Leveraging real-world data to predict cancer cachexia stage, quality of life, and survival in a racially and ethnically diverse multi-institutional cohort of treatment-naïve patients with pancreatic ductal adenocarcinoma

Cancer-associated cachexia (CC) is a progressive syndrome characterized by unintentional weight loss, muscle atrophy, fatigue, and poor outcomes that affects most patients with pancreatic ductal adenocarcinoma (PDAC). The ability to identify and classify CC stage along its continuum early in the dis...

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Published in:	Frontiers in oncology Vol. 14; p. 1362244
Main Authors:	Permuth, Jennifer B, Park, Margaret A, Chen, Dung-Tsa, Basinski, Toni, Powers, Benjamin D, Gwede, Clement K, Dezsi, Kaleena B, Gomez, Maria, Vyas, Shraddha L, Biachi, Tiago, Cortizas, Elena M, Crowder, Sylvia, Genilo-Delgado, Maria, Green, B Lee, Greene, Anna, Gregg, Christopher, Hoffe, Sarah E, Jiang, Kun, Kim, Bora, Vasudevan, Vanitha, Garcialopez De Llano, Jeronimo, Menon, Anjana A, Mo, Qianxing, MorenoUrazan, Lina M, Mok, Shaffer, Parker, Nathan, Rajasekhara, Sahana, Rasool, Ghulam, Sinnamon, Andrew, Sparks, Lauren, Stewart, Paul A, Tardif, Kenneth, Tassielli, Alexandra F, Teer, Jamie K, Tran, Dan Viet, Turner, Kea L, Vadaparampil, Susan T, Whelan, Christopher J, Douglas, Wade G, Velanovich, Vic, Karachristos, Andreas, Legaspi, Adrian, Meredith, Kenneth, Molina-Vega, Manual A, Huguet, Kevin L, Arnoletti, Juan P, Bloomston, Mark, Trevino, Jose, Merchant, Nipun B, Pimiento, Jose M, Hodul, Pamela J, Malafa, Mokenge, Fleming, Jason, Judge, Sarah M, Jeong, Daniel K, Judge, Andrew
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 23-07-2024
Subjects:	cancer-associated cachexia health-related quality of life longitudinal prospective cohort Oncology pancreatic adenocarcinoma racial and ethnic disparities pancreatic adenocarcinoma cancer-associated cachexia longitudinal prospective cohort health-related quality of life racial and ethnic disparities
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Summary:	Cancer-associated cachexia (CC) is a progressive syndrome characterized by unintentional weight loss, muscle atrophy, fatigue, and poor outcomes that affects most patients with pancreatic ductal adenocarcinoma (PDAC). The ability to identify and classify CC stage along its continuum early in the disease process is challenging but critical for management. The main objective of this study was to determine the prevalence of CC stage overall and by sex and race and ethnicity among treatment-naïve PDAC cases using clinical, nutritional, and functional criteria. Secondary objectives included identifying the prevalence and predictors of higher symptom burden, supportive care needs, and quality of life (QoL), and examining their influence on overall survival (OS). A population-based multi-institutional prospective cohort study of patients with PDAC was conducted between 2018 and 2021 by the Florida Pancreas Collaborative. Leveraging patient-reported data and laboratory values, participants were classified at baseline into four stages [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca), and refractory cachexia (RCa)]. Multivariate regression, Kaplan Meier analyses, and Cox regression were conducted to evaluate associations. CC stage was estimated for 309 PDAC cases (156 females, 153 males). The overall prevalence of NCa, PCa, Ca, and RCa was 12.9%, 24.6%, 54.1%, and 8.4%, respectively. CC prevalence across all CC stages was highest for males and racial and ethnic minorities. Criteria differentiated NCa cases from other groups, but did not distinguish PCa from Ca. The most frequently reported symptoms included weight loss, fatigue, pain, anxiety, and depression, with pain significantly worsening over time. The greatest supportive care needs included emotional and physical domains. Males, Black people, and those with RCa had the worst OS. Using clinical, nutritional, and functional criteria, nearly one-quarter of the PDAC cases in our diverse, multi-institutional cohort had PCa and 62.5% had Ca or RCa at the time of diagnosis. The PCa estimate is higher than that reported in prior studies. We recommend these criteria be used to aid in CC classification, monitoring, and management of all incident PDAC cases. Findings also highlight the recommendation for continued emotional support, assistance in alleviating pain, and supportive care needs throughout the PDAC treatment journey.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Reviewed by: Aneesha Dasgupta, Purdue University Indianapolis, United States Brittany Counts, Oregon Health and Science University, United States Edited by: Jung Mi Oh, Seoul National University, Republic of Korea
ISSN:	2234-943X 2234-943X
DOI:	10.3389/fonc.2024.1362244