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cachexia-anorexia syndrome

Etiology: 1) cancer 2) AIDS Epidemiology: - almost all patients with cancer or AIDS experience this syndrome before they die Pathology: 1) thought to be cytokine-mediated a) interleukin-6 (IL-6) b) tumor necrosis factor (TNF)-alpha 2) ADAMTS1 may play a role Clinical manifestations: 1) progressive weight loss 2) lipolysis 3) loss of visceral & skeletal protein mass 4) profound anorexia almost always accompanies cachexia 5) asthenia Complications: 1) weight loss diminishes chance of survival 2) patients with cachexia experience more complications after a) surgery b) radiation c) chemotherapy Management: 1) aggressive nutritional support (enteral & parenteral) is not indicated a) no significant improval in patient survival b) limited effects on complications of surgery, radiation & chemotherapy c) unclear if any symptomatic benefits d) avoid using prescription appetite stimulants or high-calorie supplements [5] 2) optimize social supports, provide feeding assistance & clarify patient goals & expectations [5] - small meals of the patient's preferred foods [11] 3) enteral nutrition, parenteral nutrition &/or pharmaceuticals do not improve morbidity, mortality or quality of life [6] - contrast this with suggestions below 4) pharmaceutical agents a) glucocorticoids 1] beneficial effect on appetite, food intake, sense of well-being & overall performance 2] effect is limited lasting up to 4 weeks 3] taper to lowest effective dose b) progestational agents, i.e. megestrol (Megace) 1] beneficial effect on appetite, food intake, sense of well-being & weight gain 2] weight gain mainly in fat 3] only 20-30% of patients gain weight [6] 4] no improvement in mortality of quality of life [6] c) pentoxyfylline decreases TNF-alpha d) beta-2 adrenergic agonists decrease breakdown of muscle protein e) androgens enhance protein synthesis f) melatonin decreases TNF-alpha & modulates other cytokines g) thalidomide decreases TNF-alpha & modulates other cytokines h) dronabinol (Marinol) increases appetite through central mechanisms i) omega-3 fatty acids decrease IL-6 j) ondansetron improves enjoyment of food k) olanzapine may be of benefit in patients with cancer cachexia

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asthenia

General

cachexia syndrome

References

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  9. Sadeghi M, Keshavarz-Fathi M, Baracos V et al. Cancer cachexia: diagnosis, assessment, and treatment. Crit Rev Oncol Hematol. 2018;127:91-104 PMID: 29891116 https://www.sciencedirect.com/science/article/abs/pii/S1040842817302731
  10. Sandhya L et al. Randomized double-blind placebo-controlled study of olanzapine for chemotherapy- related anorexia in patients with locally advanced or metastatic gastric, hepatopancreaticobiliary, and lung cancer. J Clin Oncol 2023 May 10; 41:2617 PMID: 36977285 Clinical Trial. https://ascopubs.org/doi/10.1200/JCO.22.01997 - Roeland EJ, Bohlke K, Baracos VE et al Cancer Cachexia: ASCO Guideline Rapid Recommendation Update J Clin Oncol. 2023 Sep 1;41(25):4178-4179. PMID: 37467399
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