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
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 
Published: July 2024

Introduction

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.

Objectives

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).

Materials and methods

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.

Results

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.

Conclusions

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.