Health professionals' attitudes toward the detection and management of cancer-related anorexia-cachexia syndrome, and a proposal for standardized assessment

Background: The identification and management of patients with cancer anorexia-cachexia syndrome (CACS) can be a challenge despite recent international consensus on the definition of the condition.

Objectives: To describe the current views and practice patterns of community oncologists and oncology nurses in regard to CACS and to propose a standardized, pragmatic assessment of CACS for oncological practice.

Methods and materials: Responses from 151 community oncologists and nurses obtained across 5 surveys were analyzed. Questions addressed CACS in general and in patients with non-small-cell lung cancer (NSCLC). Surveys 1-3 were directed at physicians, and surveys 4 and 5 were directed at nurses. Surveys 1, 2, 4, and 5 focused on the recognition and monitoring of CACS, and Survey 3 on symptom management.

Results: 67% of medical oncologists in Survey 3 selected weight loss as the most important criterion for diagnosing CACS and cited declining appetite and performance status (PS) as the most bothersome effects for patients and families. Weight maintenance/gain was the primary treatment objective for oncologists. Respondents to surveys 1 and 2 acknowledged the risk for CACS is high (60%) in NSCLC but considered the risk much lower (4%) in patients completing a first course of therapy with good PS. 91% of oncologists in Survey 3 reported that symptoms that had an impact on calorie intake were important/very important, and 73% were willing to consider a symptom assessment instrument that included appetite. Nurses in surveys 4 and 5 reported weight loss and appetite were most commonly used to identify cachexia. They considered responsibility for the initial assessment of cachexia was the oncologist's (32%), followed by the nurse practitioner (28%), and the nurse (16%).

Conclusion: Most oncologists and nurses recognize the core criteria for the CACS, although there may be under-recognition of the condition's prevalence, particularly earlier in the course of treatment. There is considerable interest in adopting a brief assessment tool for screening, management, and referral of patients who are affected by or at-risk of CACS.