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Active lifestyle patterns reduce the risk of colorectal cancer in the Mecca region, Saudi Arabia: a case–control study. Eur J Cancer Prev 2018; 27:438-442. [DOI: 10.1097/cej.0000000000000361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Jones K, Gordon-Weeks A, Coleman C, Silva M. Radiologically Determined Sarcopenia Predicts Morbidity and Mortality Following Abdominal Surgery: A Systematic Review and Meta-Analysis. World J Surg 2018; 41:2266-2279. [PMID: 28386715 PMCID: PMC5544798 DOI: 10.1007/s00268-017-3999-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Individualised risk prediction is crucial if targeted pre-operative risk reduction strategies are to be deployed effectively. Radiologically determined sarcopenia has been shown to predict outcomes across a range of intra-abdominal pathologies. Access to pre-operative cross-sectional imaging has resulted in a number of studies investigating the predictive value of radiologically assessed sarcopenia over recent years. This systematic review and meta-analysis aimed to determine whether radiologically determined sarcopenia predicts post-operative morbidity and mortality following abdominal surgery. Method CENTRAL, EMBASE and MEDLINE databases were searched using terms to capture the concept of radiologically assessed sarcopenia used to predict post-operative complications in abdominal surgery. Outcomes included 30 day post-operative morbidity and mortality, 1-, 3- and 5-year overall and disease-free survival and length of stay. Data were extracted and meta-analysed using either random or fixed effects model (Revman® 5.3). Results A total of 24 studies involving 5267 patients were included in the review. The presence of sarcopenia was associated with a significant increase in major post-operative complications (RR 1.61 95% CI 1.24–4.15 p = <0.00001) and 30-day mortality (RR 2.06 95% CI 1.02–4.17 p = 0.04). In addition, sarcopenia predicted 1-, 3- and 5-year survival (RR 1.61 95% CI 1.36–1.91 p = <0.0001, RR 1.45 95% CI 1.33–1.58 p = <0.0001, RR 1.25 95% CI 1.11–1.42 p = 0.0003, respectively) and 1- and 3-year disease-free survival (RR 1.30 95% CI 1.12–1.52 p = 0.0008). Conclusion Peri-operative cross-sectional imaging may be utilised in order to predict those at risk of complications following abdominal surgery. These findings should be interpreted in the context of retrospectively collected data and no universal sarcopenic threshold. Targeted prehabilitation strategies aiming to reverse sarcopenia may benefit patients undergoing abdominal surgery. Electronic supplementary material The online version of this article (doi:10.1007/s00268-017-3999-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keaton Jones
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
- CRUK Centre for Radiation Oncology, Radiobiology Research Institute, Department of Oncology, University of Oxford, Churchill Hospital, Roosevelt Drive, Oxford, OX3 7LE, UK.
| | - Alex Gordon-Weeks
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Claire Coleman
- Buckinghamshire Healthcare NHS Trust, High Wycombe, Buckinghamshire, UK
| | - Michael Silva
- Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Parvy JP, Hodgson JA, Cordero JB. Drosophila as a Model System to Study Nonautonomous Mechanisms Affecting Tumour Growth and Cell Death. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7152962. [PMID: 29725601 PMCID: PMC5872677 DOI: 10.1155/2018/7152962] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/04/2018] [Indexed: 12/26/2022]
Abstract
The study of cancer has represented a central focus in medical research for over a century. The great complexity and constant evolution of the pathology require the use of multiple research model systems and interdisciplinary approaches. This is necessary in order to achieve a comprehensive understanding into the mechanisms driving disease initiation and progression, to aid the development of appropriate therapies. In recent decades, the fruit fly Drosophila melanogaster and its associated powerful genetic tools have become a very attractive model system to study tumour-intrinsic and non-tumour-derived processes that mediate tumour development in vivo. In this review, we will summarize recent work on Drosophila as a model system to study cancer biology. We will focus on the interactions between tumours and their microenvironment, including extrinsic mechanisms affecting tumour growth and how tumours impact systemic host physiology.
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Affiliation(s)
- Jean-Philippe Parvy
- CRUK Beatson Institute, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Joseph A. Hodgson
- CRUK Beatson Institute, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Julia B. Cordero
- CRUK Beatson Institute, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow G61 1QH, UK
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Gray S, Axelsson B. The prevalence of deranged C-reactive protein and albumin in patients with incurable cancer approaching death. PLoS One 2018. [PMID: 29534089 PMCID: PMC5849305 DOI: 10.1371/journal.pone.0193693] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction Amongst patients with incurable cancer approaching death, cachexia is common and associated with adverse outcomes. The term cachexia lacks a universally accepted definition and there is no consensus regarding which variables are to be measured. Furthermore, an elevated C-reactive protein is a common clinical challenge in this patient group. This study aims to add to the ongoing discussion regarding the definition of cancer cachexia and to study the role of C-reactive protein and s-albumin in this context. Material and methods A 1-year cohort, consisting of 155 cancer patients enrolled in a specialized palliative home care team in the city of Östersund, Sweden, that were deceased during the year of 2015 was studied. Laboratory measures were studied within 0–30 and 31–60 days prior to death. C-reactive protein >10 mg/L and coinciding s-albumin <30 g/L was referred to as “laboratory cachexia”. Also, the number of days from the first found “laboratory cachexia” until death was noted. Results The prevalence of “laboratory cachexia” was 85% 0–30 days prior to death compared to 66% 31–60 days prior to death (p<0.01). The majority of patients (75%) had an onset of “laboratory cachexia” within 0–120 days prior to death, with a median of 47 days. The median values for C-reactive protein and s-albumin within 0–30 days prior to death were 84mg/L and 23g/L respectively. Discussion Could markedly deranged values of C-reactive protein and s-albumin, such as found in this study, signal a relatively short remaining survival time in patients with incurable cancer and no clinical signs of ongoing infection? The role of “laboratory cachexia” in this context as well as the cut off values for the laboratory measures included may be further discussed.
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Affiliation(s)
- Sarah Gray
- Research and Development Unit, Östersund Hospital, Östersund, Sweden
- * E-mail:
| | - Bertil Axelsson
- Department of Radiation sciences, Unit of Clinical research—Östersund, Umeå University, Umeå, Sweden
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Jeejeebhoy KN, Duerksen DR. Malnutrition in Gastrointestinal Disorders: Detection and Nutritional Assessment. Gastroenterol Clin North Am 2018; 47:1-22. [PMID: 29413007 DOI: 10.1016/j.gtc.2017.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
All patients with significant gastrointestinal disease should be clinically assessed for protein calorie malnutrition by using the Subjective Global Assessment. Blood tests for anemia, electrolytes, calcium, phosphorus, magnesium, ferritin, vitamin B12, and folate should be considered for assessment of major micronutrients. Where malabsorption or inflammatory bowel disease is diagnosed, bone mineral density using dual beam x-ray absorptiometry, 25-OH vitamin D levels, and measurement of other vitamins and trace elements should be considered. In addition, in at-risk patients, vitamin and trace element clinical deficiency syndromes should be considered during patient assessment.
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Affiliation(s)
- Khursheed N Jeejeebhoy
- Department of Medicine, University of Toronto, 784 Alexander Road, Hamilton, Ontario L9G 3E9, Canada.
| | - Donald R Duerksen
- University of Manitoba, C 5120 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
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Abstract
PURPOSE OF REVIEW Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. RECENT FINDINGS Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. SUMMARY We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.
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Abstract
The objective of this article is to introduce the Clinical Framework for Quality Improvement of Cancer Cachexia (Cachexia Care Framework) as a tool to demonstrate the relevance of integrating the clinical components of cancer cachexia and the organizational strategies of a cancer institution on the quality of patient care and delivery of services throughout the cancer cachexia continuum. The data sources included peer-reviewed literature relevant to cancer cachexia and quality cancer care, and the authors’ expertise. The Cachexia Care Framework results from a combination of the international consensus definition of cancer cachexia, the Institute of Medicine report Ensuring Quality Cancer Care, and the authors’ experience with a cancer cachexia clinic. This framework is proposed as a guidance for oncology nurses and other healthcare providers to improve the quality of care of cancer cachexia patients. Specifically, the framework can be used by oncology nurses involved in the care of patients diagnosed with cancer cachexia either in direct patient care, administration, research, or education. Nurses can use the framework in clinical practice to identify specific assessments and interventions based on the cachexia stage of the patient; in nursing administration, the framework offers a wide view of potential errors that can happen and the opportunity to prevent them; in nursing research, the framework illustrates the several factors and processes that can impact patient outcomes; and in nursing education, the framework outlines the elements necessary to develop and implement a continuum education curriculum to educate the workforce of oncology nurses, and in the academic setting, an interprofessional curriculum to educate nurses and many other healthcare disciplines.
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Affiliation(s)
- Clara Granda-Cameron
- Undergraduate Program, College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary Pat Lynch
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
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Sarcopenia Is an Important Prognostic Factor in Patients With Cervical Cancer Undergoing Concurrent Chemoradiotherapy. Int J Gynecol Cancer 2018; 28:168-175. [DOI: 10.1097/igc.0000000000001127] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
ObjectiveThis study aimed to investigate the correlation of sarcopenia findings with prognostic factors in patients with cervical cancer (CC) undergoing concurrent chemoradiotherapy (CCRT).MethodsWe retrospectively collected data on body composition and clinicopathological features from the medical records of 60 patients with CC who underwent CCRT and analyzed correlations between prognosis and changes in body composition as measured by computed tomography (skeletal muscle and iliopsoas muscle [IM]). Statistical analyses were performed using the Mann-Whitney U test. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Cox proportional hazard regression was used for univariate and multivariate analyses.ResultsThe median follow-up for all patients who were alive at the last follow-up was 33.5 months (range, 1–104 months). The PFS and OS rates were worse for patients with at least 15.0% than for those with less than 15.0% loss of skeletal muscle and IM from baseline (P < 0.001 for both). Furthermore, multivariate analyses showed that at least 15.0% loss of IM was an independent prognostic factor for PFS and OS (P = 0.002 for both).ConclusionsSarcopenia (≥15.0% loss of IM from baseline) was revealed to be an important prognostic factor in patients with CC undergoing CCRT.
