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

Nutrients. 2021 Mar 12;13(3):915. doi: 10.3390/nu13030915.


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.

Keywords: cancer cachexia; nutritional intervention; palliative care; refractory cachexia; terminal cancer patients.

MeSH terms

  • Adult
  • Cachexia / diagnosis*
  • Cachexia / diet therapy
  • Cachexia / etiology
  • Cachexia / mortality
  • Diagnosis, Differential
  • Humans
  • Neoplasms / complications*
  • Neoplasms / diet therapy
  • Neoplasms / mortality
  • Nutritional Support / methods*
  • Palliative Care / methods
  • Parenteral Nutrition
  • Terminal Care / methods*
  • Treatment Failure