Cachexia in the Cancer Patient
What is cachexia?
Cachexia, sometimes referred to as cancer cachexia or cancer anorexia cachexia, is a wasting syndrome in which both fat and muscle are lost due to the presence of a chronic disease, such as cancer, and malnourishment (not eating enough nutrients). Cachexia causes the patient to lose weight and appetite and, as a result, become weak and fatigued. This weakness can add to the patient’s disinterest in eating, a difficult circle to break.
Drastic losses of body mass (fat and muscle) may lead to electrolyte imbalances, which are too high or too low levels of certain electrolytes, such as potassium, magnesium, and sodium. This leads to reduced strength, increased fatigue and weakness, and can cause numbness, tingling, involuntary twitching, and even pain. Severely malnourished people can have difficulty performing even basic tasks, such as bathing and grooming. In severe cases, these imbalances can affect how your heart functions and lead to pneumonia and infection.
Cachexia is a common side effect of cancer. Cancer cachexia most often affects patients with cancers of the upper gastrointestinal tract, including the esophagus, stomach, and pancreas. Not all cancer patients are affected equally by cachexia; for example it is frequently seen in lung cancer, but rarely in breast cancer. Cancer related cachexia does not usually occur in early stage cancer and is seen almost exclusively in advanced and metastatic disease.
There are three stages of cachexia:
- Precachexia – weight loss of less than 5% of body weight
- Cachexia – weight loss greater than 5% of body weight
- Refractory Cachexia – refers to patients with cachexia whose cancer treatments are no longer working and have a life expectancy of less than 3 months
What are the signs and symptoms of cachexia?
The most common sign of cachexia is drastic (greater than 10% of total body weight) weight loss. This includes loss of both fatty tissue and muscle mass. Other symptoms include loss of appetite, no desire to eat, lack of any sense of taste, weakness, fatigue, electrolyte imbalance, anemia (low red blood cell count), and a depressed immune system (inability to fight infection).
What happens to a cachectic individual?
Poor nutrition results in the body using itself for energy. The skeletal muscle and fatty tissue break down to provide the body with the energy it needs, which results in the loss of body and muscle mass. This leads to fatigue and weakness, which results in difficulty performing daily activities.
Drastic weight loss can be a risk factor for poor survival of a cancer diagnosis. Cachectic patients have worse outcomes with surgery, chemotherapy, and radiation therapy. Good nutrition is important for healing and recovery from treatment. Cachexia is also a cause of distress and anxiety among patients and their family members, as changes in body image are very visible.
Treatment for cachexia
As soon as cachexia is suspected, it is important for a patient’s nutritional status to be monitored closely and for interventions to be started. Early treatment typically leads to better outcomes. Cachexia can be treated by better managing symptoms that affect appetite, including nausea, pain and constipation. Treatments can attempt to stimulate the appetite with medications including synthetic hormones and corticosteroids. Nutritional supplements, such as high calorie and high protein drinks and snacks can help combat cachexia. The support of a dietician to identify supplements and dietary changes can help increase the number of calories a person gets in and reverse weight loss.
Parenteral nutrition, which is nutrition given intravenously (by IV), can also be of benefit. However, it should only be used temporarily since it can increase the risk of infection. It is important to keep in mind that even with treatment, a person with cachexia may not gain or even maintain his or her weight.
When to contact your provider
It is important to notify your provider if you begin to lose weight unintentionally, as this one of the first signs of cachexia. Cachexia may not be avoidable or reversed completely, but it is treatable with the help of your care team.
Dhanapal R et al. Cancer cachexia. Journal of Oral and Maxillofacial Pathology. Sep-Dec 2011; 15(3):257-260.
NCI. Tackling the conundrum of cachexia in cancer. 2011. Found at: https://www.cancer.gov/about-cancer/treatment/research/cachexia
Tazi EM and Errhani H. Treatment of cachexia in oncology. Indian Journal of Palliative Care. Sep-Dec 2010; 16(3): 129-137.