Cancer Cachexia

Definition:

Cancer cachexia or cancer associated fatigue is defined as a multi factorial 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 characteristic feature is the negative protein energy balance that occurs due to reduction in the food intake and an abnormal metabolism.

Classification:

There are 3 stages of relevance clinically, forming a spectrum, however not all of these subjects traverse the entire spectrum.

1. Precachecia: The early clinical signs like anorexia and metabolic signs like impaired glucose test precede weight loss (≤5%). The progression varies and depends on the cancer type and staging, low food intake, any systemic inflammation, poor response to anti cancer therapy.
2. Cachexia: A stable weight loss more than 5% over 6 months OR a Body mass index (BMI) of lesser than 20 kg/m² OR sacrcopenia and ongoing weight loss of more than 2%, but not yet entered the refractory stage classified as cachexia.
3. Refractory cachexia: Very advanced cancer OR rapidly progressive cancer, unresponsive to anticancer therapy. Associated with active catabolism and the factors associated with active management of weight loss here no longer stand appropriate. Low performance status and a life expectancy of less than 3 months are characteristic.

Diagnosis of cancer cachexia

BMI <20 and any degree of weight loss >2%;

Weight loss >5% over past 6 months (in absence of simple starvation)

Appendicular skeletal muscle index consistent with sarcopenia (males <7·26 kg/m²; females <5·45 kg/m²) and any degree of weight loss >2%