BACKGROUND & AIMS

Considering that cachexia-related symptoms interfere with dietary intake and compromise nutritional status in advanced cancer patients, these symptoms are classified as nutrition impact symptoms (NISs). However, the extent to which each NIS interferes with dietary intake remains unclear.

Therefore, we examined the association between each NIS and dietary intake, considering the impact of an NIS cluster, and investigated the ability of each NIS to predict reduced dietary intake.

METHODS

This is a secondary analysis using two datasets obtained from two surveys using a self-reported questionnaire conducted among advanced cancer patients referred to palliative care in multiple cancer hospitals. Participants evaluated 19 NISs (e.g., lack of appetite, early satiety, nausea, abnormal taste, and fatigue) and their dietary intake using a numerical rating scale (NRS) and the Ingesta-Verbal/Visual Analog Scale (IVVAS), respectively.

To assess associations between each NIS and dietary intake, multivariate logistic regression analysis was performed adjusting for potential confounders, including four or more NISs with an NRS score of 4 or more as an NIS cluster. Values of the area under the curve (AUC) were also calculated for predicting a median IVVAS score or lower.

RESULTS

Data were obtained from 328 participants in Survey 1 and 220 participants in Survey 2.

Lack of appetite, early satiety, nausea, vomiting, abnormal taste, and fatigue were significantly associated with poor dietary intake (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.66-0.81; OR 0.84, 95% CI 0.77-0.92; OR 0.80, 95% CI 0.72-0.89; OR 0.80, 95% CI 0.71-0.91; OR 0.91, 95% CI 0.84-1.00; OR 0.90, 95% CI 0.81-0.99, respectively). However, no significant association was observed for the other 13 NISs.

All AUC values were greater than 0.750 for the 19 NISs. The highest AUC values were observed for lack of appetite, early satiety, and nausea (0.831, 95% CI 0.797-0.866; 0.810, 95% CI 0.773-0.848; 0.801, 95% CI 0.764-0.838, respectively).

CONCLUSIONS

Lack of appetite, early satiety, nausea, vomiting, abnormal taste, and fatigue were significantly associated with dietary intake independently of the influence of other symptoms and other confounders.

Furthermore, lack of appetite, early satiety, and nausea were good predictors for reduced dietary intake.