Management of Cancer Anorexia and Cachexia
Jean Klastersky, Jean Schimpff, Hans-Jorg Senn in Supportive Care In Cancer, 1999
Cancer cachexia is a wasting syndrome associated with the presence of uncontrolled malignancy and usually characterized by loss of appetite (anorexia), weight loss, and weakness. Cancer anorexia/cachexia is commonly seen in advanced malignancy, involving up to 85% of patients with cancer (1). This syndrome can occur early in the course of cancer in a minority of patients (2). Cancer anorexia/cachexia leads to inanition and may be the most direct cause of death in some patients. In addition, anorexia/cachexia can cause major physical and psychological morbidity, and usually signifies a poor prognosis (3).
Cachexia
Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson in Care of the Cancer Patient, 2018
This chapter considers all the patient's symptoms and all the information available to doctors and assesses the symptoms, signs and information given using this to choose the appropriate remedies for the problem and offers extra information where available and appropriate. Cachexia is more common in solid tumours of the lung, gut and pancreas, but less common in breast cancer. With the exception of breast cancer, the size of the tumour and the amount of weight lost do not seem to be correlated. Cachexia is a complex mix of symptoms comprising the following: anaemia, anorexia, organ dysfunction, reduced appetite and feeling full, wasting of muscles, weakness and weight loss. There are a number of causes of cancer cachexia, including the following: decreased nutritional intake, increased nutritional losses, metabolic changes, poor appetite or poor eating habits, psychological problems, including depression, resulting in failure to look after oneself and treatment side-effects.
Pediatric Autoimmune Liver Diseases
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
Autoimmune liver disease in childhood is a rare chronic progressive liver disease that includes autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis, overlap syndrome and de novo autoimmune hepatitis after liver transplantation. In pediatric patients with inflammatory bowel disease and primary sclerosing cholangitis, small group series showed improved liver function and improved clinical symptoms with use of vancomycin although this antibiotic has not been evaluated in large patient studies. AIH is a chronic disease of unknown etiology which presents as a progressive inflammatory liver disease characterized by elevated serum liver enzymes and immunoglobulin G with presence of autoantibodies. Physical examination varies from normal findings to the presence of jaundice, splenomegaly, cachexia, and cutaneous stigmata of chronic liver disease. Some patients within the spectrum of autoimmune liver diseases present with characteristics of both AIH and cholestatic liver disease like sclerosing cholangitis. Liver transplantation is indicated in patients who present with fulminant liver failure and those who develop end-stage liver disease despite medical management.
Cachexia in Patients with Chronic Pancreatitis and Pancreatic Cancer: Impact on Survival and Outcome
Published in Nutrition and Cancer, 2013
Jeannine Bachmann, Markus Büchler, Helmut Friess, Marc Martignoni
Chronic pancreatitis (CP) and pancreatic adenocarcinoma (PDAC) are the most common diseases of the pancreas. Cachexia—weight loss exceeding 10% of stable body weight—is present in up to 80% of patients with PDAC. Because the mechanisms of cachexia are not well known, this provides a possibility to compare clinical courses of benign and malignant cachexia. In this study, 382 patients—242 with a PDAC stage UICC II/ 140 with CP—were documented regarding the prevalence of cachexia and its influence on perioperative morbidity and mortality with a special interest to postoperative weight gain and survival. Cachexia was present in 41.4% of CP and 31% of cancer patients. We could demonstrate more pronounced systemic effects of cachexia in patients with PDAC. Weight loss was faster in PDAC patients, the amount of weight loss did not differ significantly between the groups. Cachexia had a significant impact on survival and the postoperative course in patients with PDAC and tumor resection. The development of cachexia is faster in patients with a malignant disease and the systemic effects are more pronounced. Therefore, tumor cachexia should be considered as a different entity than cachexia in benign diseases.
Impact of cancer cachexia on the therapeutic outcome of combined chemoimmunotherapy in patients with non-small cell lung cancer: a retrospective study
Published in OncoImmunology, 2021
Kenji Morimoto, Junji Uchino, Takashi Yokoi, Takashi Kijima, Yasuhiro Goto, Akira Nakao, Makoto Hibino, Takayuki Takeda, Hiroyuki Yamaguchi, Chieko Takumi, Masafumi Takeshita, Yusuke Chihara, Takahiro Yamada, Osamu Hiranuma, Yoshie Morimoto, Masahiro Iwasaku, Yoshiko Kaneko, Tadaaki Yamada, Koichi Takayama
ABSTRACT Although previous studies suggest that cancer cachexia is a poor prognostic factor for immune checkpoint inhibitor monotherapy, the impact of cancer cachexia on chemoimmunotherapy is unclear. We investigated the impact of cancer cachexia on the therapeutic outcomes of chemoimmunotherapy for non-small cell lung cancer (NSCLC). We retrospectively analyzed patients’ medical records with NSCLC who received chemoimmunotherapy in 12 institutions in Japan between January and November 2019. We defined cancer cachexia as weight loss exceeding 5% of the total body weight or a body mass index of < 20 kg/m2 and weight loss of more than 2% of the total body weight within 6 months before chemoimmunotherapy initiation, with laboratory results exceeding reference values. This study enrolled 235 patients with NSCLC, among whom 196 were eligible for analysis, and 50 (25.5%) met the criteria for cachexia diagnosis. Patients with cancer cachexia had a significantly higher frequency of a programmed death-ligand 1 (PD-L1) expression of ≥ 50% (48%, p = .01) and shorter progression-free survival (PFS; log-rank test: p = .04) than patients without cachexia. There was no significant difference in overall survival (OS) between the cachexia and no-cachexia groups (log-rank test: p = .14). In the PD-L1 ≥ 50% population, there was no significant difference in PFS and OS (log-rank test: p = .19 and p = .79, respectively) between patients with NSCLC in the cachexia or no-cachexia groups. Cancer cachexia might be a poor prognostic factor in patients with NSCLC receiving chemoimmunotherapy.
Cachexia Stage, Patient-Generated Subjective Global Assessment, Phase Angle, and Handgrip Strength in Patients with Gastrointestinal Cancer
Published in Nutrition and Cancer, 2017
Gislaine Aparecida Ozorio, Katia Barão, Nora Manoukian Forones
ABSTRACT The aim of this study was to correlate patients with gastrointestinal cancer, classified according to different stages of cancer cachexia (SCC) as proposed by Fearon, with nutritional assessment tools such as PG-SGA, phase angle (PA), and handgrip strength. One hundred one patients with a mean age of 61.8 ± 12.8 yr, with 58.4% being men were included. 32.6% were malnourished according to the body mass index (BMI). A severe or moderate malnutrition had been diagnosed in 63.3% when assessed using the PG-SGA, 60.4% had decreased handgrip strength, and 57.4% had lower grades of PA. Among the patients in the study, 26% did not have cachexia, 11% had precachexia, 56% cachexia, and 8% refractory cachexia. The PG-SGA, PA, and handgrip strength were associated with cachexia (P ≤ 0.001). An increased risk of death was found in patients with cachexia [RR: 9.1; confidence interval (CI) 95%: 0.1–90.2, P = 0.039], refractory cachexia (RR: 69.4, CI 95%: 4.5–1073.8, P = 0.002), and increased serum C-reactive protein (CRP) levels (P < 0.001). In conclusion, most of the patients with digestive system cancer had cachexia or refractory cachexia in the first nutritional assessment. Nutritional risk, as determined by PG-SGA, was correlated with PA and handgrip strength. High CRP levels, cachexia, and refractory cachexia were prognostic factors for cancer patients.