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Poff A, Koutnik AP, Egan KM, Sahebjam S, D'Agostino D, Kumar NB. Targeting the Warburg effect for cancer treatment: Ketogenic diets for management of glioma. Semin Cancer Biol 2017; 56:135-148. [PMID: 29294371 DOI: 10.1016/j.semcancer.2017.12.011] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/07/2017] [Accepted: 12/29/2017] [Indexed: 12/29/2022]
Abstract
Gliomas are a highly heterogeneous tumor, refractory to treatment and the most frequently diagnosed primary brain tumor. Although the current WHO grading system (2016) demonstrates promise towards identifying novel treatment modalities and better prediction of prognosis over time, to date, existing targeted and mono therapy approaches have failed to elicit a robust impact on disease progression and patient survival. It is possible that tumor heterogeneity as well as specifically targeted agents fail because redundant molecular pathways in the tumor make it refractory to such approaches. Additionally, the underlying metabolic pathology, which is significantly altered during neoplastic transformation and tumor progression, is unaccounted for. With several molecular and metabolic pathways implicated in the carcinogenesis of CNS tumors, including glioma, we postulate that a systemic, broad spectrum approach to produce robust targeting of relevant and multiple molecular and metabolic regulation of growth and survival pathways, critical to the modulation of hallmarks of carcinogenesis, without clinically limiting toxicity, may provide a more sustained impact on clinical outcomes compared to the modalities of treatment evaluated to date. The objective of this review is to examine the emerging hallmark of reprogramming energy metabolism of the tumor cells and the tumor microenvironment during carcinogenesis, and to provide a rationale for exploiting this hallmark and its biological capabilities as a target for secondary chemoprevention and treatment of glioma. This review will primarily focus on interventions to induce ketosis to target the glycolytic phenotype of many cancers, with specific application to secondary chemoprevention of low grade glioma- to halt the progression of lower grade tumors to more aggressive subtypes, as evidenced by reduction in validated intermediate endpoints of disease progression including clinical symptoms.
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Affiliation(s)
- Angela Poff
- The University of South Florida, Department of Molecular Pharmacology and Physiology, 12901 Bruce B. Downs Blvd, MDC 8, Tampa, FL 33612, United States.
| | - Andrew P Koutnik
- The University of South Florida, Department of Molecular Pharmacology and Physiology, 12901 Bruce B. Downs Blvd, MDC 8, Tampa, FL 33612, United States.
| | - Kathleen M Egan
- Moffitt Cancer Center, H. Lee Moffitt Cancer Center and Research Institute, Department of Cancer Epidemiology, 12902 Magnolia Drive, MRC/CANCONT, Tampa, FL 22612-9497, United States.
| | - Solmaz Sahebjam
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Department of Cancer Epidemiology, 12902 Magnolia Drive, Tampa, FL 22612-9497, United States.
| | - Dominic D'Agostino
- The University of South Florida, Department of Molecular Pharmacology and Physiology, 12901 Bruce B. Downs Blvd, MDC 8, Tampa, FL 33612, United States.
| | - Nagi B Kumar
- Moffitt Cancer Center, H. Lee Moffitt Cancer Center and Research Institute, Department of Cancer Epidemiology, 12902 Magnolia Drive, MRC/CANCONT, Tampa, FL 22612-9497, United States.
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A cross-sectional study examining the prevalence of cachexia and areas of unmet need in patients with cancer. Support Care Cancer 2017; 26:1871-1880. [PMID: 29274028 DOI: 10.1007/s00520-017-4022-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE The semantics of defining cancer cachexia over the last decade has resulted in uncertainty as to the prevalence. This has further hindered the recognition and subsequent treatment of this condition. Following the consensus definition for cancer cachexia in 2011, there is now a need to establish estimates of prevalence. Therefore, the primary aim of the present study was to assess the prevalence of cachexia in an unselected cancer population. A secondary aim was to assess patient-perceived need of attention to cachexia. METHODS A cross-sectional study in hospital patients was undertaken. Key inclusion criteria were the following: age > 18 years, cancer diagnosis, and no surgery the preceding 24 h. Data on demographics, disease, performance status, symptoms, cachexia, and patients' perceived need of attention to weight loss and nutrition were registered. RESULTS Data were available on 386 of 426 eligible patients. Median age (IQR) was 65 years (56-72), 214 (55%) were male and 302 (78%) had a performance status of 0-1 (Eastern Cooperative Oncology Group). Prevalence of cachexia (inpatients/outpatients) was 51/22%. Prevalence was highest in patients with gastrointestinal cancer (62/42%) and lung cancer (83/36%). There was no major difference in prevalence between patients with metastatic (55/24%) and localized disease (47/19%). Twenty percent of inpatients and 15% of outpatients wanted more attention to weight loss and nutrition. Cachexia (p < 0.001), symptoms of mood disorder (p < 0.001), and male gender (p < 0.01) were independently associated with increased need of attention. CONCLUSION Cachexia is a prevalent condition, affecting both patients with localized and metastatic cancer. Clinical attention to the condition is a sizeable unmet need.
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Wang B, Zhang F, Zhang H, Wang Z, Ma YN, Zhu MJ, Du M. Alcohol intake aggravates adipose browning and muscle atrophy in cancer-associated cachexia. Oncotarget 2017; 8:100411-100420. [PMID: 29245988 PMCID: PMC5725030 DOI: 10.18632/oncotarget.22243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/13/2017] [Indexed: 11/25/2022] Open
Abstract
Cancer is commonly associated with cachexia, a paraneoplastic syndrome characterized by body weight loss, muscle wasting, adipose tissue atrophy and inflammation. Chronic alcohol consumption increases the risk of multiple types of cancer, and enhances cancer-associated cachexia (CAC), but the underlying mechanisms remain poorly defined. To test, C57BL/6 mice were fed with 0% or 20% (w/v) alcohol for 3 months, then inoculated with B16BL6 melanoma cells subcutaneously in the right side of the hip and continued to feed with/without alcohol for 3 or 4 weeks. Alcohol intake upregulated ALDH1A1 expression and elevated retinoic acid (RA) content in inguinal white adipose tissue (iWAT), which led to enhanced iWAT browning and brown adipose tissue (BAT) activation, accelerating fat loss. Moreover, alcohol increased muscle loss through augmenting muscle protein degradation, cell apoptosis and inflammation. In addition, alcohol reduced satellite cell density and impaired myogenesis in skeletal muscle. Taken together, alcohol aggravates cancer-associated cachexia at least partially through elevating adipose browning and muscle atrophy.
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Affiliation(s)
- Bo Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing 100094, P. R. China
- Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - Faya Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, WA 99210, USA
| | - Hui Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, WA 99210, USA
| | - Zhixiu Wang
- Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
| | - Yan-Nan Ma
- Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
- Department of Chemistry and Lifer Sciences, Gansu Normal University for Nationalities, Hezuo 747000, P. R. China
| | - Mei-Jun Zhu
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, WA 99210, USA
| | - Min Du
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing 100094, P. R. China
- Department of Animal Sciences, Washington State University, Pullman, WA 99164, USA
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Vagnildhaug OM, Blum D, Wilcock A, Fayers P, Strasser F, Baracos VE, Hjermstad MJ, Kaasa S, Laird B, Solheim TS. The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis. J Cachexia Sarcopenia Muscle 2017; 8. [PMID: 28627024 PMCID: PMC5659057 DOI: 10.1002/jcsm.12220] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression. METHODS An international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0-4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains [anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade. RESULTS One thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS ≤ 70). The overall effect of the WLGS on survival was significant as expressed by change in -2 log likelihood (P < 0.001) and persisted after adjustment for age, sex, and cancer type and stage (P < 0.001). Median survival decreased across the weight loss grades ranging from 407 days (95% CI 312-502)-weight loss grade 0 to 119 days (95% CI 93-145)-weight loss grade 4. All cachexia domains significantly deteriorated with increasing weight loss grade, and deterioration was greatest for dietary intake, with a difference corresponding to 0.87 standard deviations between weight loss grades 0 and 4. The addition of KPS, anorexia, and physical and emotional functioning improved the prognostic accuracy of the WLGS. Likelihood of cachexia progression was greater in patients with weight loss grade 2 (39%) than that with weight loss grade 0 (19%) or 1 (22%). CONCLUSIONS The WLGS is related to survival, cachexia domains, and the likelihood of progression. Adding certain cachexia domains to the WLGS improves prognostic accuracy.
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Affiliation(s)
- Ola Magne Vagnildhaug
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - David Blum
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St Gallen, Switzerland
| | - Andrew Wilcock
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Fayers
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Florian Strasser
- Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St Gallen, Switzerland
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Marianne J Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Oncology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Barry Laird
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Edinburgh Cancer Research UK Centre, University of Edinburgh, Edinburgh, UK.,Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Tora S Solheim
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Obesity and malnutrition similarly alter the renin–angiotensin system and inflammation in mice and human adipose. J Nutr Biochem 2017; 48:74-82. [DOI: 10.1016/j.jnutbio.2017.06.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022]
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Maurício SF, Xiao J, Prado CM, Gonzalez MC, Correia MITD. Different nutritional assessment tools as predictors of postoperative complications in patients undergoing colorectal cancer resection. Clin Nutr 2017; 37:1505-1511. [PMID: 28918167 DOI: 10.1016/j.clnu.2017.08.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/21/2017] [Accepted: 08/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Malnutrition in patients with colorectal cancer contributes to increased postoperative complications. The aim of the study was to evaluate the prognostic value of several nutritional assessment parameters: body mass index versus percentage of weight loss grading system (BMI/%WL); Patient-Generated Subjective Global Assessment (PG-SGA); standardized phase angle (SPA) by BIA; muscle strength by handgrip strength; muscle mass by computerized tomography; and the combination of muscle mass and strength in patients undergoing resection surgery. METHODS Patients diagnosed with cancer of the colon or rectum, who were over 18 years old and were scheduled to undergo surgical treatment were invited to participate. Postoperative complications were assessed from the first day post-surgery until discharge. Complications classified as Grade II or above according to the Clavien-Dindo classification were considered. Chi-square test or Fisher's exact test, bivariate analysis, Poisson regression and receiver operator characteristic (ROC) curve were utilized and p < 0.05 was considered significant. RESULTS 84 patients were evaluated, with 28 (33.3%) presenting with Grade II postoperative complications. SPA showed no association with postoperative complications (p = 0.199). In multivariate analysis, low skeletal muscle mass showed a relative risk (RR) of 1.80 (CI: 1.02-3.17), BMI/%WL equal or higher than grade 3 had a RR of 1.90 (95% CI: 1.22-3.39). PG-SGA classified as malnutrition showed a RR of 2.08 (95% CI: 1.06-4.06); and low muscle mass plus low muscle strength showed a RR 2.13 (95% CI: 1.23-3.69). Low strength alone was not associated with postoperative complications after controlling for confounding factors (p = 0.16; 95% CI: 0.83-2.77). Low muscle mass in combination with low strength showed the highest predictive power for postoperative complications (AUC: 0.68; CI: 0.56-0.80). CONCLUSIONS BMI/%WL > grade 3, PG-SGA defined malnutrition, low muscle mass and low muscle mass plus low strength were independent risk factors for complications controlling for confounding factors. However, low muscle mass in combination with low muscle strength were the strongest variables associated with complications. CLINICAL TRIALS IDENTIFICATION NUMBER NCT02901132 (www.clinicaltrials.gov).
