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
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