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Palliative care: Assessment and management of anorexia and cachexia

Eduardo Bruera, MD
Rony Dev, DO
Section Editor
Deputy Editor
Diane MF Savarese, MD


Hippocrates described a syndrome of wasting and progressive inanition among patients who were ill and dying. Derived from the Greek words kakos, meaning “bad things,” and hexus, meaning “state of being,” the term cachexia has been used to describe weight loss. From an, meaning “without,” and orexis, meaning “appetite, desire,” the word anorexia is used to characterize loss of appetite. Cachexia, a hypercatabolic state that is defined by an accelerated loss of skeletal muscle in the context of a chronic inflammatory response, is best described in the setting of cancer but is also seen in other advanced chronic illnesses including AIDS, heart failure, and chronic obstructive pulmonary disease (COPD) [1]. Although body composition changes are not identical in all of these disease states, the term cachexia is used in all of these settings.

Loss of appetite and weight loss are common among patients with an advanced serious life-threatening illness such as cancer. However, the profound weight loss suffered by patients with cachexia cannot be entirely attributed to poor caloric intake. In contrast to simple starvation, which is characterized by a caloric deficiency that can be reversed with appropriate feeding, cachexia is not reversed by the supplementation of calories [2].

This topic review will cover the diagnosis, evaluation, and management of anorexia and cachexia in palliative care patients. A more detailed review of the clinical features, pathogenesis, and management of cancer-associated anorexia and cachexia is available elsewhere. (See "Pathogenesis, clinical features, and assessment of cancer cachexia" and "Pharmacologic management of cancer anorexia/cachexia".)


Anorexia may be simply defined as either loss of appetite or reduced caloric intake [3].

Cachexia has historically been most often defined by weight loss (most often total involuntary weight loss of more than 10 percent of premorbid body weight [4]). However, the measurement of body weight may underestimate the frequency of cachexia in patients who are overweight/obese or who have gained weight because of edema or a growing tumor mass [5,6].

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Literature review current through: Oct 2017. | This topic last updated: Sep 21, 2017.
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