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Affiliation(s)
- Sílvia Fernandes Maurício
- Post-graduate Program on Surgery and Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Jingjie Xiao
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Maria Cristina Gonzalez
- Post-graduate Program on Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
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Abstract
Patients with cancer frequently experience unintended weight loss due to gastrointestinal (GI) dysfunction caused by the malignancy or treatment of the malignancy. However, others may present with weight loss related to other symptoms not clearly associated with identifiable GI dysfunction such as anorexia and early satiety. Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by ongoing loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. CC is associated with poor tolerance of antitumor treatments, reduced quality of life (QOL), and negative impact on survival. Symptoms associated with CC are thought to be caused in part by tumor-induced changes in host metabolism that result in systemic inflammation and abnormal neurohormonal responses. Unfortunately, there is no single standard treatment for CC. Nutrition consequences of oncologic treatments should be identified early with nutrition screening and assessment. Pharmacologic agents directed at improving appetite and countering metabolic abnormalities that cause inefficient nutrient utilization are currently the foundation for treating CC. Multiple agents have been investigated for their effects on weight, muscle wasting, and QOL. However, few are commercially available for use. Considerations for choosing the most appropriate treatment include effect on appetite, weight, QOL, risk of adverse effects, and cost and availability of the agent.
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Naidoo DB, Chuturgoon AA, Phulukdaree A, Guruprasad KP, Satyamoorthy K, Sewram V. Centella asiatica modulates cancer cachexia associated inflammatory cytokines and cell death in leukaemic THP-1 cells and peripheral blood mononuclear cells (PBMC's). Altern Ther Health Med 2017; 17:377. [PMID: 28764778 PMCID: PMC5540453 DOI: 10.1186/s12906-017-1865-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/28/2017] [Indexed: 12/31/2022]
Abstract
Background Cancer cachexia is associated with increased pro-inflammatory cytokine levels. Centella asiatica (C. asiatica) possesses antioxidant, anti-inflammatory and anti-tumour potential. We investigated the modulation of antioxidants, cytokines and cell death by C. asiatica ethanolic leaf extract (CLE) in leukaemic THP-1 cells and normal peripheral blood mononuclear cells (PBMC’s). Methods Cytotoxcity of CLE was determined at 24 and 72 h (h). Oxidant scavenging activity of CLE was evaluated using the 2, 2-diphenyl-1 picrylhydrazyl (DPPH) assay. Glutathione (GSH) levels, caspase (−8, −9, −3/7) activities and adenosine triphosphate (ATP) levels (Luminometry) were then assayed. The levels of tumour necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β and IL-10 were also assessed using enzyme-linked immunosorbant assay. Results CLE decreased PBMC viability between 33.25–74.55% (24 h: 0.2–0.8 mg/ml CLE and 72 h: 0.4–0.8 mg/ml CLE) and THP-1 viability by 28.404% (72 h: 0.8 mg/ml CLE) (p < 0.0001). Oxidant scavenging activity was increased by CLE (0.05–0.8 mg/ml) (p < 0.0001). PBMC TNF-α and IL-10 levels were decreased by CLE (0.05–0.8 mg/ml) (p < 0.0001). However, PBMC IL-6 and IL-1β concentrations were increased at 0.05–0.2 mg/ml CLE but decreased at 0.4 mg/ml CLE (p < 0.0001). In THP-1 cells, CLE (0.2–0.8 mg/ml) decreased IL-1β and IL-6 whereas increased IL-10 levels (p < 0.0001). In both cell lines, CLE (0.05–0.2 mg/ml, 24 and 72 h) increased GSH concentrations (p < 0.0001). At 24 h, caspase (−9, −3/7) activities was increased by CLE (0.05–0.8 mg/ml) in PBMC’s whereas decreased by CLE (0.2–0.4 mg/ml) in THP-1 cells (p < 0.0001). At 72 h, CLE (0.05–0.8 mg/ml) decreased caspase (−9, −3/7) activities and ATP levels in both cell lines (p < 0.0001). Conclusion In PBMC’s and THP-1 cells, CLE proved to effectively modulate antioxidant activity, inflammatory cytokines and cell death. In THP-1 cells, CLE decreased pro-inflammatory cytokine levels whereas it increased anti-inflammatory cytokine levels which may alleviate cancer cachexia.
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Abstract
Adipose tissue represents a critical component in healthy energy homeostasis. It fulfills important roles in whole-body lipid handling, serves as the body's major energy storage compartment and insulation barrier, and secretes numerous endocrine mediators such as adipokines or lipokines. As a consequence, dysfunction of these processes in adipose tissue compartments is tightly linked to severe metabolic disorders, including obesity, metabolic syndrome, lipodystrophy, and cachexia. While numerous studies have addressed causes and consequences of obesity-related adipose tissue hypertrophy and hyperplasia for health, critical pathways and mechanisms in (involuntary) adipose tissue loss as well as its systemic metabolic consequences are far less understood. In this review, we discuss the current understanding of conditions of adipose tissue wasting and review microenvironmental determinants of adipocyte (dys)function in related pathophysiologies.
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Affiliation(s)
- Alexandros Vegiopoulos
- Junior Group Metabolism and Stem Cell Plasticity, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Maria Rohm
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stephan Herzig
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Joint Heidelberg-IDC Translational Diabetes Program Inner Medicine I, Neuherberg, Germany
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Amano K, Maeda I, Morita T, Baba M, Miura T, Hama T, Mori I, Nakajima N, Nishi T, Sakurai H, Shimoyama S, Shinjo T, Shirayama H, Yamada T, Ono S, Ozawa T, Yamamoto R, Yamamoto N, Shishido H, Kinoshita H. C-reactive protein, symptoms and activity of daily living in patients with advanced cancer receiving palliative care. J Cachexia Sarcopenia Muscle 2017; 8:457-465. [PMID: 28247593 PMCID: PMC5476854 DOI: 10.1002/jcsm.12184] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/09/2016] [Accepted: 12/28/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The association between C-reactive protein (CRP) level, symptoms, and activities of daily living (ADL) in advanced cancer patients is unclear. METHODS Secondary data analysis of a multicenter prospective cohort study consisted of 2426 advanced cancer patients referred to palliative care settings was conducted to examine the cross-sectional relationships between CRP level, symptoms, and ADL disabilities. Laboratory data, symptoms, ADL, and manual muscle testing (MMT) results were obtained at baseline. Participants were divided into four groups: low (CRP < 1 mg/dl), moderate (1 = < CRP <5 mg/dl), high (5 = < CRP < 10 mg/dl), and very high CRP (10 mg/dl = < CRP). The proportions of eight symptoms, five ADL disabilities, and three categories of MMT according to the CRP groups were tested by chi-square tests. Multiple-adjusted odd ratios (ORs) were calculated by using ordinal logistic regression after adjustment for age, gender, site of primary cancer, metastatic disease, performance status, chemotherapy, and setting of care. RESULTS A total of 1702 patients were analysed. Positive rates of symptoms and ADL disabilities increased with increasing CRP level. In the very high-CRP group, rates of positivity for anorexia, fatigue, and weight loss were 89.8%, 81.0%, and 79.2%, respectively, and over 70% of patients received assistance for bathing, dressing, going to the toilet, and transfer. The grade of MMT also deteriorated with increasing CRP level. Adjusted ORs for the accumulated symptoms significantly increased with increasing CRP level in the moderate-CRP, high-CRP, and very high-CRP groups [1.6 (95% confidence interval 1.2-2.0), P < 0.001; 2.5 (1.9-3.2), P < 0.001; 3.5 (2.7-4.6), P < 0.001, respectively]. Adjusted ORs for the accumulated ADL disabilities significantly increased in the very high-CRP groups [2.1 (1.5-2.9), P < 0.001]. CONCLUSIONS Associations between CRP level, symptoms, and ADL were observed in advanced cancer patients receiving palliative care.
