The cachexia anorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions. Cachexia has been defined as involuntary weight loss involving both fat and muscle, due to shifts in metabolism caused by tumour by-products and cytokines. [1]
Although the definition of the syndrome varies, symptoms which are usually identified as part of the cachexia anorexia syndrome include weight loss, anorexia, early satiety, weakness, anaemia, and oedema. [2] Nutritional assessment tools that include markers of inflammation are being investigated. [3] Their role in clinical practice may be to identify patients earlier in the palliative trajectory, and be incorporated into clinical practice guidelines about management of the syndrome. [4]
What is known
- The detailed neurophysiology of appetite / anorexia is not well understood in humans. It may be different from the mechanism of cachexia / weight loss. [5]
- The metabolic profile of cachexia is not the same as that of starvation. [2]
- Appetite loss occurs in over half of all palliative care patients, and weight loss becomes more common in the last weeks and months of life. [6]
- Loss of weight and appetite due to cancer progression have prognostic relevance for symptom burden, performance state, survival, and the ability to tolerate palliative chemotherapy. [2]
What it means in practice
- Appetite is a subjective symptom. Simple assessment tools are available, such as the Symptom Assessment Scale which is part of the PCOC database.
- A simple and valid nutrition assessment tool used in research and practice is the Patient Generated Subjective Global Assessment, which has been used in cancer cachexia and recommended in the evidence based practice guidelines for nutritional management of cancer cachexia. [7]
- Eating and food have great social significance for patients and their families, and issues relating to nutritional support are often socially and ethically complex. [8]
- If an underlying malignancy can be effectively treated, this is likely to reverse the cachexia anorexia syndrome.
- In patients with dementia, loss of appetite and decreasing oral intake may be a marker of the transition to advanced disease, although contributing factors should be sought and addressed as appropriate. [9] Families of patients with end-stage dementia may require increased support as they deal with this change [10]. It may also be a prognostic factor in other non-malignant conditions. [11]
Finding out more
Guidelines
Evidence-based practice guidelines for the nutritional management of cancer cachexia
Bauer et al Nutrition & Dietetics, Volume 63, Supplement 2, September 2006 , pp. S3-S32(1)
Link to prescribing information
NB Prescribing information may not yet have been updated to include the most recent evidence.
Overview articles
Related CareSearch pages
Appetite stimulants
Artificial nutrition
Nausea
Fatigue
Depression
References
- Del Fabbro E, Dalal S, Bruera E. Symptom control in palliative care--Part II: cachexia/anorexia and fatigue. Journal of Palliative Medicine. 2006 Apr;9(2):409-21.
- Dahele M, Fearon, KC. Research methodology: cancer cachexia syndrome. Palliative Medicine. 2004 Jul;18(5):409-417.
- Walsh D, Mahmoud F, Barna B. Assessment of nutritional status and prognosis in advanced cancer: interleukin-6, C-reactive protein, and the prognostic and inflammatory nutritional index. Supportive Care in Cancer, 2003 Jan;11(1):60-2.
- Mirhosseini N, Fainsinger RL, Baracos V. Parenteral nutrition in advanced cancer: indications and clinical practice guidelines. Journal of Palliative Medicine. 2005 Oct;8(5):914-8.
- Davis MP, Dreicer R, Walsh D, Lagman R, LeGrand SB. Appetite and cancer-associated anorexia: a review. Journal of Clinical Oncology. 2004 Apr 15;22(8):1510-7.
- Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. Journal of Pain & Symptom Management. 2007 Jul;34(1):94-104.
- Bauer JD, Ash S, Davidson WL, Hill JM, Brown T, Isenring EA, et al. Evidence based practice guidelines for the nutritional management of cancer cachexia. Nutrition & Dietetics. 2006 Sep;63(Suppl 2):S3-S32(1).
- Hughes N, Neal RD. Adults with terminal illness: a literature review of their needs and wishes for food. Journal of Advanced Nursing. 2000 Nov;32(5):1101-7.
- Australian Palliative Residential Aged Care Project (APRAC). Guidelines for a palliative approach to residential aged care: a systematic review of the literature. Canberra; National Health & Medical Research Council: 2005. http://www.nhmrc.gov.au/publications/synopses/ac12to14syn.htm http://www.nhmrc.gov.au/publications/synopses/_files/ac14.pdf
- Edith Cowan University. Guidelines for a palliative approach in residential aged care: enhanced version. Canberra; National Health & Medical Research Council & National Palliative Care Program:2006.
- Coventry PA, Grande GE, Richards DA, Todd CJ. Prediction of appropriate timing of palliative care for older adults with non-malignant life-threatening disease: a systematic review. Age & Ageing. 2005 May;34(3):218-27.
This page was created on 6 May 2008 and is due for review in May 2010
Last updated 26 May 2008