Barriers in Nursing Practice in Cancer Cachexia: A Scoping Review

Factors affecting the assessment of cancer cachexia by nurses caring for patients with advanced cancer undergoing chemotherapy: A cross-sectional survey

“…The condition should be comprehensively assessed; however, doing so is difficult because of a lack of standardized tools and limited human resources. 21 , 23 , 38 Research on clinically usable and effective methods is being conducted currently. 39 , 40 , 41 …”

“…The difficulty may also arise because many healthcare providers have realized that the nutritional management in patients with cancer is important, but few nurses understand the etiology and management of cancer cachexia and its unfavorable effects. 23 Furthermore, the condition has not been actively assessed to date. 8 , 19 , 20 , 21 , 42 , 43 In particular, it had been found that oncology nurses were less aware of the guidelines and received less relevant nutritional training than physicians and dietitians.…”

“…45 There are few nurse-led studies for cancer cachexia, and nurses rarely learn about cancer cachexia in pre-graduate education. 23 , 38 Studies have reported that even oncology nurses may not be fully aware of the prevalence of early stage cancer cachexia, which is reversible. 2 , 46 This is consistent with this study's results, which showed that nurses may not have the knowledge of the reversible “cachexia” defined by the EPCRC, such as skeletal muscle mass loss and rate of weight loss.…”

“…Based on a literature review, 6 , 11 , 18 , 26 , 27 , 28 , 29 we developed eight items regarding the definition, classification, pathogenesis, and symptoms of cancer cachexia. Regarding definitions, we used the EPCRC's definitions 6 , 30 , 31 for the items “Cancer cachexia can be reversed only with nutrition counseling” and “Cancer cachexia is characterized by persistent loss of skeletal muscle mass.” For the tendency to view cancer cachexia as a terminal condition, 23 we referred to Fearon's classification 6 for the items “Cancer cachexia refers to both reversible and irreversible conditions” and “Unintentional weight loss of > 5% in the past six months may indicate cancer cachexia.” Regarding the pathogenesis of cancer cachexia, 27 we created the items “Cancer cachexia results from the patient's host and also from systemic inflammation of the tumor” and “Cancer cachexia-related weight loss and starvation-related weight loss have the same mechanism.” Regarding the NIS, 29 , 32 , 33 we created the items “Weight loss can be due not only to adverse events of the chemotherapy but also gastrointestinal symptoms caused by cancer cachexia.” As cancer cachexia has been reported to cause weight-related distress and eating-related distress, 15 , 16 we created an item with reference to the Functional Assessment of Anorexia/Cachexia Treatment and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL) Module for Cancer Cachexia (QLQ-CAX24), 34 , 35 “Patients with cancer cachexia have eating-related distress and conflicts with caregivers regarding food.” Nurses were asked to respond to each of these items with “correct,” “incorrect,” or “I do not know.” We scored “incorrect” and “I do not know” as 0 points and “correct” as 1 point. The total scores ranged from 0 to 8.…”

“… 6 , 20 However, among the various symptoms presented in patients with advanced cancer, cancer cachexia has been poorly conceptualized, lacks evidence for its treatment, and is rarely recognized, evaluated, and managed by healthcare professionals. 8 , 9 , 10 , 21 , 22 , 23 In particular, the current status of nurses' awareness, knowledge, and assessment of cancer cachexia is unclear. Hence, this study aimed to identify the awareness, knowledge, and assessment of cancer cachexia among nurses who cared for patients with advanced cancer undergoing chemotherapy.…”