Cachexia-anorexia syndrome in patients with peritoneal metastasis: an observational study

Background: Little is known about the nutritional status of patients with peritoneal metastasis (PM), in particular about the evolution of the so-called anorexia-cachexia syndrome in these patients. The objective of the study was to assess nutritional status in PM patients at the end of life, including metabolic aspects. Methods: Observational study. Prospective nutritional status assessment in 87 PM patients, including Subjective Global Assessment: (SGA), physical examination (body mass index [BMI], bioelectrical impedance analysis [BIA], anthropometry and blood chemistry). Results: 85% patients had received previous chemotherapy. Peritoneal carcinomatosis index was 16 +/- 11, Karnofsky 81 +/- 14% and ascites volume 1,000 +/- 1,690 ml. SGA was reduced with 22.0 +/- 9.6 points, BMI normal with 25.3 +/- 5.8 kg/m(2) and resting metabolism was 1,527 +/- 248 kcal/day. Serum total protein and albumin were at the inferior normal limit (6.5 +/- 0.8 g/dl, respectively 3.7 +/- 0.8 g/dl) and C-reactive protein (CRP) was elevated (2.9 +/- 4.1 g/dl). Serum levels of protein (p = 0.05), albumin (p = 0.003) and transferrin (p = 0.001) were higher in gastrointestinal than in ovarian PM patients. When patients were grouped according to time from first assessment to death, serum protein and albumin decreased until end of life, whereas ascites volume, resting metabolism and CRP increased. Conclusion: Both increased resting metabolism and decreased caloric intake contribute to the development of the cachexia-anorexia syndrome in PM patients. End of life is caused by energetic dysbalance and exhaustion.