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Affiliation(s)
- Koji Amano
- Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, 534-0021, Japan
| | - Isseki Maeda
- Department of Palliative Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Mika Baba
- Department of Palliative Care, Saito Yukoukai Hospital, 7-2-18 Saito Asagi, Ibaragi, Osaka, 567-0085, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chibay, 277-8577, Japan
| | - Takashi Hama
- Palliative Care Team, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan
| | - Ichiro Mori
- Gratia Hospital Hospice, 6-14-1 Aomadaninishi, Mino, Osaka, 562-8567, Japan
| | - Nobuhisa Nakajima
- Department of Palliative Medicine, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Tomohiro Nishi
- Kawasaki Comprehensive Care Center, Kawasaki Municipal Ida Hospital, 2-27-1 Ida Nakahara-ku, Kawasaki, Kanagawa, 211-0035, Japan
| | - Hiroki Sakurai
- Department of Palliative Care, St. Luke's International Hospital, Tokyo, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Satofumi Shimoyama
- Department of Palliative Care, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Takuya Shinjo
- Shinjo Clinic, Kobe, 1-5-1-307 Kitagoyou, Kita-ku, Kobe, Hyogo, 651-1131, Japan
| | - Hiroto Shirayama
- Osaka Kita Homecare Clinic, Shin-Osaka 3rd Doi-biru 3F, 1-8-24 Nisimiyahara Yodogawa-ku, Osaka, 532-0004, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Shigeki Ono
- Division of Palliative Medicine, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Taketoshi Ozawa
- Megumi Zaitaku Clinic, 2-4-3 Hashido, Seya-ku, Yokohama, Kanagawa, 246-0037, Japan
| | - Ryo Yamamoto
- Department of Palliative Medicine, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 385-0051, Japan
| | - Naoki Yamamoto
- Department of Primary Care Service, Shinsei Hospital, 851 Obusechou, Kamitakai-gun, Nagano, 381-0295, Japan
| | - Hideki Shishido
- Shishido Internal Medicine Clinic, 1-18-7 Ojidai, Sakura, Chiba, 285-0837, Japan
| | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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Ozorio GA, Barão K, Forones NM. Cachexia Stage, Patient-Generated Subjective Global Assessment, Phase Angle, and Handgrip Strength in Patients with Gastrointestinal Cancer. Nutr Cancer 2017; 69:772-779. [PMID: 28524706 DOI: 10.1080/01635581.2017.1321130] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this study was to correlate patients with gastrointestinal cancer, classified according to different stages of cancer cachexia (SCC) as proposed by Fearon, with nutritional assessment tools such as PG-SGA, phase angle (PA), and handgrip strength. One hundred one patients with a mean age of 61.8 ± 12.8 yr, with 58.4% being men were included. 32.6% were malnourished according to the body mass index (BMI). A severe or moderate malnutrition had been diagnosed in 63.3% when assessed using the PG-SGA, 60.4% had decreased handgrip strength, and 57.4% had lower grades of PA. Among the patients in the study, 26% did not have cachexia, 11% had precachexia, 56% cachexia, and 8% refractory cachexia. The PG-SGA, PA, and handgrip strength were associated with cachexia (P ≤ 0.001). An increased risk of death was found in patients with cachexia [RR: 9.1; confidence interval (CI) 95%: 0.1-90.2, P = 0.039], refractory cachexia (RR: 69.4, CI 95%: 4.5-1073.8, P = 0.002), and increased serum C-reactive protein (CRP) levels (P < 0.001). In conclusion, most of the patients with digestive system cancer had cachexia or refractory cachexia in the first nutritional assessment. Nutritional risk, as determined by PG-SGA, was correlated with PA and handgrip strength. High CRP levels, cachexia, and refractory cachexia were prognostic factors for cancer patients.
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Affiliation(s)
| | - Katia Barão
- b Escola Paulista de Medicina , Universidade Federal de São Paulo , Sao Paulo , Brazil
| | - Nora Manoukian Forones
- c Division of Gastroenterology, Department of Medicine , Universidade Federal de Sao Paulo , Sao Paulo , Brazil
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Spotten L, Corish C, Lorton C, Ui Dhuibhir P, O’Donoghue N, O’Connor B, Walsh T. Subjective and objective taste and smell changes in cancer. Ann Oncol 2017; 28:969-984. [DOI: 10.1093/annonc/mdx018] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Park S, Komatsu T, Kim SE, Tanaka K, Hayashi H, Mori R, Shimokawa I. Neuropeptide Y resists excess loss of fat by lipolysis in calorie-restricted mice: a trait potential for the life-extending effect of calorie restriction. Aging Cell 2017; 16:339-348. [PMID: 28101970 PMCID: PMC5334538 DOI: 10.1111/acel.12558] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/01/2022] Open
Abstract
Neuropeptide Y (NPY) is an orexigenic peptide that plays an essential role in caloric restriction (CR)‐mediated lifespan extension. However, the mechanisms underlying the NPY‐mediated effects in CR are poorly defined. Here, we report that NPY deficiency in male mice during CR increases mortality in association with lipodystrophy. NPY−/− mice displayed a rapid decrease in body weight and fat mass, as well as increased lipolysis during CR. These alterations in fat regulation were inhibited by the lipolysis inhibitor, acipimox, a treatment associated with reduced mortality. The lipolytic/thermogenic signaling, β3‐adrenergic receptor/hormone sensitive lipase, was markedly activated in white adipose tissue of NPY−/− mice compared with that of NPY+/+ mice, and thermogenesis was controlled by NPY under negative energy balance. These results demonstrate the critical role of NPY in the regulation of lipid metabolic homeostasis and survival via control of lipolysis and thermogenesis in a state of negative energy balance.
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Affiliation(s)
- Seongjoon Park
- Department of Pathology; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
| | - Toshimitsu Komatsu
- Department of Pathology; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
| | - Sang Eun Kim
- Department of Pathology; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
| | - Katsuya Tanaka
- Department of Pathology; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
- Department of Plastic and Reconstructive Surgery; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
| | - Hiroko Hayashi
- Department of Pathology; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
| | - Ryoichi Mori
- Department of Pathology; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
| | - Isao Shimokawa
- Department of Pathology; Nagasaki University School of Medicine; Graduate School of Biomedical Sciences; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
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Jager-Wittenaar H, Dijkstra PU, Dijkstra G, Bijzet J, Langendijk JA, van der Laan BF, Roodenburg JL. High prevalence of cachexia in newly diagnosed head and neck cancer patients: An exploratory study. Nutrition 2017; 35:114-118. [DOI: 10.1016/j.nut.2016.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/06/2016] [Accepted: 11/29/2016] [Indexed: 01/10/2023]
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Jaap K, Hunsinger M, Dove J, Mcginty K, Stefanowicz E, Fera J, Wild J, Shabahang M, Blansfield J. Morphometric Predictors of Morbidity after Pancreatectomy. Am Surg 2016. [DOI: 10.1177/000313481608201230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreatic surgery has historically been associated with high morbidity and mortality. One model that could predict outcomes is the assessment of preoperative morphometrics. The objective of this study was to compare different clinical and morphometric features of patients undergoing pancreatectomy to predict morbidity. This is a retrospective chart review of patients undergoing pancreatectomy from December 2004 to October 2013. Morphometric parameters on preoperative CT scans were measured and patients were grouped to examine their association with postoperative morbidity. A total of 180 patients were included in this study (90 males and 90 females). At the time of diagnosis, patients had an average age of 66.7 years (range = 24–90), and median body mass index of 27.4 kg/m2 (range = 16–58 kg/m2). Sixty-one patients (33.9%) experienced surgical complications. Of the individual morphometric variables examined, sarcopenia was the best predictor of length of stay and surgical complications. On multivariate analysis, there was a strong statistically significant correlation of sarcopenia with surgical complications (odds ratio = 3.524, P = 0.0049). No other morphometric variables predicted morbidity. Sarcopenia is a useful predictor for postoperative morbidity after pancreatectomy. The results of this study suggest that noninvasive preoperative testing can be used to quantify postoperative complications after pancreatic surgery.
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Affiliation(s)
- Kathryn Jaap
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Marie Hunsinger
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - James Dove
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Katrina Mcginty
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Edward Stefanowicz
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jillian Fera
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey Wild
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Mohsen Shabahang
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Joseph Blansfield
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
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D'Souza V, Daudt H, Kazanjian A. Survivorship care plans for people with colorectal cancer: do they reflect the research evidence? ACTA ACUST UNITED AC 2016; 23:e488-e498. [PMID: 27803610 DOI: 10.3747/co.23.3114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM In the present study, we synthesized the published literature about the psychosocial aspects of colorectal cancer (crc) survivorship to support an update of the evidentiary base of the survivorship care plans (scps) created in our jurisdiction. METHODS The psychosocial topics identified in the crc scps created by two different initiatives in our province were used as search criteria: quality of life (qol), sexual function, fatigue, and lifestyle behaviors. An umbrella review was conducted to retrieve the best possible evidence. Only reviews that investigated the intended outcomes in crc survivors and those with moderate-to-high methodologic quality scores were included. RESULTS Of 462 retrieved reports, eight reviews met the inclusion criteria for the synthesis. Of those eight, six investigated the challenges of crc survivors and two investigated the effect of physical activity on survivor well-being. Our results indicate that emotional and physical challenges are common in crc survivors and that physical activity is associated with clinically important benefits for the fatigue and physical functioning of crc survivors. CONCLUSIONS Our study findings update the evidence and indicate that existing scps in our province concerning the physical and emotional challenges of crc survivors reflect the evidence at the time of their issue. However, the literature concerning cancer risks specific to crc survivors is lacking. Although systematic reviews are considered to be the "gold standard" in knowledge synthesis, our findings suggest that much remains to be done in the area of synthesis research to better guide practice in cancer survivorship.
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Affiliation(s)
- V D'Souza
- BC Cancer Agency, Vancouver Island Centre, University of British Columbia, Vancouver, BC
| | - H Daudt
- BC Cancer Agency, Vancouver Island Centre, University of British Columbia, Vancouver, BC
| | - A Kazanjian
- BC Cancer Agency, Vancouver Island Centre, University of British Columbia, Vancouver, BC.; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC
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Preoperative cancer cachexia and short-term outcomes following surgery. J Surg Res 2016; 205:398-406. [DOI: 10.1016/j.jss.2016.06.076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/11/2016] [Accepted: 06/27/2016] [Indexed: 11/21/2022]
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Hansen JS, Plomgaard P. Circulating follistatin in relation to energy metabolism. Mol Cell Endocrinol 2016; 433:87-93. [PMID: 27264073 DOI: 10.1016/j.mce.2016.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 12/18/2022]
Abstract
Recently, substantial evidence has emerged that the liver contributes significantly to the circulating levels of follistatin and that circulating follistatin is tightly regulated by the glucagon-to-insulin ratio. Both observations are based on investigations of healthy subjects. These novel findings challenge the present view of circulating follistatin in human physiology, being that circulating follistatin is a result of spill-over from para/autocrine actions in various tissues and cells. Follistatin as a liver-derived protein under the regulation of glucagon-to-insulin ratio suggests a relation to energy metabolism. In this narrative review, we attempt to reconcile the existing findings on circulating follistatin with the novel concept that circulating follistatin is a liver-derived molecule regulated by the glucagon-to-insulin ratio. The picture emerging is that conditions associated with elevated levels of circulating follistatin have a metabolic denominator with decreased insulin sensitivity and/or hyperglucagoneimia.
