Cachexia
Cachexia and the Cancer Patient | Cancer Care
Cachexia is a condition that is common in advanced cancer patients. It’s characterized by severe weight loss and muscle reduction. It is estimated that cachexia affects and severely diminishes the quality of life for:
Up to 80 percent of patients with advanced gastrointestinal or lung cancer- Up to 60 percent of patients with cancers of the pancreas, colon, stomach, esophagus, liver, or head and neck cancers
- Up to 30 percent of patients with breast, prostate, chronic lymphocytic leukemia, or lymphoma
Cachexia can cause dangerous weight loss, muscle wasting, loss of strength, and severe fatigue. Combined, all of this accelerates the underlying illness while diminishing the ability to cope with the cancer treatments.
Perhaps the most important things to note about cachexia is screening early for the warning signs aids the prognosis; and consistent, aggressive treatment of the cancer itself is key in avoiding it altogether.
We help individuals with a cancer diagnosis access clinical trials and treatments tailored to their needs. Our goal is to provide individualized care that is both compassionate and professional, helping patients make informed decisions as to what the best available treatment is for them.
What are the Symptoms of Cachexia?
Symptoms of Cachexia include:
Involuntary (Unintentional) Weight Loss
Weight loss associated with cachexia is involuntary -.Unintentional weight loss is defined as the loss of at least 5% of body weight over a 6 to 12 month period.
Skeletal Muscle Wasting
Muscle wasting is a hallmark of cachexia and occurs with a loss of fat. In a way it can be insidious in that for patients who were overweight when initially diagnosed.Significant loss of muscle mass may occur without any obvious appearance of weight loss.
Anorexia/Loss of Appetite
Cachexia can cause loss of appetite. Note that with cachexia, ‘loss of appetite’, is not just a reduced desire for food, it’s a complete lack of interest to eat.
Complications
One of the most detrimental effects of cachexia is the interference with treatments for the cancer that the patient has. Cancer patients are typically less able to tolerate treatments, like chemotherapy and radiation and may experience more side effects and complications post surgeries.
Cachexia also worsens cancer fatigue and lowers pain tolerance. With muscle wasting, it should be noted, can lead to difficulty walking and eventually lead to the loss of the ability to live independently.
How is Cachexia Diagnosed?
Researchers are learning that cachexia is often present prior to any weight loss. That, of course, makes early screening essential.
There are several ways that cachexia can be evaluated.
Some measures include:
Body Mass Index (BMI) : Body mass index describes not only relative body weight, but can give more information about a healthy weight. BMI is calculated using a formula of height and weight.
Food Intake Diaries : Keeping a food diary is important when looking to prevent or cope with cachexia.
Lean Muscle Mass : Measuring body composition can help determine the ratio of lean muscle mass to body fat. Tests used to determine lean muscle mass may include skin folds and bioimpedance.
Blood Tests : Some lab tests that are useful in evaluating cachexia include white blood cell counts (WBC), serum albumin, transferrin levels, uric acid, and inflammatory markers, such as C-reactive protein (CRP). Thyroid levels should also be assessed to rule out hyperthyroidism (thyroid conditions are common with cancer treatment), and conditions such as adrenal insufficiency and/or hypogonadism.
Other : Screening tools that look at a combination of the above to identify cachexia, such as the Malnutrition Universal Screening Tool (MUST).
Please note that there is no single screening tool that is effective in detecting cachexia in every case.
What is the Treatment for Cachexia?
The first step is to treat any physical symptoms or conditions that could lead to a decreased appetite or ability to eat. These include:
Mouth sores
Taste changes (especially with some chemotherapy drugs)
Nausea and vomiting
Constipation
Pain
Depression
Gastroparesis
That aside, right now most researchers believe a combination of treatments (multimodality therapy) is essential. These include:
Diet
While replacing and supplementing calories has not had a major effect in the syndrome of cachexia, it’s especially important to make sure that those coping with cancer eat a healthy diet.
Omega-3 Fatty Acids
It’s ideal if nutrients can be obtained through food, but we know that’s not always the case. Fish oil has been evaluated for its ability to treat cachexia with some studies (but not all) suggesting that fish oil supplements may be helpful.
Amino Acid Supplements
Centers that treat cachexia often recommend amino acid supplements, particularly glutamine, L-carnitine, and L-arginine. These amino acids are evaluated in combination with other therapies to assess their potential benefit.
Exercise
Increasing activity (if possible) may help. An obvious benefit of exercise is increased appetite, but endurance training may go beyond eating habits to help slow the decline in muscle mass seen with cachexia. It’s thought that exercise may reduce inflammation and also affect metabolism in muscles themselves.
Appetite Stimulants
Appetite stimulants have been used for treating cachexia (though their effects are unclear).
Anti-Inflammatory Medications
Anti-inflammatory medications such as Celebrex (celecoxib) have shown some promise, particularly if inflammation is occuring.
Medical Marijuana
Thus far the evidence for the use of cannabis for cancer-related cachexia-anorexia is equivocal. Hopefully, with changes in regulations leading to a greater ability to study substances such as THC and CBD in clinical trials, the question of their efficacy will be addressed.
Clinical Trials
A wide range of medications have been investigated to some degree for their potential role in addressing cachexia. Both selective androgen receptor modulators as well as medications that target the ghrelin receptor (ghrelin is the hunger hormone) are currently being studied.
Can a Person Recover From Cachexia?
The best hope for recovery from cachexia is to improve the underlying condition at the root of it.
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