Integrated assessment of cachexia, body composition, and patient-reported outcomes in unplanned hospitalizations of patients with metastatic cancer (PRO-HAND study).

Abstract

12075 Background: Patients with metastatic cancer hospitalized for unplanned admissions represent a highly vulnerable population with substantial short-term mortality and readmission risk. Cachexia, altered body composition, and patient-reported outcomes (PROs) frequently coexist in this setting, yet their integrated relevance during hospitalization remains insufficiently characterized. Methods: PRO-HAND is a cross-sectional observational study including metastatic cancer patients hospitalized for unplanned admissions between September 2024 and September 2025 who had received systemic anticancer therapy within the preceding 6 months. Cachexia-related indices, bioelectrical impedance analysis (BIA)-derived body composition parameters, and PROs were assessed during hospitalization. Primary outcomes were 30-day mortality, 90-day mortality, and unplanned 30-day hospital readmission. Associations were evaluated using hierarchical multivariable logistic regression models with sequential adjustment for clinical variables, cachexia indices, body composition parameters, and PROs. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: A total of 233 patients were included (median age 62 years; 71.2% ECOG ≥2). Median follow-up was 3.35 months. Thirty-day mortality occurred in 21.9%, 90-day mortality in 23.2%, and unplanned 30-day readmission in 57.9%. Lower handgrip strength–based cachexia index (H-CXI) was associated with higher odds of 30-day mortality (OR per 10-unit decrease 1.43; 95% CI 1.19–1.74; p<0.001). ECOG ≥2 and lower phase angle were also associated with early mortality, whereas the composite triglyceride–glucose and inflammation index was not. For 90-day mortality, lower global quality-of-life scores and higher pain burden showed stronger associations than cachexia indices. For unplanned 30-day readmission, a higher total body water/fat-free mass (TBW/FFM) ratio was associated with increased risk. Conclusions: Cachexia severity, body composition abnormalities, and PROs show distinct, outcome-specific associations in metastatic cancer patients hospitalized for unplanned admissions. Integrated assessment during hospitalization may provide complementary clinical information across these domains. Clinical trial identification NCT07167082. Selected baseline characteristics and outcomes. Characteristic n (%) or median (IQR) Age ≥65 years 98 (42.1) ECOG performance status ≥2 167 (71.7) Weight loss ≥10% (6 months) 126 (54.1) H-CXI 34.23 (14.95–71.02) Phase angle, degrees 4.03 (2.95–5.52) FFMI, kg/m² 17.14 (15.48–19.31) FACT-G total score 62 (56–68) Pain score (VAS 0–10) 4 (2–6) Unplanned 30-day readmission 135 (57.9) 30-day mortality 51 (21.9)