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Affiliation(s)
- Jakob Schiøler Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; The Centre of Inflammation and Metabolism, Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark
| | - Peter Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; The Centre of Inflammation and Metabolism, Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark.
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Consul N, Guo X, Coker C, Lopez-Pintado S, Hibshoosh H, Zhao B, Kalinsky K, Acharyya S. Monitoring Metastasis and Cachexia in a Patient with Breast Cancer: A Case Study. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2016; 10:83-94. [PMID: 27660506 PMCID: PMC5019129 DOI: 10.4137/cmo.s40479] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 01/05/2023]
Abstract
Cachexia, a wasting syndrome associated with advanced cancer and metastasis, is rarely documented in breast cancer patients. However, the incidence of cachexia in breast cancer is now thought to be largely underestimated. In our case report of a breast cancer patient with bone metastasis monitored during the course of her treatment, we document the development of cachexia by image analysis in relation to her metastatic burden. Elucidation of the link between metastatic burden and cachexia could unveil a highly specific screening process for metastasis, by assessing true muscle mass loss. Our patient was a 49-year-old premenopausal woman, with metastatic invasive ductal breast carcinoma in the vertebral and iliac bones on presentation, which progressed with new metastases to her hips, thigh bones, and vertebrae. In the two-year period, that is between her diagnosis and death, she lost >10% of her baseline weight. During these two years, we retrospectively identified a decrease in paraspinal muscle (PM) at the third lumbar vertebra followed by a sharp decline in weight. The increased tumor burden over time in metastatic sites was accompanied by a decrease in abdominal muscle and visceral and subcutaneous fat and was followed by the patient’s demise. The increasing tumor burden in the patient was correlated with the mass of other tissues to determine the tissue that could best serve as a surrogate marker to cachexia and tumor burden. We noted a strong negative correlation between PM area and metastatic tumor area at the third lumbar vertebral level, with PM loss correlating to increasing tumor burden. The monitoring of PM wasting may serve as a marker, and therefore a prognostic factor, for both cachexia and extent of metastatic disease, especially in breast cancer, where metastasis to bone is frequent. Based on our data and review of the literature in this case study, longitudinal monitoring of cachexia in the selected muscle groups can give clinicians early indications of the extent of cachexia in metastatic breast cancer patients.
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Affiliation(s)
- Nikita Consul
- Department of Medicine, College of Physicians and Surgeons, Columbia University
| | - Xiaotao Guo
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Courtney Coker
- Institute for Cancer Genetics, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Sara Lopez-Pintado
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hanina Hibshoosh
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Kevin Kalinsky
- Division of Hematology and Medical Oncology, Columbia University Medical Center, New York, NY, USA
| | - Swarnali Acharyya
- Institute for Cancer Genetics, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
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Rohm M, Schäfer M, Laurent V, Üstünel BE, Niopek K, Algire C, Hautzinger O, Sijmonsma TP, Zota A, Medrikova D, Pellegata NS, Ryden M, Kulyte A, Dahlman I, Arner P, Petrovic N, Cannon B, Amri EZ, Kemp BE, Steinberg GR, Janovska P, Kopecky J, Wolfrum C, Blüher M, Berriel Diaz M, Herzig S. An AMP-activated protein kinase-stabilizing peptide ameliorates adipose tissue wasting in cancer cachexia in mice. Nat Med 2016; 22:1120-1130. [PMID: 27571348 DOI: 10.1038/nm.4171] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/27/2016] [Indexed: 12/17/2022]
Abstract
Cachexia represents a fatal energy-wasting syndrome in a large number of patients with cancer that mostly results in a pathological loss of skeletal muscle and adipose tissue. Here we show that tumor cell exposure and tumor growth in mice triggered a futile energy-wasting cycle in cultured white adipocytes and white adipose tissue (WAT), respectively. Although uncoupling protein 1 (Ucp1)-dependent thermogenesis was dispensable for tumor-induced body wasting, WAT from cachectic mice and tumor-cell-supernatant-treated adipocytes were consistently characterized by the simultaneous induction of both lipolytic and lipogenic pathways. Paradoxically, this was accompanied by an inactivated AMP-activated protein kinase (Ampk), which is normally activated in peripheral tissues during states of low cellular energy. Ampk inactivation correlated with its degradation and with upregulation of the Ampk-interacting protein Cidea. Therefore, we developed an Ampk-stabilizing peptide, ACIP, which was able to ameliorate WAT wasting in vitro and in vivo by shielding the Cidea-targeted interaction surface on Ampk. Thus, our data establish the Ucp1-independent remodeling of adipocyte lipid homeostasis as a key event in tumor-induced WAT wasting, and we propose the ACIP-dependent preservation of Ampk integrity in the WAT as a concept in future therapies for cachexia.
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Affiliation(s)
- Maria Rohm
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Michaela Schäfer
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Victor Laurent
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Bilgen Ekim Üstünel
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Katharina Niopek
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Carolyn Algire
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Oksana Hautzinger
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Tjeerd P Sijmonsma
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Annika Zota
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Dasa Medrikova
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Natalia S Pellegata
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Mikael Ryden
- Lipid Laboratory, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Agné Kulyte
- Lipid Laboratory, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Dahlman
- Lipid Laboratory, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Peter Arner
- Lipid Laboratory, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Natasa Petrovic
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Barbara Cannon
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Ez-Zoubir Amri
- Université Côte d'Azur, Nice, France.,Centre National de la Recherche Scientifique (CNRS), Nice, France
| | - Bruce E Kemp
- St Vincent's Institute of Medical Research, University of Melbourne, Fitzroy, Victoria, Australia.,Mary MacKillop Institute for Health, Research Australian Catholic University, Melbourne, Victoria, Australia
| | - Gregory R Steinberg
- Department of Medicine, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Petra Janovska
- Department of Adipose Tissue Biology, Institute of Physiology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Jan Kopecky
- Department of Adipose Tissue Biology, Institute of Physiology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Christian Wolfrum
- Swiss Federal Institute of Technology, Institute of Food Nutrition and Health, Schwerzenbach, Switzerland
| | - Matthias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Mauricio Berriel Diaz
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Stephan Herzig
- Institute for Diabetes and Cancer (IDC), Helmholtz Center Munich, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
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80
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Shiono M, Huang K, Downey RJ, Consul N, Villanueva N, Beck K, Fenn K, Dietz D, Yamaguchi T, Kato S, Divgi C, Kalinsky K, Wei Y, Zhang Y, Borczuk AC, Inoue A, Halmos B, Acharyya S. An analysis of the relationship between metastases and cachexia in lung cancer patients. Cancer Med 2016; 5:2641-8. [PMID: 27485414 PMCID: PMC5055184 DOI: 10.1002/cam4.841] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/13/2016] [Accepted: 07/05/2016] [Indexed: 12/30/2022] Open
Abstract
Weight loss and hematogenous metastases are poor prognosis factors in lung cancer patients that can but do not necessarily co‐occur. We retrospectively investigated the clinical association between cachexia, tumor characteristics (such as metastatic burden and mutational status), and treatment in lung cancer patients. The medical records of 394 lung cancer patients from two institutions (Columbia University, USA and Tohoku University, Japan) were reviewed. Information collected included the presence of cachexia, histologic subtype, tumor stage, number of metastases, mutation status, treatment, and survival. Descriptive statistics were performed. Only stage IV patients exhibited >5% weight loss (0.8%, 2.2%, 3.6%, and 5.1%, for stages I to IV; P = 0.0001). Patients with metastases developed cachexia more often than patients without metastases independent of treatment (6.0% and 7.1% weight loss in patients with metastases vs. 2.5% and 2.0% in patients without metastases, before [P = 0.0001] and after [P < 0.0001] treatment, respectively). The change in number of metastatic sites over time correlated with increasing weight loss (5.2%, 10.6%, 13.4%, and 13.4%, for an increase of 0, 1, 2, and ≥3 metastatic sites, from initial diagnosis to the endpoint; P < 0.0001). Patients with cachexia had worse survival than patients without cachexia (hazard ratio, 2.94; 95% confidence interval, 2.08–4.16; P < 0.0001). Tumors with mutated KRAS were associated with an increased risk of weight loss (11.4% weight loss in patients with mutated KRAS vs. 6.0% in patients with wild‐type KRAS; P = 0.0011). Our findings suggest that the capabilities of lung cancer to metastasize and cause cachexia might be linked intrinsically and are independent of treatments administered. KRAS‐mutated tumors were more commonly associated with cachexia.
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Affiliation(s)
- Masatoshi Shiono
- Institute for Cancer Genetics, Columbia University, New York, New York
| | - Kan Huang
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, New York
| | - Robert J Downey
- Department of Surgery, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nikita Consul
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nicolas Villanueva
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, New York
| | - Kristen Beck
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kathleen Fenn
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, New York
| | - Donald Dietz
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, New York
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunsuke Kato
- Department of Clinical Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Chaitanya Divgi
- Department of Radiology, Columbia University Medical Center, New York, New York.,Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Kevin Kalinsky
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, New York.,Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Ying Wei
- Department of Biostatistics, Columbia University, New York, New York
| | - Yuan Zhang
- Department of Biostatistics, Columbia University, New York, New York
| | - Alain C Borczuk
- Department of Anatomic Pathology, Weill Cornell Medical College, New York, New York
| | - Akira Inoue
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan.,Department of Palliative Medicine, Tohoku University Hospital, Sendai, Japan
| | - Balazs Halmos
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Swarnali Acharyya
- Institute for Cancer Genetics, Columbia University, New York, New York. .,Herbert Irving Comprehensive Cancer Center, New York, New York.
