From Validation to Implementation: Staging and Reducing Cancer Cachexia in Advanced Cancer; Evidence From Sri Lanka

PURPOSE Cancer cachexia is an underrecognized yet clinically significant complication of advanced cancer, including in Sri Lanka. It contributes to functional decline, reduced treatment response, and increased mortality. Despite its impact, validated tools and structured interventions remain limited in local settings. To validate the Cachexia Staging Score (CSS) for the Sri Lankan context, determine the prevalence and associated factors of cancer cachexia among patients with advanced-stage cancers at National Hospital Galle (NHG), and evaluate the effectiveness of a structured nutritional intervention. METHODS This study consisted of two components. Component one addressed validation, prevalence, and determinants. In Phase I, a cross-sectional study of 120 patients in Oncology Unit A assessed construct validity of CSS using known-group comparisons. Differences in body composition (bioelectrical impedance analysis), quality of life (FACT-G), and anorexia-cachexia symptoms (ACS) across CSS stages were examined. In phase II, 320 patients in Oncology Unit B were evaluated using CSS to estimate prevalence, and associated factors were identified using multiple logistic regression. Component two evaluated intervention effectiveness using a quasi-experimental design. Newly diagnosed advanced-stage cancer patients from Oncology Unit C were allocated to intervention and control groups (n = 85 each). The intervention included dietary counselling and physical activity promotion delivered via a dedicated cachexia clinic with bi-monthly follow-up. Outcomes assessed at six months included cachexia prevalence and body composition (primary), and survival and recurrence (secondary). RESULTS All five CSS components differed significantly across cachexia stages ( P < .001). Body composition, FACT-G, and ACS domains also showed significant differences ( P < .01), confirming construct validity. The overall prevalence of cachexia was 75.0% (no cachexia 6.6%, pre-cachexia 18.4%, cachexia 53.8%, refractory cachexia 21.2%). Significant associated factors included omission of main meals (OR = 5.01, P < .001), disturbances to food intake (OR = 3.43, P = .010), use of nutritional formulae (OR = 6.01, P = .045), low physical activity (OR = 3.12, P = .005), cancer type (OR = 0.30, P = .009), and recurrence (OR = 5.98, P = .003). After six months, the intervention group had a significantly lower risk of cachexia (OR = 0.27, 95% CI: 0.09 to 0.75), while improvements in body composition, survival, and recurrence were not statistically significant. CONCLUSION CSS is a valid screening tool for advanced-stage cancer patients in Sri Lanka. The high prevalence indicates a substantial and previously under addressed burden. A structured