Recognition and management patterns of cachexia in patients with pancreatic adenocarcinoma in a safety net hospital.

e24079 Background: Cachexia is a metabolic syndrome marked by disrupted protein and energy balance, affecting up to 80% of patients with advanced cancer. Muscle loss and weakness reduce performance status, quality of life, and treatment tolerance. Despite contributing to ~20% of cancer deaths, cachexia remains under-diagnosed and under-treated. Methods: We performed a retrospective review of adults aged ≥18 years treated at Harbor UCLA, a safety net county hospital, from 2015-2025 with biopsy-confirmed pancreatic adenocarcinoma. Cachexia was defined as BMI < 20 kg/m2 and/or ≥5% weight loss over 6 months. Collected variables included patient demographics, stage, initial treatment, BMI at diagnosis and last follow-up, baseline albumin, cachexia status and documentation, cachexia-directed medications, and nutrition or palliative care involvement. We analyzed the prevalence of cancer cachexia, referral patterns for this condition, as well as treatments utilized. Analysis was conducted through descriptive statistics. Results: 66 patients were included in this study. Median age at diagnosis was 60 years; 51.5% were male. The cohort was 54.5% Hispanic, 27.3% Black, 9% Asian, 4.5% Caucasian, 3% other/unknown, and 1.5% American Indian. Patients were 24.2% stage 1, 28.8% stage 2, 28.8% stage 3, and 18% stage 4. FOLFIRINOX (54.5%) and Gemcitabine plus Protein-Bound Paclitaxel (25.8%) were the two most common chemotherapy regimens. 25.8% received radiation, while 42.4% of patients underwent surgery. 35.7% of patients who originally were candidates for surgery ultimately did not undergo planned surgical resection. 63.6% of patients had progression of disease. Mean BMI at diagnosis was 25.2, while mean final BMI declined to 21.45. Mean albumin at diagnosis was 3.35. Cachexia criteria were met by 89.4% of patients, but only 16.7% had documented diagnoses. 48.5% of patients were seen by palliative care, and 45.5% of patients were seen by a dietician. Cachexia-directed medications were given to 23.7% of patients. 11.8% of patients received Dronabinol, 10.2% of patients received Mirtazapine, and 1 patient received Olanzapine. Conclusions: There is a dearth of studies that describe incidence and management patterns of cancer-related cachexia in safety net populations. Cachexia was highly prevalent yet infrequently diagnosed or documented at our institution. A minority of patients with cachexia received pharmaceutical management, while less than half were evaluated by palliative care or nutrition. One third of patients were unable to undergo planned surgery due to factors including disease progression and cachexia. Improved recognition and management strategies of cachexia are needed.