cachexia-anorexia syndrome
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Etiology
- cancer
- AIDS
Epidemiology
- almost all patients with cancer or AIDS experience this syndrome before they die
Pathology
- thought to be cytokine-mediated
- interleukin-6 (IL-6)
- tumor necrosis factor (TNF)-alpha
- ADAMTS1 may play a role
Clinical manifestations
- progressive weight loss
- lipolysis
- loss of visceral & skeletal protein mass
- profound anorexia almost always accompanies cachexia
- asthenia
Complications
- weight loss diminishes chance of survival
- patients with cachexia experience more complications after
- surgery
- radiation
- chemotherapy
Management
- aggressive nutritional support (enteral & parenteral) is not indicated
- no significant improval in patient survival
- limited effects on complications of surgery, radiation & chemotherapy
- unclear if any symptomatic benefits
- avoid using prescription appetite stimulants or high-calorie supplements[5]
- optimize social supports, provide feeding assistance & clarify patient goals & expectations[5]
- small meals of the patient's preferred foods[11]
- enteral nutrition, parenteral nutrition &/or pharmaceuticals do not improve morbidity, mortality or quality of life[6]
- contrast this with suggestions below
- pharmaceutical agents
- glucocorticoids
- progestational agents, i.e. megestrol (Megace)
- beneficial effect on appetite, food intake, sense of well-being & weight gain
- weight gain mainly in fat
- only 20-30% of patients gain weight[6]
- no improvement in mortality of quality of life[6]
- pentoxyfylline decreases TNF-alpha
- beta-2 adrenergic agonists decrease breakdown of muscle protein
- androgens enhance protein synthesis
- melatonin decreases TNF-alpha & modulates other cytokines
- thalidomide decreases TNF-alpha & modulates other cytokines
- dronabinol (Marinol) increases appetite through central mechanisms
- omega-3 fatty acids decrease IL-6
- ondansetron improves enjoyment of food
- olanzapine may be of benefit in patients with cancer cachexia
More general terms
Additional terms
References
- ↑ Bruera E, Neumann CM. Management of specific symptom complexes in patients receiving palliative care. CMAJ. 1998 Jun 30;158(13):1717-26. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9676549
- ↑ Abrahm JL A Physician's Guide to Pain and Symptom Management in Cancer Patients,2nd ed, Baltimore, MD, Johns Hopkins University Press, 2005
- ↑ Loprinzi C Supportive care. In: Cheson BD (ed) Oncology MKSAP, 3rd ed Alexandria, VA: American Society of Clinical Oncology, 2004:451
- ↑ Mantovani G, Madeddu C, Maccio A. Drugs in development for treatment of patients with cancer- related anorexia and cachexia syndrome. Drug Des Devel Ther. 2013 Aug 12;7:645-56. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23976842 Free PMC Article
Maccio A, Madeddu C, Mantovani G. Current pharmacotherapy options for cancer anorexia and cachexia. Expert Opin Pharmacother. 2012 Dec;13(17):2453-72. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23072481
Mantovani G, Madeddu C. Cancer cachexia: medical management. Support Care Cancer. 2010 Jan;18(1):1-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19688225
Madeddu C, Mantovani G. An update on promising agents for the treatment of cancer cachexia. Curr Opin Support Palliat Care. 2009 Dec;3(4):258-62. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19667995 - ↑ 5.0 5.1 5.2 AGS Choosing Wisely Workgroup. American Geriatrics Society identifies another five things that healthcare providers and patients should question. J Am Geriatr Soc. 2014;62:950-960 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24575770
- ↑ 6.0 6.1 6.2 6.3 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ Mattox TW. Cancer cachexia: cause, diagnosis, and treatment. Nutr Clin Pract. 2017;32(5):599-606 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28825869 https://aspenjournals.onlinelibrary.wiley.com/doi/abs/10.1177/0884533617722986
- ↑ Sadeghi M, Keshavarz-Fathi M, Baracos V et al. Cancer cachexia: diagnosis, assessment, and treatment. Crit Rev Oncol Hematol. 2018;127:91-104 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29891116 https://www.sciencedirect.com/science/article/abs/pii/S1040842817302731
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/37467399 - ↑ 11.0 11.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022