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Cancer Cachexia
Management Strategies
Review Date 2/12 O-0537
Agenda
1. What is cancer cachexia?
2. Prevalence
3. Strategies to manage cachexia
2
Cancer Cachexia
Defined
• A complex metabolic syndrome
associated with underlying illness and
characterized by the loss of muscle with
or without loss of fat mass
Braun TP, Marks DL. Pathophysiology and treatment of inflammatory anorexia in chronic disease. Journal of Cachexia, Sarcopenia,
3
and Muscle. 2010;1:135-145.
Causes of Cachexia
• Tumor-induced response that causes an
increase in proinflammatory cytokines:
– Results in a breakdown in skeletal muscle
– Chronic inflammatory state
Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 2011;62:265-279.
4
Results of Cachexia
•
•
•
•
•
Weight loss
Anorexia
Muscle wasting
Altered immune function
Fatigue
Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 2011;62:265-279.
5
Results of Cachexia
(cont’d)
• Physical disability
• Diminished quality of life:
– Poor treatment outcomes
– Increased toxicity with chemotherapy
• Reduced survival
Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 2011;62:265-279.
6
Cycle of
Malnutrition
Eat Less
Too
Tired
to Eat
Too Tired
to Cook
CYCLE OF
MALNUTRITION
Tire Out Quickly
Lose
Weight
Lose Strength
7
Cascade of Cachexia
Cancer Diagnosis
Tumor-Induced Inflammation
TNF
INF
IL-6
IL-6
Increased protein catabolism
Decreased protein anabolism
Decreased calorie intake
Increased insulin resistance
Increased lipolysis
Increased REE
IL=interleukin, REE=resting energy expenditure, TNF=tumor necrosis factor
Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 2011;62:265-279.
8
Managing Cachexia
• Increases in protein and calories alone
will not halt the catabolic processes
responsible for cachexia
9
Managing Cachexia
(cont’d)
• Targeted nutrition therapy that might
prove beneficial:
– Eicosapentaenoic acid (EPA), an omega-3
fatty acid
– ß-hydroxy-ß-methylbutyrate, found in
Juven® and Ensure® Clinical Strength
Argilés JM, Olivan M, Busquets S, López-Soriano FJ. Optimal management of cancer anorexia-cachexia syndrome. Cancer Manag
10
Res. 2010;22:27-38.
Managing Cachexia
(cont’d)
• Pharmacological agents:
– Appetite stimulants, such as Megace®
– B2 antagonists, such as Symbicort®, that
increase protein deposition
– Thalomid®, which targets proinflammatory
cytokines
– Oxandrin®, which promotes the anabolic
process
Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment
11
strategies. Annu Rev Med. 2011;62:265-279.
Summary
• May need targeted nutrition therapy or
medications to treat cancer cachexia
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