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In 2019, the Cancer Cachexia Web Questionnaire Survey(J-EPOCC)was conducted among cancer patients, their families and healthcare professionals in Japan, and it showed that the term"cancer cachexia"was highly recognized among health care professionals, whereas the staging and criteria for cancer cachexia defined by European Palliative Care Research Collaborative( EPCRC)was less understood. Also, many healthcare professionals tended to consider the term"cancer cachexia" as the terminal stage of cancer, and most of them lacked the knowledge that cancer cachexia is a disease complication which is potentially developed from the early stage of cancer. Since anamorelin was approved in 2021 for"Cancer cachexia in unresectable advanced or recurrent of non-small cell lung cancer, gastric cancer, pancreatic cancer and colorectal cancer", the treatment environment for cancer cachexia has greatly changed. Thus, the second Web Questionnaire Survey(J-EPOCC Ⅱ) was conducted in June 2022 to investigate changes in the problem awareness of cancer cachexia, especially appetite loss and weight loss, among patients and their families and healthcare professionals1). The results for healthcare professionals showed that the awareness of the staging and criteria has increased among doctors in 2022 compared with 2019, and an increasing number of doctors considered"cancer cachexia"was associated with loss of muscle mass, totally body weight loss, appetite loss and systemic inflammation that may occur in early stages of cancer. On the other hand, awareness of staging and diagnostic criteria for cancer cachexia has not remarkably changed among medical staff since 2019, with levels of awareness varying among those with different job categories. Therefore, in order to achieve early detection and intervention of cancer cachexia, it is necessary to raise the awareness of cancer cachexia among not only doctors but also medical staff by increasing their opportunities to get to know the disease condition, diagnosis, and treatment of cancer cachexia.

In 2019, the Cancer Cachexia Web Questionnaire Survey(J-EPOCC), conducted among cancer patients, their families and healthcare professionals in Japan showed that nearly half of patients who had experienced appetite loss or weight loss during cancer treatment had not consulted with healthcare professionals about their symptoms, and it meant that patients missed the opportunity to receive medical intervention. Since anamorelin was approved in 2021 fo"r Cancer cachexia in non- small cell lung cancer, gastric cancer, pancreatic cancer and colorectal cancer", the treatment environment for cancer cachexia has greatly changed. Thus, the second Web Questionnaire Survey(J-EPOCCⅡ)was conducted in June 2022 to investigate changes in the problem awareness of cancer cachexia, especially appetite loss and weight loss, among patients and their family and healthcare professionals. The results showed that there was no apparent change in awareness of appetite loss and weight loss, suggesting many patients may miss treatment opportunities. Further disease awareness is required among patients and their families to enhance the understanding of the significance of therapeutic interventions for appetite loss or weight loss, and to call their attention for early detection and treatment.

Cancer cachexia is multifactor syndrome that occurs in 50-80% of cancer patients and accounts for 20% of cancer deaths. We conducted a web questionnaire survey for healthcare professionals(doctors and medical staff), patients and families to clarify the understanding of cancer cachexia. As a result, it was revealed that the understanding of cancer cachexia among patients and families was low. Cancer cachexia was widely recognized by healthcare professionals, but 3 stages of EPCRC was not. Many of healthcare professionals recalled the image of terminal stage of cancer from the term "cancer cachexia", and they lack awareness that cancer cachexia was a disease complication which developed from the early stage of cancer. Furthermore, there were many doctors who were faced with the problem such as a lack of treatment options for cancer cachexia. From these facts, it is necessary to disseminate scientific concept of cancer cachexia and establish standard of care from the early stage.

Appetite loss and weight loss associated with cancer have negative effects on the quality of life and OS of cancer patients. We conducted a web questionnaire survey for healthcare professionals(doctors and medical staff), patients and families to clarify the problem awareness for appetite loss and weight loss associated with cancer. As a result, it turned out that families were more concerned about patients' appetite loss and weight loss, and nearly half of patients haven't consulted their symptoms to healthcare professionals, and it meant that patients missed the opportunity to receive medical intervention due to no consultation. While healthcare professionals have a strong desire to provide dedicated treatment for appetite loss and weight loss in cancer patients, the proportion of patients and families who replied their symptom had improved with the intervention was low. In the near future, it will be necessary to enlighten the importance of symptom management to patients and families and pay attention to their symptom change for healthcare professionals.