Differential Diagnosis of Cachexia and Refractory Cachexia and the Impact of Appropriate Nutritional Intervention for Cachexia on Survival in Terminal Cancer Patients

Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of nutritional intervention for them. Study subjects were terminal cancer patients admitted for palliative care and were judged refractory cachexia in the last five years. We retrospectively examined to find useful indices for identifying such cachectic patients and for evaluating the effect of nutritional intervention. Out of 223 patients in refractory cachexia, 26 were diagnosed cachexia with starvation after symptom management. Comparing before and one week after this management, Palliative Performance Scale (PPS) and transthyretin significantly improved (p < 0.0001, p = 0.0002, respectively) Then, we started nutritional intervention for these cachectic patients and divided into effective group (n = 17) and non-effective group (n = 9) using the criteria for cachexia. Comparing between the two groups, PPS significantly improved2 weeks after intervention in effective group (p = 0.006). Survival time was significantly longer in effective group (p = 0.008). PPS and transthyretin were useful for differential diagnosis of cachexia and refractory cachexia. PPS was useful for evaluating nutritional intervention for cachectic patients. Appropriate nutritional intervention improved survival.

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Changes in the palliative performance scale may be as important as the initial palliative performance scale for predicting survival in terminal cancer patients

Palliative & Supportive Care ◽

10.1017/s1478951520001248 ◽

2021 ◽

pp. 1-5

Author(s):

Guk Jin Lee ◽

Ji Hyun Gwak ◽

Myoung Sim Kim ◽

Mi Yeong Lee ◽

Seo Ree Kim ◽

...

Keyword(s):

Cancer Patients ◽

Gastrointestinal Cancer ◽

Poor Prognosis ◽

Accurate Estimation ◽

Terminal Cancer ◽

Hospice Patients ◽

Terminal Cancer Patients ◽

Group A ◽

Group B ◽

Performance Scale

Abstract Objective The accurate estimation of expected survival in terminal cancer patients is important. The palliative performance scale (PPS) is an important factor in predicting survival of hospice patients. The purpose of this study was to examine how initial status of PPS and changes in PPS affect the survival of hospice patients in Korea. Method We retrospectively examined 315 patients who were admitted to our hospice unit between January 2017 and December 2018. The patients were divided based on the PPS of ≥50% (group A) and ≤40% (group B). We performed survival analysis for factors associated with the length of survival (LOS) in group A. Based on the hospice team's weekly evaluation of PPS, we examined the effect of initial levels and changes in group A on the prognosis of patients who survived for 2 weeks or more. Results At the time of admission to hospice, 265 (84.1%) patients were PPS ≥50%, and 50 (15.9%) were PPS ≤40%. The median LOS of PPS ≥50% and PPS ≤40% were 15 (2–158 days) and 9 (2–43 days), respectively. Male, gastrointestinal cancer, and lower initial PPS all predicted poor prognosis in group A. Male, gastrointestinal cancer, and a PPS change of 10% or greater, compared with initial status 1 week and 2 weeks of hospitalization, were all predictors of poor prognosis in group A patients who survived for 2 weeks or longer. Significance of results Our research demonstrates the significance of PPS change at 1 week and 2 weeks, suggesting the importance of evaluating not only initial PPS but also change in PPS.

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The Impact of Hemodialysis on Terminal Cancer Patients in Hospices: A Nationwide Retrospective Study in Taiwan

Journal of Palliative Medicine ◽

10.1089/jpm.2018.0299 ◽

2019 ◽

Vol 22 (2) ◽

pp. 188-192 ◽

Cited By ~ 2

Author(s):

Shih-Chao Kang ◽

Chih-Ching Lin ◽

Yu-Chun Chen ◽

Wei-Shu Wang

Keyword(s):

Retrospective Study ◽

Cancer Patients ◽

Terminal Cancer ◽

Terminal Cancer Patients ◽

The Impact

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Nothing left to chance? The impact of locus of control on physical and mental quality of life in terminal cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-017-3605-z ◽

2017 ◽

Vol 25 (6) ◽

pp. 1985-1991 ◽

Cited By ~ 4

Author(s):

Alaina J. Brown ◽

Premal H. Thaker ◽

Charlotte C. Sun ◽

Diana L. Urbauer ◽

Eduardo Bruera ◽

...

Keyword(s):

Quality Of Life ◽

Locus Of Control ◽

Cancer Patients ◽

Terminal Cancer ◽

Terminal Cancer Patients ◽

The Impact

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1509P Impact of differential diagnosis of cachexia and refractory cachexia and appropriate nutritional support for cachexia on survival in terminal cancer patients

Annals of Oncology ◽

10.1016/j.annonc.2020.08.135 ◽

2020 ◽

Vol 31 ◽

pp. S933

Author(s):

N. Nakajima

Keyword(s):

Differential Diagnosis ◽

Cancer Patients ◽

Nutritional Support ◽

Terminal Cancer ◽

Terminal Cancer Patients

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The use of anticoagulants in terminal cancer patients admitted in hospice center.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21503 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21503-e21503 ◽

Cited By ~ 1

Author(s):

Hyun Jeong Shim ◽

Ka-rham Kim ◽

Jun Eul Hwang ◽

Woo Kyun Bae ◽

Sang-Hee Cho ◽

...

Keyword(s):

Cancer Patients ◽

Hospice Care ◽

Clinical Signs ◽

Study Patient ◽

Cancer Center ◽

Terminal Cancer ◽

Care Clinic ◽

Terminal Cancer Patients ◽

The Mean ◽

The Impact

e21503 Background: Venous thromboembolism (VTE) is common in patients with cancer and the risk increases with advanced disease. However, no management guidelines exist specific to terminal cancer patients in hospice. We conducted a retrospective analysis to determine the patterns of anticoagulant use in hospice setting. Methods: We identified patients who were prescribed anticoagulants in the Hospice and Palliative Care Clinic at Jeonnam Regional Cancer Center from August 2008 to September 2016 in this study. Patient characteristics included age, gender, cancer diagnosis, length of hospice stay, type and duration of anticoagulation. Results: Of 1,494 consecutive patients who received hospice care in our center, 57 (3.8%) were prescribed ≥ 1 anticoagulants. Types of anticoagulants prescribed were; LMWH only (n = 44, 77.2%), warfarin only (n = 7, 12.3%), rivaroxaban (n = 2, 3.5%) and both LMWH and warfarin (n = 4, 7%). Indications for anticoagulation were DVT (n = 17, 29.8%), PTE (11 = 19.3%), clinical suspicion of DVT with leg swelling (n = 23, 40.4%) and atrial fibrillation (n = 6, 10.5%), respectively. The mean age was 65 years (range 28-84) and 37 (52.6%) were male. The mean age was 63.5 years in LMWH treated patients and 67 years in warfarin treated patients (p < 0.95). The median duration of hospice stay and anticoagulation use were 18.5 days and 11.2 days. The reasons for discontinuation of anticoagulants were bleeding (n = 8, 14%), no palliative benefit (n = 10, 17.5%) and clinical signs of impending death (n = 39, 68.4%). Conclusions: In this retrospective study, anticoagulants were used in highly selected patients. In the absence of specific evidence, decisions are difficult for clinicians to initiate and stop anticoagulation treatment in hospice patients with terminal cancer. Further research is needed to determine the impact of anticoagulation on outcomes, especially cost, quality of life and complications for cancer patients in hospice.

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