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81
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Presley CJ, Dotan E, Soto-Perez-de-Celis E, Jatoi A, Mohile SG, Won E, Alibhai S, Kilari D, Harrison R, Klepin HD, Wildes TM, Mustian K, Demark-Wahnefried W. Gaps in nutritional research among older adults with cancer. J Geriatr Oncol 2016; 7:281-92. [PMID: 27197919 PMCID: PMC4969118 DOI: 10.1016/j.jgo.2016.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/03/2016] [Accepted: 04/18/2016] [Indexed: 01/01/2023]
Abstract
Nutritional issues among older adults with cancer are an understudied area of research despite significant prognostic implications for treatment side effects, cancer-specific mortality, and overall survival. In May of 2015, the National Cancer Institute and the National Institute on Aging co-sponsored a conference focused on future directions in geriatric oncology research. Nutritional research among older adults with cancer was highlighted as a major area of concern as most nutritional cancer research has been conducted among younger adults, with limited evidence to guide the care of nutritional issues among older adults with cancer. Cancer diagnoses among older adults are increasing, and the care of the older adult with cancer is complicated due to multimorbidity, heterogeneous functional status, polypharmacy, deficits in cognitive and mental health, and several other non-cancer factors. Due to this complexity, nutritional needs are dynamic, multifaceted, and dependent on the clinical scenario. This manuscript outlines the proceedings of this conference including knowledge gaps and recommendations for future nutritional research among older adults with cancer. Three common clinical scenarios encountered by oncologists include (1) weight loss during anti-cancer therapy, (2) malnutrition during advanced disease, and (3) obesity during survivorship. In this manuscript, we provide a brief overview of relevant cancer literature within these three areas, knowledge gaps that exist, and recommendations for future research.
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Affiliation(s)
- Carolyn J Presley
- Yale Cancer Center/Yale University School of Medicine, New Haven, CT, USA.
| | - Efrat Dotan
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Enrique Soto-Perez-de-Celis
- Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Supriya G Mohile
- James Wilmot Cancer Center at the University of Rochester, Rochester, NY, USA
| | - Elizabeth Won
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shabbir Alibhai
- Department of Medicine,University Health Network and University of Toronto,Canada
| | - Deepak Kilari
- Froedtert Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert Harrison
- SCOREboard,University of Rochester Medical Center, Rochester, NY, USA
| | - Heidi D Klepin
- Wake Forrest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Tanya M Wildes
- Washington University School of Medicine, St. Louis, MO, USA
| | - Karen Mustian
- James Wilmot Cancer Center at the University of Rochester, Rochester, NY, USA
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82
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Mauricio SF, Ribeiro HS, Correia MITD. Nutritional Status Parameters as Risk Factors for Mortality in Cancer Patients. Nutr Cancer 2016; 68:949-57. [DOI: 10.1080/01635581.2016.1188971] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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83
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Ní Bhuachalla É, O’ Connor A, Healy J, Dwyer F, Ryan AM. Good Nutrition for Cancer Recovery - a nutritional resource for the treatment of cancer-induced weight loss. NUTR BULL 2016. [DOI: 10.1111/nbu.12204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- É. Ní Bhuachalla
- School of Food & Nutritional Sciences; University College Cork; Cork Ireland
| | - A. O’ Connor
- Department of Tourism and Hospitality; Cork Institute of Technology; Cork Ireland
| | - J. Healy
- Department of Tourism and Hospitality; Cork Institute of Technology; Cork Ireland
| | - F. Dwyer
- School of Food & Nutritional Sciences; University College Cork; Cork Ireland
| | - A. M. Ryan
- School of Food & Nutritional Sciences; University College Cork; Cork Ireland
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84
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Cheung WW, Cherqui S, Ding W, Esparza M, Zhou P, Shao J, Lieber RL, Mak RH. Muscle wasting and adipose tissue browning in infantile nephropathic cystinosis. J Cachexia Sarcopenia Muscle 2016; 7:152-64. [PMID: 27493869 PMCID: PMC4864942 DOI: 10.1002/jcsm.12056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/21/2015] [Accepted: 06/03/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Muscle wasting is a common complication in patients with infantile nephropathic cystinosis, but its mechanism and association with energy metabolism is not known. We define the metabolic phenotype in Ctns(-/-) mice, an established murine model of infantile nephropathic cystinosis, with focus on muscle wasting and energy homeostasis. METHODS Male Ctns(-/-) mice and wild-type (WT) controls were studied at 1, 4, 9, and 12 months of age. As Ctns(-/-) mice started to develop chronic kidney disease (CKD) at 9 months of age, 9- and 12-month-old Ctns(-/-) mice were also compared with age-matched WT mice with CKD. Serum and urine chemistry and energy homeostasis parameters were measured. Skeletal muscle histomorphometry and in vivo muscle function were measured. We studied expression of genes involved in muscle mass regulation, thermogenesis, energy metabolism, adipogenesis, and adipose tissue browning in Ctns(-/-) mice. RESULTS Ctns(-/-) mice showed loss of weight and lean mass and increased energy expenditure. Ctns(-/-) mice exhibited abnormal energy homeostasis before the onset of their CKD. Food intake in Ctns(-/-) mice was comparable with age-matched WT controls. However, significantly lower total body mass starting at 1 month of age and increased energy expenditure at 4 months of age preceded the onset of CKD at 9 months of age in Ctns(-/-) mice. Muscle accept content in 1- and 4-month-old Ctns(-/-) mice was significantly lower than that in age-matched WT controls. At 12 months of age, muscle fibre area and in vivo muscle strength was reduced in Ctns(-/-) mice than that in WT or CKD controls. Muscle wasting in Ctns(-/-) mice was associated with inhibition of myogenesis, activation of muscle proteolysis pathways, and overexpression of pro-inflammatory cytokines. Increased energy expenditure was associated with elevation of thermogenesis in skeletal muscle and adipose tissues. The development of beige adipocytes in Ctns(-/-) mice is a novel finding. Expression of beige adipose cell surface markers (CD137, Tmem26, and Tbx1) and uncoupling protein-1, which is a brown adipose tissue marker, was observed in inguinal white adipose tissue of Ctns(-/-) mice. Expression of key molecules implicated in the pathogenesis of adipose tissue browning (Cox2, cytochrome c oxidase subunit II; PGF2α, prostaglandin F2α; IL-1α, interleukin 1α; IL-6, interleukin 6; TNF-α, tumor necrosis factor α) was significantly increased in inguinal white adipose tissue of Ctns(-/-) mice than that in WT controls. CONCLUSION This study describes a mouse model of nephropathic cystinosis presenting with profound muscle wasting. The mechanism for hypermetabolism in Ctns(-/-) mice may involve up-regulation of thermogenesis pathways in skeletal muscle and adipose tissues. This study demonstrates, for the first time, the development of beige adipocytes in Ctns(-/-) mice. Understanding the underlying mechanisms of adipose tissue browning in cystinosis may lead to novel therapy.
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Affiliation(s)
- Wai W Cheung
- Department of Pediatrics University of California San Diego CA USA
| | | | - Wei Ding
- Department of Pediatrics University of California San Diego CA USA; Division of Nephrology, The 5th People's Hospital of Shanghai Fudan University Shanghai China
| | - Mary Esparza
- Department of Orthopedic Surgery University of California San Diego CA USA
| | - Ping Zhou
- Department of Pediatrics University of California San Diego CA USA; Department of Pediatrics The 2nd Hospital of Harbin Medical University Harbin China
| | - Jianhua Shao
- Department of Pediatrics University of California San Diego CA USA
| | - Richard L Lieber
- Department of Orthopedic Surgery University of California San Diego CA USA; Rehabilitation Institute of Chicago Chicago
| | - Robert H Mak
- Department of Pediatrics University of California San Diego CA USA
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85
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Alterations in inflammatory biomarkers and energy intake in cancer cachexia: a prospective study in patients with inoperable pancreatic cancer. Med Oncol 2016; 33:54. [PMID: 27119533 DOI: 10.1007/s12032-016-0768-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/19/2016] [Indexed: 12/18/2022]
Abstract
Chronic systemic inflammatory response is proposed as an underlying mechanism for development of cancer cachexia. We conducted a prospective study to examine changes in inflammatory biomarkers during the disease course and the relationship between inflammatory biomarkers and cachexia in patients with inoperable pancreatic cancer. Twenty patients, median (range) age 67.5 (35-79) years, 5 females, were followed for median 5.5 (1-12) months. Cachexia was diagnosed according to the 2011 consensus-based classification system (weight loss >5 % past six months, BMI < 20 kg/m(2) and weight loss >2 %, or sarcopenia) and the modified Glasgow Prognostic score (mGPS) that combines CRP and albumin levels. Inflammatory biomarkers were measured by enzyme immunoassays. The patients had increased levels of most inflammatory biomarkers, albeit not all statistically significant, both at study entry and close to death, indicating ongoing inflammation. According to the consensus-based classification system, eleven (55 %) patients were classified as cachectic upon inclusion. They did not differ from non-cachectic patients with regard to inflammatory biomarkers or energy intake. According to the mGPS, seven (35 %) were defined as cachectic and had a higher IL-6 (p < 0.001) than the non-cachectic patients. They also had a slightly, but insignificantly longer survival than non-cachectic patients (p = 0.08). The mGPS should be considered as an additional framework for identification of cancer cachexia.
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86
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Bossola M, Marzetti E, Rosa F, Pacelli F. Skeletal muscle regeneration in cancer cachexia. Clin Exp Pharmacol Physiol 2016; 43:522-7. [DOI: 10.1111/1440-1681.12559] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Maurizio Bossola
- Department of Surgery; Catholic University of the Sacred Heart School of Medicine; Rome Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics; Catholic University of the Sacred Heart School of Medicine; Rome Italy
| | - Fausto Rosa
- Department of Surgery; Catholic University of the Sacred Heart School of Medicine; Rome Italy
| | - Fabio Pacelli
- Department of Surgery; Catholic University of the Sacred Heart School of Medicine; Rome Italy
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87
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Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc 2016; 75:199-211. [PMID: 26786393 DOI: 10.1017/s002966511500419x] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.
