Cachexia

• Diagnosis
• Treatment

Cachexia means “poor condition” in Greek. Cachexia has been defined as a syndrome characterised by progressive loss of lean tissue and body fat. Losses are often in excess to that explained by the associated anorexia. Cachexia occurs with various diseases, especially those that are chronic and debilitating. Diseases commonly associated with cachexia are cancer, AIDS, congestive heart failure, COPD and chronic inflammatory rheumatological diseases (e.g. rheumatoid arthritis, systemic lupus erythematosus (SLE), scleroderma, polymyositis, etc).
Weight loss in cancer cachexia is different to weight loss in simple starvation , due to accelerated loss of muscle compared with fat tissue, presence of proinflammatory cytokines and prolonged acute phase protein response that contributes to increased resting energy expenditure and weight loss. Patients with cancer cachexia experience anorexia, early satiety, weakness, sarcopenia, fatigue, anaemia and severe weight loss.

Diagnosis

There are no definitive methods for diagnosis of cancer cachexia. Clinical signs of anorexia and weight loss ≥5% in 6 months would be expected but clinical judgement is required.

Treatment

Treatment of cachexia should be directed towards:

• Treatment of underlying disease
• Controlling the symptoms of cachexia

Controlling the symptoms of cachexia
Several treatment options have been outlined to treat cachexia. The principle is to improve the nutrition of the patients and to suppress the inflammatory response that is eating up the body’s energy. These include:

• Feeding the patient with high calorie food
• Drugs to stimulate the appetite
• Drugs to stimulate the body to build up more muscle mass

It has been proposed that eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, may reduce the production of proinflammatory cytokines and thus may improve energy and protein intake, performance status and quality of life in cancer patients with cachexia. This may be taken as fish oil capsules or commercial nutrition supplements. However, the results of studies into the effects of EPA have been inconsistent. Your dietitian can provide more information about the dietary management of cancer cachexia.

Article kindly reviewed by:
The DAA WA Oncology Interest Group
and
Food4Health (Helen Baker Dietitian-APD)

References

1. Kotler D. Review: Cachexia. Ann Intern Med. 2000;133:622-634.
2. Dietitians Association of Australia. 2005. Evidence Based Practice Guidelines for Nutritional Management of Cancer Cachexia.