Cancer Cachexia
Definition:[edit | edit source]
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.[1]
The characteristic feature is the negative protein energy balance that occurs due to reduction in the food intake and an abnormal metabolism.
Classification:[edit | edit source]
There are 3 stages of relevance clinically, forming a spectrum, however not all of these subjects traverse the entire spectrum.
- 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.
- 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.
- 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.[2]
Diagnosis of cancer cachexia[edit | edit source]
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%[3]
Assessment[edit | edit source]
Muscle mass and strength:
Anorexia and reduced food intake: Quantification of protein may be relevant. The mechanisms behaind this may be chemosensory distrubances, reduced upper gastrointestinal mobility, distal tract dysmobility. The secondary causes include stomatitis, consti[ation, dyspnoea, pain and poor dietary habits.
Catabolic drivers
Functional and psychosocial effects
- ↑ Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011 May 1;12(5):489-95.
- ↑ Blum D, Omlin A, Fearon K, Baracos V, Radbruch L, Kaasa S, Strasser F, European Palliative Care Research Collaborative. Evolving classification systems for cancer cachexia: ready for clinical practice?. Support Care Cancer. 2010 Mar 1;18(3):273-9.
- ↑ Wallengren O, Lundholm K, Bosaeus I. Diagnostic criteria of cancer cachexia: relation to quality of life, exercise capacity and survival in unselected palliative care patients. Support Care Cancer. 2013 Jun 1;21(6):1569-77.
