and (B) the finalized model.
See this image and copyright information in PMC

References

    1. Baracos VE, Martin L, Korc M, Guttridge DC, Fearon KC. Cancer-associated cachexia. Nat Rev Dis primers. (2018) 4:1–18. doi: 10.1038/nrdp.2017.105 - DOI - PubMed
    1. Farkas J, von Haehling S, Kalantar-Zadeh K, Morley JE, Anker SD, Lainscak M. Cachexia as a major public health problem: frequent, costly, and deadly. J cachexia sarcopenia muscle. (2013) 4:173–8. doi: 10.1007/s13539-013-0105-y - DOI - PMC - PubMed
    1. Sun L, Quan X-Q, Yu S. An epidemiological survey of cachexia in advanced cancer patients and analysis on its diagnostic and treatment status. Nutr cancer. (2015) 67:1056–62. doi: 10.1080/01635581.2015.1073753 - DOI - PubMed
    1. Bauer J, Capra S, Battistutta D, Davidson W, Ash S. Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer. Clin Nutr (Edinburgh Scotland). (2005) 24:998–1004. doi: 10.1016/j.clnu.2005.07.002 - DOI - PubMed
    1. Neuzillet C, Sauvanet A, Hammel P. Prognostic factors for resectable pancreatic adenocarcinoma. J Visc Surg. (2011) 148:e232–43. doi: 10.1016/j.jviscsurg.2011.07.007 - DOI - PubMed

LinkOut - more resources