Addressing the Neglected Burden of Cancer Cachexia: A Quasi-Experimental Study at Uganda Cancer Institute

Abstract

Background: Cancer cachexia is a debilitating syndrome contributing to significant morbidity and mortality. Despite its impact on survival and quality of life, it remains under-recognized and undertreated, particularly in low- and middle-income countries (LMICs) where structured care models are scarce. Objective: This study evaluated impact of a structured educational intervention on patient knowledge, emotional coping, and practice outcomes at Uganda Cancer Institute (UCI). Methods: A longitudinal quasi experimental with a pre and post study design was used to enroll 484 patients with cancer cachexia. The intervention consisted of structured educational sessions delivered in-person and via SMS, and data were collected using a questionnaire aligned with international cachexia tools and guidelines. Analysis was performed in STATA (v18) with descriptive statistics. Results: Awareness of cancer cachexia increased to 94.2% following the intervention. Improvements were noted in nutrition-impacting symptoms and emotional well-being including reductions in eating-related distress (15– 25%), family conflict (14– 17%) and body image concerns (23– 29%). In contrast, declines were observed in coping ability (37%), self-rated health (42%), and quality of life (35%) reflecting awareness paradox. While weight-loss and sarcopenia improved (9– 13%), physical strength and activity levels decreased (6– 8%) due to disease progression reflected in a higher proportion of patients with worsened ECOG and advanced malignancies (61.7%). Conclusion: Tailored interventions can enhance awareness and self-care in cancer cachexia, even in LMICs. Sustainable impact requires early detection and integration into multimodal care with institutional support. Keywords: cancer cachexia, knowledge, attitude, practices, Uganda, cachexic patients