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Epidemiology

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Cachexia due to any disease

The overall prevalence of cachexia is high and in industrialized countries (North America, Europe, Japan) it is growing. It is currently estimated that cachexia affects approximately 9 million patients, which is about 1% of all patients with any disease.1,2

In the United States alone, cachexia resulting from any disease is estimated to affect more than 5 million people (Table 1).3 In Asian countries, the relative presence of cachexia is somewhat less, but also represents a growing problem.2 Cachexia is a medical problem also in Africa and South America, although data is scarce.2

Disease No. with disease Cachexia No. needing treatment
    %  
AIDS2 900 000 35 315 000
Cancer 1 368 000 30 410 400
COPD 16 000 000 20 3 200 000
Kidney failure 375 000 40 150 000
Rheumatoid arthritis 2 100 000 10 210 000
Heart failure 4 800 000 20 960 000
Nursing home 1 600 000 20 320 000

Cachexia in the United States 3

Numbers are based on generally reported prevalence of disease and literature estimations of unintentional weight loss in these conditions. COPD, chronic obstructive pulmonary disease.

Cachexia in cancer

Half of all patients with cancer lose some body weight and one third lose more than 5% of their original body weight, which represents a defining criterion of Cancer Anorexia Cachexia.4,5

The incidence of weight loss upon diagnosis has been shown to vary greatly according to the tumor site.4,6 A landmark study of over 3,000 patients enrolled in various Eastern Cooperative Oncology Group (ECOG) chemotherapy trials reported that the greatest incidence of weight loss was seen among patients with solid tumors (e.g. gastric, pancreatic, lung, colorectal, head and neck).4,6

In particular, about 50% of prostate, colon, and lung cancer patients, and 85% of gastric/pancreatic patients lost weight, while 30% of those with breast cancer or acute leukemia had weight loss. One-third had more than 10% weight loss, although any weight loss (0-5%) was associated with a poorer prognosis when compared to patients with no weight loss.1,6 

The greatest incidence of weight loss has been observed among patients with solid tumors (e.g. gastric, pancreatic, lung, colorectal, and head and neck).1,6

It is interesting to note that the prognostic effect of weight loss was greater in patients with a more favorable prognosis, for example those with good performance status or early tumor stage. Other studies also reported a high prevalence of weight loss among patients with good performance status (e.g. two-thirds of patients with solid tumors and a favorable performance status lost ≥ 5% of their weight following diagnosis), suggesting that anticachectic interventions should be considered early on (Figure 1).1,6 

Published data reports a prevalence of Cachexia in advanced cancer ranging from 60% to 80%, and the overall prevalence of weight loss in cancer patients may rise as high as 86% in the last 1–2 weeks of life.2,4   Estimates of Cancer Anorexia Cachexia indicate that this syndrome may directly contribute to 30% of cancer deaths and more than 50% of patients with cancer die with cachexia being present.1,2 

Importantly, when discussing the prevalence of Cancer Anorexia Cachexia, it has to be considered that different definitions have been used so far by researchers to describe this condition (Table 2).2 

Disease Classification Reference Definitions used Number
of patients
Prevalence
of cachexia (%)
Cancer

Advanced head and neck cancer

Lees [17] Incidence of any weight loss (mean weight loss 6.5 kg~10% of body weight) n=100 57
  Non-small cell lung cancer DeWys et al. [18] Weight loss >5% of body weight at diagnosis n=3,047 36
  Pancreatic cancer, perioperative Bachmann et al. [19] Cachexia: weight loss >10% of the pre-illness stable body weight n=227 40.5
  Pancreatic cancer DeWys et al. [18] Weight loss >5% of body weight at diagnosis n=3,047 54
  Colorectal cancer DeWys et al. [18] Weight loss >5% of body weight at diagnosis n=3,047 28

Prevalence of Cancer Cachexia at various tumor sites according to different definitions2

This highlights the need for a well-accepted definition of Cancer Anorexia Cachexia in order to improve clinical research, diagnosis and treatment. Currently, unintentional weight loss of ≥5% in cancer patients may be considered the best criterion to alert clinicians that detailed follow-up for cachexia may be needed after ruling out reversible causes of weight loss.7 

Despite its high prevalence, Cancer Anorexia Cachexia is still a syndrome that is underdiagnosed.2,8 Furthermore, Cachexia may be obscured in certain conditions such as obesity. Literature reports that in overweight and obese patients a substantial ongoing muscle depletion (sarcopenic obesity) can be present, even at the time of cancer diagnosis, that seems to be an independent risk factor for reduced survival.9 

References

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