Bibliographic record
Abstract
We thank Molfino et al for their thoughtful comments regarding our article. Anorexia is a burdensome symptom for patients with cancer, and is significantly associated with survival. Anorexia is associated with systemic inflammatory response in cancer. Therefore, loss of appetite was chosen as a secondary outcome in our trial assessing the effects of methylprednisolone for cancer pain. Our trial showed a significant improvement of appetite loss, which coincides with the findings of Yennurajalingam et al. They also found a significant improvement in anorexia using the Functional Assessment of Anorexia/Cachexia Therapy subscale of 4.89 points on day 15 (P .013) in favor of the dexamethasone group as compared with the placebo group. As Molfino et al correctly point out, appetite is only one part of the symptom complex causing anorexia and reduced food intake. In addition to appetite, changes in taste and GI motility are important, together with secondary factors caused by the disease itself or the treatment, such as stomatitis, diarrhea, and constipation. Furthermore, food intake is an important item to measure separately, as it shows only a weak association with loss of appetite. Consequently, it is recommended to assess all these symptoms as well as food intake in cancer cachexia trials. Different assessment tools have been proposed to assess the anorexia symptom, including the Functional Assessment of Anorexia/ Cachexia Therapy, which rates the intensity of anorexia and cachexia and the related symptoms on a verbal rating scale 0 to 4. The abridged Patient-Generated Subjective Global Assessment assesses the symptoms on a yes or no basis together with nutritional and functional levels. Finally, loss of appetite can be quantitatively evaluated by a numeric rating scale like the Edmonton Symptom Assessment System, and the European Association for Palliative Care minimum data set, or health-related quality-of-life tools like the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30). Loss of appetite can be measured by the EORTC QLQ-C30 in a reliable way. Indeed, the EORTC group is currently developing a lack of appetite item bank for computer-adaptive testing as a further development of this single item. Due to the risk of adverse effects in prolonged use, it is generally agreed that corticosteroids should be used to treat anorexia in the end-of-life setting. In patients with short life expectancy, the primary foci are symptom control and quality of life. Therefore, patientreported outcomes are recommended at this stage of disease, and only a minor improvement in appetite may be important to the patients. The risk of adverse effects from the use of high-dose corticosteroids is substantial. This needs to be assessed and may counterbalance the positive effects on appetite. Ornulf Paulsen Telemark Hospital Trust, Skien; Norwegian University of Science and Technology, Trondheim, Norway
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.081 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.004 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.039 | 0.051 |
| Insufficient payload (model declined to judge) | 0.011 | 0.011 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".