Background: A number of advanced cancer patients are suffering from physical and psychosocial burdens because of cancer cachexia, and these burdens also greatly impact on their family members and relationships between patients and family members. It is necessary to consider the psychosocial impact of cancer cachexia on family members of advanced cancer patients.Methods: A cross‐sectional anonymous nationwide survey was conducted involving 925 bereaved family members of cancer patients who had been admitted to 133 inpatient hospices throughout Japan.Results: A total of 702 bereaved family members returned the questionnaires (response rate, 75.9%). Concerning eating‐related distress, ‘I served what the patient wanted without consideration of calories and nutritional composition’ was highest (75.1%), and ‘I tried making many kinds of meals for the patient’ and ‘I was concerned about planning meals for the patient every day’ followed (63.0% and 59.4%, respectively). The top 5 of the 19 items were categorized as ‘fighting back’. Need for nutritional support was high (72.2%), and need for explanations about the reasons for anorexia and weight loss of patients was moderate (41.4%). Explanatory factor analysis of eating‐related distress identified the following four domains: (factor 1) feeling that family members forced the patient to eat to avoid death, (factor 2) feeling that family members made great efforts to help the patient eat, (factor 3) feeling that eating was a cause of conflicts between the patient and family members, and (factor 4) feeling that correct information was insufficient. Results of multiple logistic regression analysis showed that spouse, fair/poor mental status, factors 1, and 4 were identified as independent determinants of major depression {odds ratio [OR] 3.27 [95% confidence interval (CI) 1.24–8.60], P = 0.02; OR 4.50 [95% CI 2.46–8.25], P < 0.001; OR 2.51 [95% CI 1.16–5.45], P = 0.02; OR 2.33 [95% CI 1.13–4.80], P = 0.02, respectively}.Conclusions: A number of family members of advanced cancer patients experienced high levels of eating‐related distress and had a need for nutritional support.

Background: The association between C‐reactive protein (CRP) level, symptoms, and activities of daily living (ADL) in advanced cancer patients is unclear.Methods: Secondary data analysis of a multicenter prospective cohort study consisted of 2426 advanced cancer patients referred to palliative care settings was conducted to examine the cross‐sectional relationships between CRP level, symptoms, and ADL disabilities. Laboratory data, symptoms, ADL, and manual muscle testing (MMT) results were obtained at baseline. Participants were divided into four groups: low (CRP < 1 mg/dl), moderate (1 = < CRP <5 mg/dl), high (5 = < CRP < 10 mg/dl), and very high CRP (10 mg/dl = < CRP). The proportions of eight symptoms, five ADL disabilities, and three categories of MMT according to the CRP groups were tested by chi‐square tests. Multiple‐adjusted odd ratios (ORs) were calculated by using ordinal logistic regression after adjustment for age, gender, site of primary cancer, metastatic disease, performance status, chemotherapy, and setting of care.Results: A total of 1702 patients were analysed. Positive rates of symptoms and ADL disabilities increased with increasing CRP level. In the very high‐CRP group, rates of positivity for anorexia, fatigue, and weight loss were 89.8%, 81.0%, and 79.2%, respectively, and over 70% of patients received assistance for bathing, dressing, going to the toilet, and transfer. The grade of MMT also deteriorated with increasing CRP level. Adjusted ORs for the accumulated symptoms significantly increased with increasing CRP level in the moderate‐CRP, high‐CRP, and very high‐CRP groups [1.6 (95% confidence interval 1.2–2.0), P < 0.001; 2.5 (1.9–3.2), P < 0.001; 3.5 (2.7–4.6), P < 0.001, respectively]. Adjusted ORs for the accumulated ADL disabilities significantly increased in the very high‐CRP groups [2.1 (1.5–2.9), P < 0.001].Conclusions: Associations between CRP level, symptoms, and ADL were observed in advanced cancer patients receiving palliative care.