Cancer, Malnutrition and Cachexia: We Must Break the Triad (original) (raw)
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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.
Collegium antropologicum, 2014
Cachexia is defined as an unintended loss of stable weight exceeding 10%. Patients with advanced cachexia express anorexia, early satiety, severe weight loss, weakness, anemia, and edema. Anorexia represents the result of a failure of the usual appetite signals whereas cachexia is the debilitating state of involuntary weight loss. This syndrome, referred to as the cancer anorexia-cachexia syndrome, (CACS) and usually consists of a combination of anorexia, tissue wasting, malnutrition, weight loss and loss of compensatory increase in feeding. CACS represents the result of a complex interaction between cancer growth and host response and is associated with a poor response to chemotherapy and with an increase in drug-related toxicity. In advanced cachexia (mostly in metastatic cancer and terminally disease) any interventions with nutritional suplements are ineffective. Therefore, nutritional support in the reversion of tumor cachexia and in the importance of maintaining patient weight,...
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.
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.
From laboratory to bedside: New strategies in the treatment of malnutrition in cancer patients
Nutrition, 1996
The objective of this review is to present and discuss the current and the possible future perspectives of artificial nutrition in preventing and treating cancer cachexia. English-language studies published in the last 25 years were retrieved using MEDLINE, bibliographies and consultation with experts. MEDLINE search terms included "cancer," "malnutrition," and "nutritional support." In vivo and in vitro controlled studies were selected, and data from each study were independently abstracted by the authors. Data obtained indicate that cancer cachexia is a common manifestation of advanced malignant disease, characterized by marasmus due to impaired nutrient metabolism, weight loss, and anemia. In patients, the presence of cachexia increases morbidity and mortality, delays or impedes the delivery of the adequate treatment, reduces the efficacy of anti-neoplastic therapy, and impairs patient's quality of life. Indirect evidence indicates that cancer cachexia is mediated by circulating cytokines, produced by the host in response to the presence of the malignancy. In the past two decades, nutritional support was used to counteract the detrimental effect of cancer cachexia on the host, but with limited success. More recently, the better understanding of the mechanisms of cancer cachexia and the identification of pharmacologic effects provided by specific nutrients, has formed the rationale for a "new" mode of nutrition therapy/nutritional support, adding pharmacotherapy to adjunctive initial care. Nutrition 1996;12:112-122 20% of cancer-related deaths are attributable to malnutrition and host tissue wasting.' For surgeons, host depletion represents an additional major concern as malnourished oncology patients often have an increased incidence of postoperative complications such as sepsis, wound dehiscence, and ileus,6 as well as impaired immune status and pulmonary function.
Annals of Oncology, 2014
Background: Weight loss and cachexia are common, reduce tolerance of cancer treatment and the likelihood of response, and independently predict poor outcome. Methods: A group of experts met under the auspices of the European School of Oncology to review the literature andon the basis of the limited evidence at present-make recommendations for malnutrition and cachexia management and future research. Conclusions: Our focus should move from end-stage wasting to supporting patients' nutritional and functional state throughout the increasingly complex and prolonged course of anti-cancer treatment. When inadequate nutrient intake predominates (malnutrition), this can be managed by conventional nutritional support. In the presence of systemic inflammation/altered metabolism (cachexia), a multi-modal approach including novel therapeutic agents is required. For all patients, oncologists should consider three supportive care issues: ensuring sufficient energy and protein intake, maintaining physical activity to maintain muscle mass and (if present) reducing systemic inflammation. The results of phase II/III trials based on novel drug targets (e.g. cytokines, ghrelin receptor, androgen receptor, myostatin) are expected in the next 2 years. If effective therapies emerge, early detection of malnutrition and cachexia will be increasingly important in the hope that timely intervention can improve both patient-centered and oncology outcomes.
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...