Multicomponent Interventions for Adults With Cancer Cachexia: A Systematic Review

Background: Cancer cachexia has substantial impacts on patient quality of life. There is no current gold standard treatment, but the complex pathophysiology of cachexia suggests a multi-targeted and individualised treatment approach is needed. We aimed to evaluate the extent to which multi-component interventions have targeted the key features of cachexia and been tailored to individuals, and differential effects on quality of life.
Methods: We conducted a systematic review of multi-component interventions for adults with cancer cachexia. We searched four databases, two clinical trial registers, and MedRxiv on 20 June 2024. Intervention components were classified by intervention category (nutritional, exercise/physical activity, pharmacological, psycho-social), cachexia feature(s) targeted (reduced energy intake, altered metabolism, involuntary weight loss, and decline in physical function), and level of tailoring. Within-arm standardised mean changes in quality of life over time, and standardised mean differences between study arms, were calculated.
Results: 62 multi-component interventions were included, of which two combined components from all four intervention categories, and nine targeted all four key features of cachexia. 18 multi-component interventions were fully tailored and 30 were partly tailored to individuals. Within-arm standardised mean changes in quality of life were calculated for 13 studies; all had a high risk of bias or raised concerns. In 11 studies, quality of life scores improved following intervention, while in two studies they declined. Standardised mean differences between study arms were calculated for four studies; in three the intervention arm showed a greater improvement in quality of life scores than the usual care arm. Amongst these data, there was no indication that the number of cachexia features targeted, or the extent of tailoring, was associated with a greater improvement in quality of life scores amongst these data, however the heterogeneity prevented us from concluding on our hypothesis.
Conclusions: This review mapped out in detail the combinations of intervention categories used, key features of cachexia targeted, and extent of tailoring across multi-component interventions for adults with cancer cachexia. Only a small proportion of the multi-component interventions targeted all four key features of cachexia, but most were either partly or fully tailored to individuals. Despite 62 multi-component interventions being investigated, only four studies compared these to usual care and reported quality of life outcomes. High risk of bias, low sample sizes, and variable outcome data remain challenges to the interpretability of results in this field.