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.

Treatment

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