Assessing Cachexia Status in Pakistani Cancer Patients Using the Mini-CASCO Score
Phase: NA
Conditions: Breast Cancer, Cachexia
Sponsor: Pakistan Society of Pediatric Oncology

 
 
EFFECTIVENESS OF INDIVIDUALIZED 
DIETARY COUNSELING AND 
NUTRITIONAL MONITORING IN 
REDUCING CANCER-ASSOCIATED 
CACHEXIA AMONG FEMALE BREAST 
CANCER PATIENTS 
 
Submitted by 
Dr. Rida Maria and Junaid Jamshed 
 
07 February 2024 
 
 

Effectiveness 
of 
Individualized 
Dietary 
Counseling 
and 
Nutritional Monitoring in Reducing Cancer-Associated Cachexia 
among Female Breast Cancer Patients  
INTRODUCTION 
Background of the Study 
 
Cancer-associated cachexia (CACS) is a multifactorial syndrome marked by 
involuntary weight loss, muscle wasting, systemic inflammation, and 
metabolic abnormalities. Among patients with advanced-stage breast 
cancer, CACS significantly impacts quality of life, treatment tolerance, and 
survival. In low- and middle-income countries like Pakistan, cachexia often 
remains underdiagnosed and poorly managed due to limited supportive 
care resources. This study aims to assess the effectiveness of personalized 
dietary counseling and regular nutritional monitoring in reducing cachexia 
severity using the validated Mini-CASCO tool. 
Objectives of the Study 
 
Primary Objective: 
 
To evaluate whether individualized dietary counseling combined with 
monthly nutritional monitoring reduces cachexia severity over six 
months in female patients with advanced breast cancer. 
Secondary Objectives: 
 
To assess changes in body composition, appetite, physical 
performance, inflammatory markers, and quality of life. 
 
To determine the adherence and feasibility of implementing 
nutrition-sensitive supportive care in an oncology setting. 

METHODOLOGY 
Study Design 
This is a two-arm; parallel-group, randomized controlled trial (RCT) 
conducted over a six-month intervention period at Fauji Foundation 
Hospital, Rawalpindi, Pakistan. Participants will be randomly assigned (1:1) 
to receive either standard oncological care alone (control group) or 
standard care plus tailored nutritional counseling and monthly monitoring 
(intervention group). Randomization will be block-stratified with allocation 
concealment using opaque, sealed envelopes. 
Patient Selection and Enrollment 
 
Inclusion Criteria: 
 
Female patients aged 20–60 years. 
 
Histologically confirmed advanced-stage breast cancer. 
 
≥ 5% unintentional weight loss in the previous 6 months. 
 
Hemoglobin < 12 g/dL or energy intake < 1500 kcal/day. 
Exclusion Criteria: 
 
Concurrent non-cancer-related malnutrition. 
 
Pregnancy or lactation. 
 
GI/endocrine disorders affecting nutrition. 
 
Enrollment involved screening for eligibility, obtaining informed 
consent, and randomization using sealed, opaque envelopes. 
Baseline data were collected before group assignment. 
Eligible patients will undergo informed consent. Those consenting will be 
randomized using a block randomization method. Baseline data will be 
collected prior to group assignment. 
 

Intervention 
Intervention Group: 
 
Individualized dietary counseling based on baseline nutritional status 
 
Monthly monitoring (every 15–21 days) of weight, intake, and 
biochemical parameters 
 
Light physical activity guidance and psychosocial support 
 
Dietary goals: 25–30 kcal/kg/day and 1.2–1.5 g/kg/day protein 
 
Compliance tracked through food intake records and goal adherence 
checklists 
Control Group: 
Standard oncological care without structured nutritional intervention 
Ethical Considerations 
This study will be approved by the Ethical Review Board of Fauji Foundation 
Hospital, Rawalpindi. All participants will provide written informed consent 
prior to enrollment. The study adheres to the ethical principles outlined in 
the Declaration of Helsinki. Confidentiality will be ensured through unique 
patient identifiers and restricted data access. 
Protocol Amendments 
No protocol amendments have been made to date. Any future 
amendments will be reviewed and approved by the Ethical Review Board 
and documented accordingly in the PRS system. 
 
 
 
 
 

REFERENCES 
 
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understanding the molecular basis. J Clin Invest. 2011;121(4):1238–
1248. doi:10.1172/JCI44476. 
 
2. Laviano A, Koverech A, Seelaender M. Assessing pathophysiology of 
cancer cachexia: A suggested approach. Lancet Oncol. 2018;19(1):e36–
e42. doi:10.1016/S1470-2045(17)30553-X. 
 
3. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. 
Definition and classification of cancer cachexia: an international 
consensus. Lancet Oncol. 2011;12(5):489–495. doi:10.1016/S1470-
2045(10)70218-7. 
 
4. World 
Health 
Organization. 
Global 
Breast 
Cancer 
Initiative 
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Geneva: 
World 
Health 
Organization; 
2021. 
Available 
from: 
https://www.who.int/publications/i/item/9789240022616 
 
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