Cancer Cachexia

  • Cancer Cachexia: A Prognostic Marker

    Cancer Cachexia: A Prognostic Marker

    A recent literature review found appetite loss to be one of the more common symptoms in patients with cancer. Similarly, both appetite and weight loss were more prevalent in the last 1 to 2 weeks of life in these patients.<sup>1</sup>

  • The Psychosocial Effects: Patients’ Perspective

    The Psychosocial Effects: Patients’ Perspective

    Patients’ awareness of weight loss affects both patients and caregivers. Patients experience altered self-perceptions, associate rapid physical changes with death, experience negative emotions (anxiety, fear, anger, and bewilderment), and are at times found to be at odds with caretakers.<sup>3</sup>

  • The Psychosocial Effects: Impact on Caretakers

    The Psychosocial Effects: Impact on Caretakers

    Caretakers were found to have poor nutrition as well, because their food intake changed to accommodate their patient’s appetite. They also felt powerless, incompetent, and rejected when their patients refused to eat, which often led to relationship conflict.<sup>3</sup>

  • Assessment of Cancer Cachexia

    Assessment of Cancer Cachexia

    Cachexic patients present with remarkable weight loss, anemia, lethargy, asthenia, and anorexia. Daily caloric intakes less than 70 cal/kg, or a 5-lb weight loss in the last 2 months, are indicators of cachexia.<sup>4</sup>

  • Pathophysiology of Cachexia

    Pathophysiology of Cachexia

    With the catabolic side effects of anti-neoplastics and continual tumor growth, there is an eventual increase in the release of pro-inflammatory cytokines, and tumor specific cachexic substances.<sup>5</sup> The etiology of cachexia involves various underlying mechanisms, as shown in this figure.<sup>4</sup>

  • Treatment Options: Progestins

    Treatment Options: Progestins

    In addition to stimulating appetite, progestins also have an effect on weight gain by increasing fat deposition.<sup>6,7</sup>

  • Treatment Options: Corticosteroids

    Treatment Options: Corticosteroids

    In addition to stimulating appetite, corticosteroids can be used to decrease nausea and vomiting, as well as improve pain and emotional well-being.<sup>6,7</sup>

  • Nonpharmacological Therapies: Diet and Exercise

    Nonpharmacological Therapies: Diet and Exercise

    Physical therapy helps cachexic patients with cancer maintain some form of strength and lean body mass, as well as in combating depression and fatigue. Exercise can increase protein synthesis, insulin sensitivity, and possibly enhance immune function and suppress the inflammatory response.<sup>8</sup>

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Cancer cachexia is a complex metabolic reaction characterized as a decrease in lipogenesis and muscle proteins, as well as an increase in acute phase proteins, energy expenditure, proteolysis, glucose turnover, lipolysis, and ketone bodies caused by a combination of the malignancy and the treatment of the cancer itself.4

As a result, patients present with anorexia and a loss of skeletal muscle mass and adipose tissue, with treatment goals revolving around restoring muscle mass and body weight, while preventing further loss.8

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