Cachexia in Cancer

Aka: Cachexia in Cancer, Anorexia in Cancer, Wasting Syndrome in Cancer, Anorexia-Cachexia Syndrome, Cachexia in Terminally Ill Patients, Cancer Related Cachexia, Cancer Cachexia, Palliative Management of Cachexia

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II. Pathophysiology

  1. Results in wasting of body fat and Muscle
  2. Cytokine elevations related to Wasting Syndromes
    1. Interferon
    2. Tumor Necrosis Factors

III. Symptoms

  1. No appetite (Anorexia)
  2. Unintentional Weight Loss (Cachexia)
  3. Fatigue (see Fatigue in Cancer)

IV. Differential Diagnosis

  1. See Unintentional Weight Loss
  2. Chronic organ failure
  3. Serious chronic infection
  4. AIDS

V. Evaluation: Identify and treat reversible causes

  1. Chronic Pain
  2. Pancreatic exocrine enzyme insufficiency
  3. Diminished gastrointestinal motility
    1. Constipation
    2. Reflux Esophagitis
    3. Gastroparesis
  4. Mouth condition
    1. Dry Mouth (Xerostomia)
    2. Dental or jaw related issues
    3. Chemotherapy related Oral Mucositis
    4. Infection
      1. Oral Candidiasis
      2. Oral Herpes Simplex infection

VI. 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

VII. 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

VIII. Management: Non-Cancer Comorbid Condition Specific Measures and Precautions

  1. Cardiac disease (e.g. CHF, CAD, Transplant Rejection)
    1. Decreased gastrointestinal perfusion may result in early satiety
    2. Favor small, frequent meals
  2. Lung Disease (e.g. COPD, ILD) with Pleuritic Pain
    1. Increased work of breathing is associated with increased caloric expenditure and decreased appetite
  3. Renal disease (e.g. Chronic Kidney Disease, Acute Renal Failure)
    1. Associated with Dysgeusia and early satiety
    2. Manage Electrolyte derangements and Uremia
  4. Liver disease (e.g. end-stage Cirrhosis) and Ascites
    1. Prokinetics (e.g. Metoclopramide) for Ascites-associated Gastroparesis
    2. Paracentesis

IX. References

  1. MacDonald (2003) J Am Coll Surg 197:143-57 [PubMed]
  2. McCann (1994) JAMA 272:1263-6 [PubMed]
  3. McGregor (2025) Am Fam Physician 112(5): 493-503 [PubMed]
  4. Nelson (2000) Semin Oncol 27:64-8 [PubMed]
  5. Ross (2001) Am Fam Physician 64(5):807-14 [PubMed]

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