Cancer-induced cachexia remains a significant cause of morbidity and mortality in cancer treatment. Unfortunately, there are no established treatment regimens for this condition. Weight loss and fatigue consistently appear in patient oncologic histories and progress notes. However, few oncologists fully understand the pathologic mechanisms causing cachexia resulting in well-meaning advice to increase caloric intake with minimal results. Our goal is to describe the pathologic basis of cancer-induced cachexia and to detail accompanying metabolic derangements. Understanding the causes of cachexia sheds light on the subsequent need for multi-modality therapy including clinical intervention with specialized nutrition support, drug therapy, lifestyle and diet changes. In addition to nutrition support modalities, practicing oncologists may prescribe medical therapies designed to increase body weight and lean body mass, including megestrol acetate, tetrahydrocannibinol, oxandrolone, and non-steroidal anti-inflammatory drugs. A variety of experimental therapies are also being investigated for cancer-induced cachexia including tumor necrosis factor-alpha inhibitors and ghrelin infusions. Both cachexia and starvation result in weight loss, however cachexia results from an altered metabolic state due to tumor-derived factors, loss of anabolic stimuli, and an increase in catabolic processes. Unlike starvation, where metabolism slows to conserve body mass, current data suggests that CIC cannot be reversed by feeding alone. The clinical picture is further compounded by muscle loss, a physiologic process as one ages, which may result in sarcopenia.
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Nutrition is an important factor in the treatment and progression of cancer. The majority of cancer patients experience weight loss as their disease progresses and, in general, weight loss is a major prognostic indicator of poor survival and impaired response to cancer treatment. Symptoms such as anorexia, depression, anxiety, fatigue, early satiety and pain can result in decreased appetite and food intake. Cancer treatment and its side effects may result in weight loss, for example surgery malabsorption, radiotherapy nausea, pain, diarrhoea, mucositis and chemotherapy nausea, vomiting, diarrhoea, mucositis. Weight loss may be due to mechanical obstruction caused by the cancer itself, such as obstruction of the oesophagus causing swallowing problems and reduced intake. Several clinical trials have demonstrated that appropriate nutrition care can help to overcome nutrition impact symptoms and help patients to maintain their weight and quality of life. Nutrition is one aspect in which people with cancer and their carers feel they can play an active role, and they may actively seek nutrition information from a variety of sources. An increasing number of patients with cancer use complementary or alternative therapies that often have little or no evidence base. Evidence-based practice guidelines for the nutritional management of cancer cachexia 12 and nutritional management of patients receiving radiotherapy 13 have recently been published. Appropriate nutrition care can lead to positive patient outcomes. Key aspects of the nutrition care process include identification of malnutrition, establishing the goals of treatment, determining the nutrition prescription and implementing the nutrition care.