Prevalence of Cancer Cachexia Among Breast Cancer Patients in Pakistan, Assessed Using the Mini-CASCO Scoring System

OBJECTIVE: This study aimed to estimate the prevalence, severity, and multidomain impact of cancer cachexia among Pakistani breast cancer patients, using the validated Mini-CASCO scoring system. METHODS: We conducted an observational, cross-sectional study from February to December 2024 at Fauji Foundation Hospital (FFH), Rawalpindi. Eligible participants were female patients aged 18 years or older, with stage I-III breast cancer, receiving chemotherapy. Cachexia was assessed using the Mini-CASCO, which encompasses body composition, inflammation, anorexia, physical performance, and quality of life. Demographic, anthropometric, biochemical, and validated patient-reported outcomes were collected. Group differences between cachectic and non-cachectic patients were analyzed using the chi-square (χ²) test, with statistical significance set at p < 0.05. RESULTS: Of 134 participants (mean age: 45.2 ± 8.3 years), the prevalence of cachexia was 61.9% (95% CI: 53.4-70.0). The mean Mini-CASCO score was 45.7 ± 9.3 (95% CI: 43.7-47.8), indicating moderate cachexia. The severity distribution was 16.9% mild, 49.4% moderate, and 33.7% severe; no terminal cases were detected. Body weight and composition (12.7 ± 4.3) and anorexia (9.2 ± 2.6) were the most impaired domains. Compared with non-cachectic patients, those with cachexia had significantly greater inflammation (11.2 vs. 7.4, p < 0.001), anorexia (10.9 vs. 6.8, p < 0.001), and poorer quality of life (6.2 vs. 4.7, p < 0.001). CONCLUSION: More than six in ten patients exhibited cachexia a rate substantially higher than global estimates highlighting its neglected burden in low- and middle-income country (LMIC) oncology settings. Early, structured assessment using the Mini-CASCO, along with the integration of multimodal nutritional and supportive interventions, is urgently needed to reduce preventable morbidity and mortality. Future multicenter, longitudinal studies are essential to guide evidence-based cachexia management in LMICs.