Management of Cancer Cachexia
Publication Date: July 12, 2023
Key Points
Key Points
- Cachexia is a multifactorial syndrome characterized by loss of appetite, weight, and skeletal muscle leading to fatigue, functional impairment, increased treatment-related toxicity, poor quality of life, and reduced survival.
- Cachexia has been described as a weight loss in excess of 5% over the preceding 6 months, or a body mass index (BMI) <20 kg/m2 with ongoing >2% weight loss, or depletion of muscle mass and >2% weight loss.
- Multiple factors contribute to the complex pathophysiology of cancer cachexia:
- Cancer profoundly alters the normal homeostatic control of energy balance.
- Reduced food intake is an important and, in some cases, predominant component of cancer-associated weight loss, and this results, in part, from altered hypothalamic control of appetite and satiety.
- Uncontrolled symptoms of cancer or its treatments (e.g., pain, nausea, vomiting, depression, dysgeusia) can, additionally, be detrimental to food intake.
- Aberrant metabolism is also implicated in cancer cachexia, distinguishing it from simple malnutrition.
- The metabolic alterations may include neuro-hormonal dysregulation, elevated energy expenditure, and increased catabolism.
- Increased catabolic mediators are derived from tumor overexpression, and inflammation elicited by a cancer can generate catabolic pro-inflammatory cytokines and eicosanoids.
- The metabolic alterations may include neuro-hormonal dysregulation, elevated energy expenditure, and increased catabolism.
Treatment
...eatment
...ritional Interventi...
...mmendation 1.1.Clinicians may refer patien...
...ion 1.2.Outside the context of a clinical trial, c...
...harmacologic interventions
...endation 2.1.(Updated) For adults with advan...
...n 2.2.(Updated) For patients who cannot tole...
...er interventio...
Recommendation 3.Outside the conte...
...Summary of recommendations for the trea...
...aceutical options for management of cancer cac...