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Pharmacologic management of cancer anorexia/cachexia

Authors
Charles L Loprinzi, MD
Aminah Jatoi, MD
Section Editor
Paul J Hesketh, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

The cancer-related anorexia/cachexia syndrome (CACS) is a hypercatabolic state characterized by anorexia and loss of body weight associated with reduced muscle mass and adipose tissue. In addition to a variable contribution from decreased energy intake, resting energy expenditure can be elevated in CACS in association with increases in both muscle protein breakdown and lipolysis, changes that appear to be due in part to an inflammatory response with the elaboration of cytokines, including tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-1 beta. Tumor-elaborated factors, such as proteolysis-inducing factor and lipid-mobilizing factor, also may play an important role. Unlike starvation, weight loss in cancer arises both from loss of muscle and fat. (See "Pathogenesis, clinical features, and assessment of cancer cachexia".)

This topic review will cover pharmacologic treatment for patients with CACS. The clinical features and pathogenesis of CACS, nutritional support for patients with cancer, and a general discussion of assessment and management of anorexia/cachexia in palliative care patients with advanced life-threatening illness are provided elsewhere. (See "Pathogenesis, clinical features, and assessment of cancer cachexia" and "The role of parenteral and enteral/oral nutritional support in patients with cancer" and "Palliative care: Assessment and management of anorexia and cachexia".)

PREVALENCE AND CLINICAL SIGNIFICANCE

The cancer-related anorexia/cachexia syndrome (CACS) is frequently seen in patients with advanced cancer. One study evaluated 644 consecutive, mostly ambulatory cancer patients: decreased appetite, decreased food intake, and weight loss in excess of 5 percent of premorbid weight were present in more than one-half [1]. Furthermore, 54 percent were underweight when compared with the calculated ideal body weight.

Weight loss in CACS is a marker for both progression of the syndrome and for prognosis [2]. In a multi-institutional, retrospective review of 3047 clinical protocol cancer patients from the Eastern Cooperative Oncology Group, weight loss of more than 5 percent of premorbid weight prior to the initiation of chemotherapy was predictive of early mortality. Weight loss was independent of disease stage, tumor histology, and patient performance status in its predictive value [2]. There was also a trend towards lower response rates with the use of chemotherapy among weight-losing patients. This trend reached statistical significance only among patients with breast cancer.

OVERVIEW OF ASSESSMENT AND TREATMENT

All cancer patients should be assessed for nutritional status and weight loss. The clinical assessment for patients with anorexia or cachexia includes a careful history that is focused on nutritional issues including risk factors that compromise the ability to obtain or take in nutrition, and a physical examination focusing on loss of subcutaneous fat, muscle wasting (temporal region, deltoids, and quadriceps with loss of bulk and tone by palpation), edema (sacral or ankle), or ascites. The most commonly used objective measures of nutritional status are serial measurement of body weight and assessment of dietary intake, while subjective information on nutritional status can be provided by malnutritional assessment tools. Laboratory measures of nutritional status (eg, albumin, transferrin) are rarely needed for assessment of nutritional status, although some screening tools (eg, the Nutrition Risk Index) do include a measurement of serum albumin. These issues are all addressed in more detail elsewhere. (See "Palliative care: Assessment and management of anorexia and cachexia", section on 'Assessment'.)

                            

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Literature review current through: Nov 2016. | This topic last updated: Thu Jun 30 00:00:00 GMT+00:00 2016.
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