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Results: A total of 1,001 patients were evaluated, including 363 patients (36.3%) with cancer cachexia. Among the patients “at nutritional risk” based on each tool, the proportions of cachexia were 87.3% for the MUST tool, 84.3% for the MST tool, 76.6% for the NRS-2002 tool, and 54.3% for the SNAQ tool. The MST tool provided the largest area under the curve for identifying cancer cachexia (0.914, P < 0.001). Conclusion: Among the tools that were examined, the MST tool had the greatest ability to detect cancer cachexia among patients with gastric cancer.
Keywords: Cachexia; Malnutrition; Gastric cancer; Nutrition screening tools
Cancer cachexia is common among cancer patients, with rates of 28–57% for various cancer types . As a multifactorial syndrome, cancer cachexia is characterized by sustained loss of skeletal muscle, with or without a M3814 (nedisertib) in fat mass, which can only be partially reversed using conventional nutritional support . The presence of cancer cachexia is associated with functional impairment, reduced tolerance of anticancer treatments, and decreased survival . For example, up to 50% of cancer patients die with coexisting cachexia and >30% of cancer patients die because of cachexia . Thus, timely detection of cachexia is needed to ensure that personalized interventions can be performed to reduce or delay its adverse effects, especially before the cachexia reaches the refractory stage . Nevertheless, it is rare in clinical practice for physicians to identify and actively manage cancer cachexia, which is a major cause of patients being undernourished or at risk of undernutrition during oncological treatment . Therefore, it is important to develop tools to identify cachexia.
Nutritional screening is mandatory within the first 1–3 days after hospital admission, which is intended to identify patients at risk of undernutrition, implement personalized nutritional support, and slow or reverse the progression of malnutrition and its detrimental effects . Various screening tools have been developed to quickly and easily estimate whether inpatients are undernourished or at risk of undernutrition, such as the Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Screening Tool (MST), and Short Nutritional Assessment Questionnaire (SNAQ). The MUST tool was developed in Britain and is used to evaluate the risk of malnutrition based on three independent criteria: acute disease effect, involuntary weight loss, and body mass index (BMI) . The NRS-2002 tool was recommended in the European Society for Clinical Nutrition and Metabolism guidelines to identify patients who might benefit from nutritional support . The MST tool was developed in Australia and is a simple, quick, and reliable instrument that includes questions regarding involuntary weight loss and appetite loss, without the need to evaluate weight loss or BMI . The SNAQ tool was developed in the Netherlands and uses a questionnaire regarding involuntary weight loss, appetite loss, and tube feeding or recent use of supplemental drinks . However, Heterochromatin remains unclear whether these screening tools can detect cancer cachexia. Thus, the present study evaluated whether the MUST, NRS-2002, MST, and SNAQ
tools could be used to identify cachexia among patients with stage I–III gastric cancer (who do not routinely undergo interventions to prevent cancer cachexia), which could help guide further evaluation and intervention.
PATIENTS AND METHODS
The study included patients who underwent gastrectomy for gastric cancer between August 2014 and February 2018 at the Gastrointestinal Surgical Department of 2