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Cachexia Anorexia Syndrome

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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 that are usually identified as part of the cachexia anorexia syndrome include weight loss, anorexia, early satiety, fatigue, weakness, anaemia, inflammation and low albumin. [2-3] Nutritional assessment tools that include markers of inflammation are being investigated. [4] 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. [5]

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. [6]

The metabolic profile of cancer cachexia is not the same as that of starvation, which is defined as secondary cachexia. Cancer cachexia involves inflammation, hypermetabolism, neuro-hormonal changes, and the production of proteolytic and lipolytic factors. [2-3]

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. [7]

Loss of weight and loss of appetite do not always occur together. Some patients have cachexia despite maintaining a relatively normal appetite and nutritional intake. [3]

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] 

Cachexia may also be a prognostic factor in non-malignant conditions. [8]

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 dataset.
  • 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 is recommended in evidence based practice guidelines for nutritional management of cancer cachexia. [9] 
  • Eating and food have great social, cultural and psychological significance for patients and their families, and issues relating to nutritional support are often socially and ethically complex. [10-12] 
  • If an underlying malignancy can be effectively treated, this is likely to reverse the cachexia anorexia syndrome.
  • In patients who have advanced dementia, loss of appetite and decreasing oral intake may be a marker of the transition to end-stage disease, although contributing factors should be sought and addressed as appropriate. [13] Families of patients with end-stage dementia may require increased support as they deal with this change. [13] Artificial nutrition (tube feeding) has not been shown to improve life expectancy in patients with end-stage dementia. [14]

Finding out more

Guidelines

Link to prescribing information

Free full text overview article 

Related CareSearch pages

Appetite stimulants
Artificial nutrition
Nausea
Fatigue
Depression

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References

  1. Del Fabbro E, Dalal S, Bruera E. Symptom control in palliative care--Part II: cachexia/anorexia and fatigue. J Palliat Med. 2006 Apr;9(2):409-21.
  2. Dahele M, Fearon KC. Research methodology: cancer cachexia syndrome. Palliat Med. 2004 Jul;18(5):409-17.
  3. 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;18(3):273-9.
  4. 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. Support Care Cancer, 2003 Jan;11(1):60-2.
  5. Mirhosseini N, Fainsinger RL, Baracos V. Parenteral nutrition in advanced cancer: indications and clinical practice guidelines. J Palliat Med. 2005 Oct;8(5):914-8.
  6. Davis MP, Dreicer R, Walsh D, Lagman R, LeGrand SB. Appetite and cancer-associated anorexia: a review. J Clin Oncol. 2004 Apr 15;22(8):1510-7.
  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. J Pain Symptom Manage. 2007 Jul;34(1):94-104.
  8. 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.
  9. Bauer JD, Ash S, Davidson WL, Hill JM, Brown T, Isenring EA, Reeves M. Evidence based practice guidelines for the nutritional management of cancer cachexia. Nutr Diet. 2006 Sep;63(Suppl 2):S3-32.
  10. Hughes N, Neal RD. Adults with terminal illness: a literature review of their needs and wishes for food. J Adv Nurs. 2000 Nov;32(5):1101-7.
  11. Shragge JE, Wismer WV, Olson KL, Baracos VE. The management of anorexia by patients with advanced cancer: a critical review of the literature. Palliat Med. 2006 Sep;20(6):623-9.
  12. Bryon E, Gastmans C, de Casterlé BD. Decision-making about artificial feeding in end-of-life care: literature review. J Adv Nurs. 2008 Jul;63(1):2-14.
  13. 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.
  14. Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007209.

Last updated 27 June 2011