Cachexia in Cancer

1. See Also
   1. Unintentional Weight Loss
2. Pathophysiology
   1. Results in wasting of body fat and muscle
   2. Cytokine elevations related to Wasting Syndromes
      1. Interferon
      2. Tumor necrosis factors
3. Symptoms
   1. No appetite (anorexia)
   2. Unintentional Weight Loss (Cachexia)
   3. Fatigue (see Fatigue in Cancer)
4. Differential Diagnosis
   1. See Unintentional Weight Loss
   2. Chronic organ failure
   3. Serious chronic infection
   4. AIDS
5. Evaluation: Identify and treat reversible causes
   1. Chronic Pain
   2. Mouth condition
      1. Dry Mouth
      2. Chemotherapy related mucositis
      3. Diminished gastrointestinal motility
         1. Constipation
         2. Reflux Esophagitis
      4. Infection
         1. Oral Candidiasis
         2. Oral Herpes Simplex infection
6. Management: Nutrition
   1. Background
      1. Wasting is not reversed by improved nutrition
      2. Aggressive alimentation may increase discomfort
   2. Management
      1. Small Frequent Meals
      2. Avoid blended, pulverized foods
      3. Avoid parenteral nutrition
      4. Patient eats what they want
         1. Avoid dietary restriction (diabetics eat ice cream)
         2. Avoid foods with unpleasant odor
      5. Educate families that wasting is not inadequate care
      6. Families can offer care in alternative ways
         1. Moisten patient's lips or mouth with sponge
         2. Offer massage
         3. Read or play soft music for patient
7. Management: Medications
   1. General
      1. Discontinue medication if no benefit in 2-6 weeks
   2. Main options
      1. Megestrol acetate (Megace) 200 mg PO q6-8 hours
      2. Dexamethasone (Decadron) 2 to 20 mg PO qAM
      3. Dronabinol (Marinol) 2.5 mg PO bid to tid
      4. Medroxyprogesterone acetate
   3. Experimental: Androgens
      1. Oxandrolone (Oxandrin)
      2. Nandrolone (Durabolin)
   4. Other options
      1. Macrolide antibiotics
      2. Cyproheptadine
      3. Hydrazine sulfate
      4. Cannabinoids
8. References
   1. MacDonald (2003) J Am Coll Surg 197:143-57
   2. McCann (1994) JAMA 272:1263-6
   3. Nelson (2000) Semin Oncol 27:64-8
   4. Ross (2001) Am Fam Physician 64(5):807-14