R-CSS: A clinically applicable score to classify cachexia stages in patients with cancer undergoing intensity-modulated radiation therapy.

Objective: Accurate cachexia staging is the key to its management. However, there is currently a lack of tools to distinguish the staging of cachexia in patients with cancer undergoing radiotherapy. The Radiotherapy Cachexia Staging Scale (R-CSS) was developed for the stratification of cachexia in patients undergoing cancer radiotherapy.

Methods: Patients with cancer undergoing radiotherapy were divided into four stages - noncachexia, precachexia, cachexia, and refractory cachexia - by the R-CSS scale, and the clinical outcomes of the four groups were compared.

Results: A total of 270 patients with cancer undergoing radiation therapy were included in the study. All participants were classified into four stages of cachexia: stage 0, I, II, and III. Patients with a higher cachexia stage had a higher prevalence of sarcopenia ( ​= ​0.015). Scores on the 16-item M. D. Anderson Symptom Inventory were higher in patients with higher cachexia stages ( ​< ​0.05), but levels of forgetfulness, numbness, and shortness of breath were not higher in these patients ( ​> ​0.05). Patients with higher cachexia stages exhibited better scores on the QLQ-C30 scale ( ​< ​0.05), except for in the domains of cognitive functioning, diarrhea, and dyspnea ( ​> ​0.05). The incidence of treatment-related events (any grade III or higher grade of [non-]hematologic adverse events, the need for hospitalization, emergency room admission) was higher in patients with higher cachexia stages.

Conclusions: The R-CSS scale is a screening tool that can simultaneously distinguish different stages of cachexia.