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88
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Anorexia-cachexia and obesity treatment may be two sides of the same coin: role of the TGF-b superfamily cytokine MIC-1/GDF15. Int J Obes (Lond) 2015; 40:193-7. [PMID: 26620888 DOI: 10.1038/ijo.2015.242] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 06/17/2015] [Accepted: 08/12/2015] [Indexed: 12/21/2022]
Abstract
Anorexia-cachexia associated with cancer and other diseases is a common and often fatal condition representing a large area of unmet medical need. It occurs most commonly in advanced cancer and is probably a consequence of molecules released by tumour cells, or tumour-associated interstitial or immune cells. These may then act directly on muscle to cause atrophy and/or may cause anorexia, which then leads to loss of both fat and lean mass. Although the aetiological triggers for this syndrome are not well characterized, recent data suggest that MIC-1/GDF15, a transforming growth factor-beta superfamily cytokine produced in large amounts by cancer cells and as a part of other disease processes, may be an important trigger. This cytokine acts on feeding centres in the hypothalamus and brainstem to cause anorexia leading to loss of lean and fat mass and eventually cachexia. In animal studies, the circulating concentrations of MIC-1/GDF15 required to cause this syndrome are similar to those seen in patients with advanced cancer, and at least some epidemiological studies support an association between MIC-1/GDF15 serum levels and measures of nutrition. This article will discuss its mechanisms of central appetite regulation, and the available data linking this action to anorexia-cachexia syndromes that suggest it is a potential target for therapy of cancer anorexia-cachexia and conversely may also be useful for the treatment of severe obesity.
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89
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Tsoli M, Swarbrick MM, Robertson GR. Lipolytic and thermogenic depletion of adipose tissue in cancer cachexia. Semin Cell Dev Biol 2015; 54:68-81. [PMID: 26529279 DOI: 10.1016/j.semcdb.2015.10.039] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/26/2015] [Indexed: 01/04/2023]
Abstract
Although muscle wasting is the obvious manifestation of cancer cachexia that impacts on patient quality of life, the loss of lipid reserves and metabolic imbalance in adipose tissue also contribute to the devastating impact of cachexia. Depletion of fat depots in cancer patients is more pronounced than loss of muscle and often precedes, or even occurs in the absence of, reduced lean body mass. Rapid mobilisation of triglycerides stored within adipocytes to supply the body with fatty acids in periods of high-energy demand is normally mediated through a well-defined process of lipolysis involving the lipases ATGL, HSL and MGL. Studies into how these lipases contribute to fat loss in cancer cachexia have revealed the prominent role for ATGL in initiating lipolysis during adipose tissue atrophy, together with links between tumour-derived factors and the signalling pathways that control lipid flux within fat cells. The recent findings of increased thermogenesis in brown fat during cancer cachexia indicate that metabolically active adipose tissue contributes to the imbalance in energy homeostasis involved in catabolic wasting. Such energetically futile use of fatty acids liberated from adipose tissue to generate heat represents a maladaptive response in conjunction with anorexia experienced by cancer patients. As IL-6 release by tumours provokes lipolysis and activates the thermogenic programme in brown fat, this review explores the overlap in dysregulated metabolic processes due to inflammatory mediators in cancer cachexia and other disease states characterised by elevated cytokines such as obesity and diabetes.
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Affiliation(s)
- Maria Tsoli
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW 2031, Australia
| | - Michael M Swarbrick
- Centre for Diabetes, Obesity and Endocrinology, The Westmead Institute for Medical Research, The University of Sydney, NSW, Australia
| | - Graham R Robertson
- School of Molecular Biosciences, University of Sydney, NSW 2006, Australia.
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90
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Granger CL, Parry SM, Edbrooke L, Denehy L. Deterioration in physical activity and function differs according to treatment type in non-small cell lung cancer - future directions for physiotherapy management. Physiotherapy 2015; 102:256-63. [PMID: 26597694 DOI: 10.1016/j.physio.2015.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate in non-surgically and surgically treated non-small cell lung cancer (NSCLC): (1) changes in physical activity, function, health-related quality of life (HRQoL) and symptoms after diagnosis; and (2) the association between physical activity and outcomes. DESIGN Prospective observational study. SETTING Three acute tertiary hospitals. PARTICIPANTS Sixty-nine individuals (43 male, median [IQR] age 68 [61 to 74] years) with stage I-IV NSCLC. MAIN OUTCOME MEASURES The primary outcome (Physical Activity Scale for the Elderly) and secondary outcome (six-minute walk test and questionnaires assessing HRQoL, function, symptoms, mood) were measured at diagnosis (pre-treatment), and eight to ten weeks post-diagnosis (post-operative and/or during chemotherapy/radiotherapy). RESULTS Individuals treated surgically (n=27) experienced a deterioration in physical activity levels (baseline median [IQR]=74 [51 to 135]; follow-up median [IQR]=29 [24 to 73]; median difference=45, effect size=0.3). At follow-up physical activity was inversely related to depression, pain and appetite loss (rho>0.5, p<0.05). In contrast non-surgical individuals (n=42) did not experience a change in physical activity, however did experience deterioration in function, functional capacity, global HRQoL, fatigue and dyspnoea. Physical activity levels were low in this group and at follow-up the strongest relationships with physical activity levels were global HRQoL, function, fatigue and mood (inverse, rho>0.5, p<0.05). CONCLUSIONS Surgically treated individuals experienced a reduction in physical activity levels after diagnosis, which was not seen in the non-surgical group. Lower physical activity levels were associated with poorer outcomes, particularly in non-surgically treated individuals. Further research is required to establish the optimal intervention to improve physical activity levels in these cohorts.
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Affiliation(s)
- C L Granger
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia; Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg Road, Heidelberg 3084, Victoria, Australia.
| | - S M Parry
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia.
| | - L Edbrooke
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia.
| | - L Denehy
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg Road, Heidelberg 3084, Victoria, Australia.
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91
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Nonmuscle Tissues Contribution to Cancer Cachexia. Mediators Inflamm 2015; 2015:182872. [PMID: 26523094 PMCID: PMC4615210 DOI: 10.1155/2015/182872] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/26/2015] [Indexed: 01/05/2023] Open
Abstract
Cachexia is a syndrome associated with cancer, characterized by body weight loss, muscle and adipose tissue wasting, and inflammation, being often associated with anorexia. In spite of the fact that muscle tissue represents more than 40% of body weight and seems to be the main tissue involved in the wasting that occurs during cachexia, recent developments suggest that tissues/organs such as adipose (both brown and white), brain, liver, gut, and heart are directly involved in the cachectic process and may be responsible for muscle wasting. This suggests that cachexia is indeed a multiorgan syndrome. Bearing all this in mind, the aim of the present review is to examine the impact of nonmuscle tissues in cancer cachexia.
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92
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Potential Biomarkers of Fat Loss as a Feature of Cancer Cachexia. Mediators Inflamm 2015; 2015:820934. [PMID: 26508820 PMCID: PMC4609871 DOI: 10.1155/2015/820934] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/17/2015] [Accepted: 04/18/2015] [Indexed: 12/21/2022] Open
Abstract
Fat loss is associated with shorter survival and reduced quality of life in cancer patients.
Effective intervention for fat loss in cachexia requires identification of the condition using prognostic biomarkers for early detection and prevention of further depletion. No biomarkers of fat mass alterations have been defined for application to the neoplastic state. Several inflammatory cytokines have been implicated in mediating fat loss associated with cachexia; however, plasma levels may not relate to adipose atrophy. Zinc-α2-glycoprotein may be a local catabolic mediator within adipose tissue rather than serving as a plasma biomarker of fat loss. Plasma glycerol and leptin associate with adipose tissue atrophy and mass, respectively; however, no study has evaluated their potential as a prognostic biomarker of cachexia-associated fat loss. This review confirms the need for further studies to identify valid prognostic biomarkers to identify loss of fat based on changes in plasma levels of biomarkers.
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93
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Talbert EE, Guttridge DC. Impaired regeneration: A role for the muscle microenvironment in cancer cachexia. Semin Cell Dev Biol 2015; 54:82-91. [PMID: 26385617 DOI: 10.1016/j.semcdb.2015.09.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/11/2015] [Indexed: 12/17/2022]
Abstract
While changes in muscle protein synthesis and degradation have long been known to contribute to muscle wasting, a body of literature has arisen which suggests that regulation of the satellite cell and its ensuing regenerative program are impaired in atrophied muscle. Lessons learned from cancer cachexia suggest that this regulation is simply not a consequence, but a contributing factor to the wasting process. In addition to satellite cells, evidence from mouse models of cancer cachexia also suggests that non-satellite progenitor cells from the muscle microenvironment are also involved. This chapter in the series reviews the evidence of dysfunctional muscle repair in multiple wasting conditions. Potential mechanisms for this dysfunctional regeneration are discussed, particularly in the context of cancer cachexia.
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Affiliation(s)
- Erin E Talbert
- Department of Molecular Virology, Immunology, and Medical Genetics, Human Cancer Genetics Program, and the Arthur G. James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Denis C Guttridge
- Department of Molecular Virology, Immunology, and Medical Genetics, Human Cancer Genetics Program, and the Arthur G. James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA.
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94
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McLean JB, Moylan JS, Horrell EMW, Andrade FH. Proteomic analysis of media from lung cancer cells reveals role of 14-3-3 proteins in cachexia. Front Physiol 2015; 6:136. [PMID: 25972815 PMCID: PMC4411971 DOI: 10.3389/fphys.2015.00136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/15/2015] [Indexed: 01/06/2023] Open
Abstract
Aims: At the time of diagnosis, 60% of lung cancer patients present with cachexia, a severe wasting syndrome that increases morbidity and mortality. Tumors secrete multiple factors that contribute to cachectic muscle wasting, and not all of these factors have been identified. We used Orbitrap electrospray ionization mass spectrometry to identify novel cachexia-inducing candidates in media conditioned with Lewis lung carcinoma cells (LCM). Results: One-hundred and 58 proteins were confirmed in three biological replicates. Thirty-three were identified as secreted proteins, including 14-3-3 proteins, which are highly conserved adaptor proteins known to have over 200 binding partners. We confirmed the presence of extracellular 14-3-3 proteins in LCM via western blot and discovered that LCM contained less 14-3-3 content than media conditioned with C2C12 myotubes. Using a neutralizing antibody, we depleted extracellular 14-3-3 proteins in myotube culture medium, which resulted in diminished myosin content. We identified the proposed receptor for 14-3-3 proteins, CD13, in differentiated C2C12 myotubes and found that inhibiting CD13 via Bestatin also resulted in diminished myosin content. Conclusions: Our novel findings show that extracellular 14-3-3 proteins may act as previously unidentified myokines and may signal via CD13 to help maintain muscle mass.
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Affiliation(s)
- Julie B McLean
- Department of Physiology, University of Kentucky Lexington, KY, USA ; Center for Muscle Biology, University of Kentucky Lexington, KY, USA
| | - Jennifer S Moylan
- Department of Physiology, University of Kentucky Lexington, KY, USA ; Center for Muscle Biology, University of Kentucky Lexington, KY, USA ; Center for Clinical and Translational Science, University of Kentucky Lexington, KY, USA
| | - Erin M W Horrell
- Department of Physiology, University of Kentucky Lexington, KY, USA ; Markey Cancer Center, University of Kentucky Lexington, KY, USA
| | - Francisco H Andrade
- Department of Physiology, University of Kentucky Lexington, KY, USA ; Center for Muscle Biology, University of Kentucky Lexington, KY, USA
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95
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Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol 2015; 7:17-29. [PMID: 25897346 PMCID: PMC4398892 DOI: 10.4251/wjgo.v7.i4.17] [Citation(s) in RCA: 276] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/17/2015] [Accepted: 03/30/2015] [Indexed: 02/05/2023] Open
Abstract
It is estimated that half of all patients with cancer eventually develop a syndrome of cachexia, with anorexia and a progressive loss of adipose tissue and skeletal muscle mass. Cancer cachexia is characterized by systemic inflammation, negative protein and energy balance, and an involuntary loss of lean body mass. It is an insidious syndrome that not only has a dramatic impact on patient quality of life, but also is associated with poor responses to chemotherapy and decreased survival. Cachexia is still largely an underestimated and untreated condition, despite the fact that multiple mechanisms are reported to be involved in its development, with a number of cytokines postulated to play a role in the etiology of the persistent catabolic state. Existing therapies for cachexia, including orexigenic appetite stimulants, focus on palliation of symptoms and reduction of the distress of patients and families rather than prolongation of life. Recent therapies for the cachectic syndrome involve a multidisciplinary approach. Combination therapy with diet modification and/or exercise has been added to novel pharmaceutical agents, such as Megestrol acetate, medroxyprogesterone, ghrelin, omega-3-fatty acid among others. These agents are reported to have improved survival rates as well as quality of life. In this review, we will discuss the emerging understanding of the mechanisms of cancer cachexia, the current treatment options including multidisciplinary combination therapies, as well an update on new and ongoing clinical trials.
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96
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Cooper C, Burden ST, Cheng H, Molassiotis A. Understanding and managing cancer-related weight loss and anorexia: insights from a systematic review of qualitative research. J Cachexia Sarcopenia Muscle 2015; 6:99-111. [PMID: 26136417 PMCID: PMC4435102 DOI: 10.1002/jcsm.12010] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/10/2014] [Accepted: 10/31/2014] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to summarize the existing qualitative literature in order to develop the evidence base for understanding and managing weight loss and anorexia, in order to make recommendations for clinical practice. A systematic search was performed to retrieve English language studies using electronic search and manual checks of selected reference lists. Keywords included qualitative, cancer cachexia, weight loss, anorexia, appetite, malnutrition, food, eating, and drinking. The selection and appraisal of papers were undertaken by two reviewers. Twenty-one qualitative articles were included in the review. There were three major findings emerging from the previous qualitative studies including 'the multidimensionality of weight loss and anorexia experience', 'patients and caregivers' responses to coping with weight loss and anorexia', and 'clinical assessment and management of weight loss and anorexia'. The literature review revealed the multidimensional nature of cachexia and weight loss experience by patients and caregivers, which was not recognized and adequately managed by healthcare professionals. Future research in this area would be helpful in enabling a deeper understanding of the complexity of cachexia and weight loss experience in order to move forward to develop an optimal model of supportive care for patients and caregivers.
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Affiliation(s)
- Christine Cooper
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sorrel T Burden
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Huilin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Alex Molassiotis
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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97
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Wesseltoft-Rao N, Hjermstad MJ, Ikdahl T, Dajani O, Ulven SM, Iversen PO, Bye A. Comparing two classifications of cancer cachexia and their association with survival in patients with unresected pancreatic cancer. Nutr Cancer 2015; 67:472-80. [PMID: 25710201 DOI: 10.1080/01635581.2015.1004728] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is no universally accepted definition of cancer cachexia. Two classifications have been proposed; the 3-factor classification requiring ≥ 2 of 3 factors; weight loss ≥ 10%, food intake ≤ 1500 kcal/day, and C-reactive protein ≥ 10 mg/l, and the consensus classification requiring weight loss >5% the past 6 mo, or body mass index <20 kg/m(2) or sarcopenia, both with ongoing weight loss >2%. Precachexia is the initial stage of the cachexia trajectory, identified by weight loss ≤ 5%, anorexia and metabolic change. We examined the consistency between the 2 classifications, and their association with survival in a palliative cohort of 45 (25 men, median age of 72 yr, range 35-89) unresected pancreatic cancer patients. Computed tomography images were used to determine sarcopenia. Height/weight/C-reactive protein and survival were extracted from medical records. Food intake was self-reported. The agreement for cachexia and noncachexia was 78% across classifications. Survival was poorer in cachexia compared to noncachexia (3-factor classification, P = 0.0052; consensus classification, P = 0.056; when precachexia was included in the consensus classification, P = 0.027). Both classifications showed a trend toward lower median survival (P < 0.05) with the presence of cachexia. In conclusion, the two classifications showed good overall agreement in defining cachectic pancreatic cancer patients, and cachexia was associated with poorer survival according to both.
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Affiliation(s)
- Nima Wesseltoft-Rao
- a Department of Health, Nutrition and Management, Faculty of Health Sciences , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
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98
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Jones KI, Doleman B, Scott S, Lund JN, Williams JP. Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Colorectal Dis 2015; 17:O20-6. [PMID: 25328119 DOI: 10.1111/codi.12805] [Citation(s) in RCA: 258] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/06/2014] [Indexed: 12/12/2022]
Abstract
AIM Radiologically assessed muscle mass has been suggested as a surrogate marker of functional status and frailty and may predict patients at risk of postoperative complications. We hypothesize that sarcopenia negatively impacts on postoperative recovery and is predictive of complications. METHOD One hundred patients undergoing elective resection for colorectal carcinoma were included in this study. Lean muscle mass was estimated by measuring the cross-sectional area of the psoas muscle at the level of the third lumbar vertebra identified on a preoperative CT scan, normalizing for patient height. Perioperative morbidity was scored according to the Clavien-Dindo classification. All statistical data analyses were carried out using the Statistical Package for the Social Sciences (SPSS) version 20.0. RESULTS Fifteen per cent of patients were identified as sarcopenic. There were no deaths in the study group. Sarcopenia was associated with a significantly increased risk of developing major complications (Grade 3 or greater, OR = 5.41, 95% CI: 1.45-20.15, P = 0.01). Sarcopenia did not predict length of stay, critical care dependency or time to mobilization. CONCLUSION Sarcopenia, as a marker of frailty, is an important risk factor in surgical patients but difficult to estimate using bedside testing. CT scans, performed for preoperative staging, provide an opportunity to quantify lean muscle mass without additional cost or exposure to radiation and eliminate the inconvenience of further investigations.
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Affiliation(s)
- K I Jones
- Department of Surgery, Oxford University Hospitals, Oxford, UK
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100
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Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M, Lundholm K, Bosaeus I, Fearon KH, Baracos VE. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol 2014; 33:90-9. [PMID: 25422490 DOI: 10.1200/jco.2014.56.1894] [Citation(s) in RCA: 484] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Existing definitions of clinically important weight loss (WL) in patients with cancer are unclear and heterogeneous and do not consider current trends toward obesity. METHODS Canadian and European patients with cancer (n = 8,160) formed a population-based data set. Body mass index (BMI) and percent WL (%WL) were recorded, and patients were observed prospectively until death. Data were entered into a multivariable analysis controlling for age, sex, cancer site, stage, and performance status. Relationships for BMI and %WL to overall survival were examined to develop a grading system. RESULTS Mean overall %WL was -9.7% ± 8.4% and BMI was 24.4 ± 5.1 kg/m(2), and both %WL and BMI independently predicted survival (P < .01). Differences in survival were observed across five categories of BMI (< 20.0, 20.0 to 21.9, 22.0 to 24.9, 25.0 to 27.9, and ≥ 28.0 kg/m(2); P < .001) and five categories of %WL (-2.5% to -5.9%, -6.0% to -10.9%, -11.0% to -14.9%, ≥ -15.0%, and weight stable (± 2.4%); P < .001). A 5 × 5 matrix representing the five %WL categories within each of the five BMI categories was graded based on median survival and prognostic significance. Weight-stable patients with BMI ≥ 25.0 kg/m(2) (grade 0) had the longest survival (20.9 months; 95% CI, 17.9 to 23.9 months), and %WL values associated with lowered categories of BMI were related to shorter survival (P < .001), as follows: grade 1, 14.6 months (95% CI, 12.9 to 16.2 months); grade 2, 10.8 months (95% CI, 9.7 to 11.9 months); grade 3, 7.6 months (95% CI, 7.0 to 8.2 months); and grade 4, 4.3 months (95% CI, 4.1 to 4.6 months). Survival discrimination by grade was observed within specific cancers, stages, ages, and performance status and in an independent validation sample (n = 2,963). CONCLUSION A robust grading system incorporating the independent prognostic significance of both BMI and %WL was developed.
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Affiliation(s)
- Lisa Martin
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pierre Senesse
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ioannis Gioulbasanis
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sami Antoun
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Federico Bozzetti
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Chris Deans
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florian Strasser
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lene Thoresen
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - R Thomas Jagoe
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Chasen
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kent Lundholm
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Bosaeus
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kenneth H Fearon
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vickie E Baracos
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
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