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 (P ​= ​0.015). Scores on the 16-item M. D. Anderson Symptom Inventory were higher in patients with higher cachexia stages (P ​< ​0.05), but levels of forgetfulness, numbness, and shortness of breath were not higher in these patients (P ​> ​0.05). Patients with higher cachexia stages exhibited better scores on the QLQ-C30 scale (P ​< ​0.05), except for in the domains of cognitive functioning, diarrhea, and dyspnea (P ​> ​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.