Managing clinical manifestations of cancer/treatment burden on functional status and quality of life remains paramount across the cancer trajectory, particularly for patients with cachexia who display reduced functional capacity. However, clinically relevant criteria for classifying functional impairment at a single point in time or for classifying meaningful functional changes subsequent to disease and/or treatment progression are lacking. This unmet clinical need remains a major obstacle to the development of therapies for cancer cachexia. This review aims to describe current literature-based evidence for clinically meaningful criteria for (1) functional impairment at a single timepoint between cancer patients with or without cachexia and (2) changes in physical function over time across interventional studies conducted in patients with cancer cachexia. The most common functional assessment in cross-sectional and interventional studies was hand grip strength (HGS). We observed suggestive evidence that an HGS deficit between 3 and 6 kg in cancer cachexia may display clinical relevance. In interventional studies, we observed that long-duration multimodal therapies with a focus on skeletal muscle may benefit HGS in patients with considerable weight loss. Future studies should derive cohort-specific clinically relevant criteria to confirm these observations in addition to other functional outcomes and investigate appropriate patient-reported anchors.
在癌症病程中，管理癌症及其治疗负担对功能状态和生活质量的影响至关重要，特别是对于功能能力下降的恶病质患者。然而，目前缺乏用于在单一时间点对功能损伤进行分类，或用于对疾病和/或治疗进展后有意义的功能变化进行分类的临床相关标准。这一未满足的临床需求仍然是开发癌症恶病质疗法的主要障碍。本综述旨在描述当前基于文献的证据，以探讨以下方面的临床有意义标准：(1) 在单一时间点上，有或无恶病质的癌症患者之间的功能损伤；(2) 在癌症恶病质患者干预研究中，身体功能随时间的变化。横断面和干预研究中最常见的功能评估是握力。我们观察到提示性证据表明，癌症恶病质患者握力下降3至6公斤可能具有临床相关性。在干预研究中，我们观察到，针对骨骼肌的长期多模式治疗可能对体重显著下降患者的握力有益。未来的研究应制定特定队列的临床相关标准，以在其他功能结果之外确认这些观察结果，并研究适当的患者报告锚点。
Clinical Relevance of Physical Function Outcomes in Cancer Cachexia
肿瘤(癌症)患者之家