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Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆

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Arends, J., Strasser, F., Gonella, S., Solheim, T.S., Madeddu, C., Ravasco, P., Buonaccorso, L., de van der Schueren, M.A.E. +3 more·2021·ESMO Open
DOI 10.1016/j.esmoop.2021.100092PMC PMC8233663
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Abstract

Cachexia remains an underdiagnosed and undertreated, complex condition which includes ‘objective’ components (e.g. inadequate food intake, weight loss, inactivity, loss of muscle mass and metabolic derangements, inducing catabolism)1,2 and ‘subjective’ components (e.g. anorexia, early satiety, taste alterations, chronic nausea, distress, fatigue and loss of concentration). Approximately half of all patients with advanced cancer experience cachexia.

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  • Patients with cachexia may show less response to nutritional intervention compared to patients with less severe stages or phenotypes of malnutrition.

    “For example, it has been known for long that patients with cachexia may show less response compared to patients with less severe stages or phenotypes of malnutrition [165,188].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [188]

    In 'Deciding on cachexia treatment' (Table 3; page unavailable), the guidelines list benefit from nutritional and metabolic interventions as possible with mild, slow weight loss but uncertain with rapid, severe weight loss or persistent inflammation. 'Nutritional requirements' also says increased energy and protein intake may not attenuate weight loss in all patients. These passages support reduced benefit in some more severe cases, but do not establish that patients with cachexia generally respond less than patients with less severe malnutrition phenotypes. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Other studies found sarcopenia to be a predictor of non-response to nutritional treatment in mixed populations.

    “There are several studies looking at biomarkers of muscle strength and/or function with some suggesting that low muscle strength measured by HGS is a predictor for response [134] (Level of evidence 1þþ) while others found sarcopenia to be a predictor of non-response in mixed populations [165,188].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [188]

    The Nutritional requirements section says that increased energy and protein intake may not prevent weight loss in all patients, while the Assessment of nutritional status section lists measures of body composition and grip strength. Neither reports that sarcopenia predicts non-response to nutritional treatment in mixed populations. Searches for sarcopenia, treatment response, and non-responders found no passage establishing that link; page numbers were unavailable in our copy. (LLM, conf=0.72)

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Sorted by citations

Authors
Arends, J., Strasser, F., Gonella, S., Solheim, T. S., Madeddu, C., Ravasco, P., Buonaccorso, L., de van der Schueren, M. A. E., Baldwin, C., Chasen, M., & Ripamonti, C. I.
Affiliations
  • University of Freiburg (DE)
  • Kantonsspital St. Gallen (CH)
  • Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
  • Norwegian University of Science and Technology (NO)
  • University of Cagliari (IT)
  • University of Lisbon (PT)
  • King's College London (GB)
  • University of Toronto (CA)
  • Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
ORCID
Venue
ESMO Open
Publisher
Elsevier BV
Published
2021-06
Volume
6
Issue
3
Pages
100092
ISSN
2059-7029 (ISSN-L)
DOI
10.1016/j.esmoop.2021.100092
PMC
PMC8233663
OpenAlex
W3157783125
Cited by
586
References
10
Citations by year
2026: 149 · 2025: 122 · 2024: 123 · 2023: 95 · 2022: 81 · 2021: 16
FWCI
49.49
Type
journal article
Language
en
Update notices
erratum (2022-12-01)
Open access
Licence
Locations
  • ESMO Open (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, cc-by)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Socio-Environmental Systems Modeling (acceptedVersion, cc-by-nc-nd)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc-nd)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion, other-oa)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-nd)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
Funders
  • Novartis
  • Celgene
  • Kyowa Hakko Kirin
  • European Society for Medical Oncology
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
Keywords
cancer cachexia, advanced cancer, weight loss, muscle mass loss, anorexia, fatigue, catabolism, metabolic disorders, cachexia treatment
MeSH terms
Adult, Cachexia, Humans, Neoplasms

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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