HUMANISTIC BURDEN OF CACHEXIA IN GASTROINTESTINAL CANCERS: A SYSTEMATIC LITERATURE REVIEW
Author(s)
Jarjieh Fang, MPH1, Patrick Hlavacek, MPH2, Nataliia Kulchytska, MD3, Adam Carie, PhD4, Pankdeep Chhabra, MD5, Deepali Mittal, MD5, Graham Ferrier, MPH1.
1Pfizer Inc, Brooklyn, NY, USA, 2Pfizer, Minneapolis, MN, USA, 3Pfizer Pharma Gmbh, Berlin, Germany, 4Pfizer Inc., New York, NY, USA, 5Red Nucleus, Greater London, United Kingdom.
1Pfizer Inc, Brooklyn, NY, USA, 2Pfizer, Minneapolis, MN, USA, 3Pfizer Pharma Gmbh, Berlin, Germany, 4Pfizer Inc., New York, NY, USA, 5Red Nucleus, Greater London, United Kingdom.
OBJECTIVES: Cancer cachexia is increasingly recognized as a distinct driver of patient burden in gastrointestinal (GI) cancers, yet its impact on patient-centered outcomes remains inconsistently characterized. This artificial intelligence-enabled SLR evaluated impact of cachexia on health-related quality of life (HRQoL), functioning, activities of daily living (ADL), and caregiver burden in GI cancers.
METHODS: MEDLINE and Embase were searched for published studies (2015-2025) and conference proceedings (2021-2025). Observational studies reporting humanistic outcomes among GI cancer patients with cachexia were included. Artificial intelligence tools were used to support study screening and data extraction, with manual validation of included studies.
RESULTS: Ten publications from 9 studies met criteria: 8 reporting HRQoL (7 studies; n=56-10,568), 3 reporting ADL/functioning (1 overlapping with HRQoL; n=1897-10,568). Study populations included predominantly older adults with mixed GI cancers, often advanced stage. Across heterogeneous instruments (EORTC QLQ-C30, QLQ-CAX24, QLQ-PAN26) and five cachexia definitions, 6 of 7 HRQoL studies reported significantly worse HRQoL among patients with cachexia versus without, with differences in EORTC summary and global score typically exceeding established minimal important differences. Global QoL scores were consistently impaired (34.1-67.7), reflecting substantial perceived health burden. A stepwise decline in HRQoL with worsening cachexia severity was observed across multiple staging approaches (CCSI, clinical stage, WLGS). Functional impairment showed a similar severity gradient, with a greater interference in daily activities reported in cachectic patients (e.g., higher MDASI-GI activity interference scores), although functioning was less consistently reported. One multivariable analysis identified AWGC-defined cachexia as an independent predictor of poor HRQoL (OR 5.92; 95% CI 3.27-10.73). No GI cancer-specific caregiver burden studies were identified.
CONCLUSIONS: Cachexia in GI cancer is associated with substantial and progressive humanistic burden across HRQoL, symptoms, and functioning. Limited evidence on functioning and absence of GI-specific caregiver data and patient preference studies highlight key unmet needs.
METHODS: MEDLINE and Embase were searched for published studies (2015-2025) and conference proceedings (2021-2025). Observational studies reporting humanistic outcomes among GI cancer patients with cachexia were included. Artificial intelligence tools were used to support study screening and data extraction, with manual validation of included studies.
RESULTS: Ten publications from 9 studies met criteria: 8 reporting HRQoL (7 studies; n=56-10,568), 3 reporting ADL/functioning (1 overlapping with HRQoL; n=1897-10,568). Study populations included predominantly older adults with mixed GI cancers, often advanced stage. Across heterogeneous instruments (EORTC QLQ-C30, QLQ-CAX24, QLQ-PAN26) and five cachexia definitions, 6 of 7 HRQoL studies reported significantly worse HRQoL among patients with cachexia versus without, with differences in EORTC summary and global score typically exceeding established minimal important differences. Global QoL scores were consistently impaired (34.1-67.7), reflecting substantial perceived health burden. A stepwise decline in HRQoL with worsening cachexia severity was observed across multiple staging approaches (CCSI, clinical stage, WLGS). Functional impairment showed a similar severity gradient, with a greater interference in daily activities reported in cachectic patients (e.g., higher MDASI-GI activity interference scores), although functioning was less consistently reported. One multivariable analysis identified AWGC-defined cachexia as an independent predictor of poor HRQoL (OR 5.92; 95% CI 3.27-10.73). No GI cancer-specific caregiver burden studies were identified.
CONCLUSIONS: Cachexia in GI cancer is associated with substantial and progressive humanistic burden across HRQoL, symptoms, and functioning. Limited evidence on functioning and absence of GI-specific caregiver data and patient preference studies highlight key unmet needs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR182
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology