Nutrition in cancer patients (original) (raw)
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Cancer, Malnutrition and Cachexia: We Must Break the Triad
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 2015
Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments causing malabsorption. The cachexiaanorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, anorexia, early satiety, fatigue and weakness due to shifts in metabolism caused by tumour by-products and cytokines. Cachexia is a distressing and debilitating condition, affecting significant numbers of patients with advanced disease and is the primary cause of death in about 20% of all patients with cancer. Though cachexia is most commonly associated with particular tumours, such as head and neck, gastrointestinal tract, pancreas, central nervous system and lung, it may affect any patient with any tumour at any site; no patient and no tumour are excluded. Current treatment for principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. A careful decision based on good clinical judgement is necessary before deciding to start either enteral or parenteral nutrition, to avoid a useless, costly and difficult treatment. Treatment should be directed toward improvement in the quality of life of the patient and should often include nutritional counseling. It should take into consideration both disease and treatment related factors as well as the cachexia syndrome itself.
Cachexia-Anorexia Syndrome and Food Supplementation in Cancer Patients
Nutrition & Food Science International Journal, 2017
Loss of appetite and weight are one of the first symptoms of a malignant disease. In rapidly advancing cancer which does not respond to therapy, severe cachexia will undoubtedly lead to death. The cancer tissue and the body itself secrete cytokines and other factors, which, combined interfere with both central and peripheral metabolic pathways causing anorexia and cachexia. Assessing nutritional state in cancer patients should be made before starting oncological treatment, but also regularly during the course of therapy. The treatment of cachexia and anorexia in cancer patients is a complex issue and includes specific treatment with a goal of reducing cancer volume, providing nutritive support and intervening with pharmaceuticals. There are different appetite-enhancing medications with the most effective being megestrol acetate, corticosteroids and cannabinoids. Eicosapentaenoic acid (EPA) on the other hand is the key in treating cachexia. Today, formulations with EPA are prepared in such ways that they can be mixed with other food and can be prepared by following many different recipes. Parenteral nutrition is also an option, but is rarely used due to its high cost and risk of infections, and should not be used in end-stage disease. Administering nutritive advice, prescribing nutritional and pharmacological support can temporarily stop weight loss and improve appetite, quality of life and social interactions of cancer patients, and allow for a longer administration of systemic anti-tumor therapy and hence probably for a longer survival.
Multitargeted Treatment of Cancer Cachexia
Critical Reviews™ in Oncogenesis, 2012
Cancer cachexia is defined as a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. The prominent clinical feature of cachexia is weight loss in adults. Anorexia, inflammation, insulin resistance, and increased muscle protein breakdown frequently are associated with cachexia. One single therapy may not be completely successful in the treatment of cachexia because of the complexity of the pathogenesis and symptoms of the cachexia syndrome. Among effective treatments, progestogens currently are considered the best available treatment option and are the only approved drugs in Europe for the treatment of cancer-and AIDS-related cachexia. However, they have limited efficacy in treating cancer cachexia. However, thalidomide, selective COX-2 inhibitors, ghrelin mimetics, and selective androgen receptor modulators showed promising results but should be defined further and confirmed in clinical trials. Therefore, to date, despite several years of coordinated efforts in basic and clinical research, the practice guidelines for the prevention and treatment of cancer-related anorexia cachexia syndrome (CACS) are lacking. The management of CACS is a complex challenge that should address the different causes underlying this clinical event. Recent studies showed that integrated, multitargeted approaches are more effective than single-agent approaches for the treatment of CACS. Further clinical trials to improve and refine current strategies to counteract cancer cachexia using multimodal interventions, including nutritional supplementation, anabolic agents, and antiinflammatory drugs along with an appropriate physical exercise program, are warranted. KEY WORDS: cancer cachexia, multitargeted approach, lean body mass, physical activity, quality of life ABBREVIATIONS CACS: cancer-related anorexia cachexia syndrome; REE: resting energy expenditure; TNF: tumor necrosis factor; IL: interleukin; ROS: reactive oxygen species; CRP: C-reactive protein; MPA: medroxyprogesterone acetate; LBM: lean body mass; SIMS: systemic immune metabolic syndrome
Current Nutrition & Food Science, 2007
The management of cancer patients is frequently complicated by the occurrence of cachexia, a complex syndrome characterized by marked depletion of body weight, associated with profound alterations of both nutritional status and metabolic homeostasis. Progressive wasting of skeletal muscle mass and adipose tissue is a typical feature of cancer cachexia. This syndrome has a large impact on morbidity and mortality, and significantly affects patients' quality of life. On this line, understanding the pathogenic mechanisms of cachexia is of crucial importance to define targeted therapeutic strategies.
Revisiting Cancer Cachexia: Pathogenesis, Diagnosis, and Current Treatment Approaches
2021
The objective of this article is to group together various management strategies and to highlight the recent treatment modifications that attempt to target the multimodal etiological factors involved in cancer cachexia. The contemporary role of nursing fraternity in psychosocial and nutritional assessment of cancer patients is briefly discussed. Cachexia is a syndrome of metabolic disturbance, characterized by the inflammation and loss of muscle with or without loss of adipose tissue. In cancer cachexia, a multifaceted condition, patients suffer from loss of body weight that leads to a negative impact on the quality of life and survival of the patients. The main cancers associated with cachexia are that of pancreas, stomach, lung, esophagus, liver, and that of bowel. The changes include increased proteolysis, lipolysis, insulin resistance, high energy expenditure, and reduced intake of food, all leading to impaired response to different treatments. There is no standardized treatment...
Cachexia is considered as a complex interplay of metabolic and behavioral parameters leading to deteriorated quality of life. In recent years many efforts by researchers and clinicians were made to improve our knowledge of cachexia. Cancer and many other chronic or end-stage diseases like AIDS, chronic obstructive pulmonary disease, rheumatoid arthritis, tuberculosis are associated with cachexia, a condition associated with weight loss and alteration in body composition. Cachexia in cancer is generally neglected and contributes to the poor prognosis. A more meticulous understanding of cachexia is needed that probably will lead to combination therapies being developed. Although its prevalence is less, it is a growing problem in Asia. This review is based on the computer-aided Pubmed database and general search for the term “cancer cachexia”. Available free articles related to the pathophysiology, diagnosis and possible treatment modalities in cancer cachexia were downloaded for the review.
Optimal management of cancer anorexia–cachexia syndrome
Cancer Management and Research, 2010
According to a recent consensus, cachexia is a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss. Cachexia occurs in the majority of cancer patients before death and it is responsible for the deaths of 22% of cancer patients. Although bodyweight is the most important endpoint of any cachexia treatment, body composition, physical performance and quality of life should be monitored. From the results presented here, one can speculate that a single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful. The objectives of any therapeutic combination are two-fold: an anticatabolic aim directed towards both fat and muscle catabolism and an anabolic objective leading to the synthesis of macromolecules such as contractile proteins.