Fluids, Electrolytes & Nutrition: Cancer-Related Cachexia

Cachexia Definition

• Modern Definition: A Complex Metabolic Syndrome Associated with Underlying Illness & Characterized by Loss of Muscle with or without Loss of Fat Mass
• Historical Definition: Unintentional Weight Loss > 10% of Body Weight
  • May Underestimate Frequency in Obese Patients
• Most Common Associated Malignancies:
  • Upper GI Malignancy
  • Pancreatic Cancer
• Associated with Poor Prognosis & Worse Outcomes

Presentation

• Weight Loss – The Prominent Clinical Feature
  • Growth Failure in Pediatrics
• Progressive Muscle Wasting
• Sarcopenia – Loss of Lean Body Mass
• Anorexia
• Fatigue
• Systemic Inflammatory Response
• Anemia or Hypoalbuminemia

Mechanism

• Increased Basal Metabolic Rate & Reduced Dietary Intake
• Associated with Proinflammatory Cytokines:
  • TNF-α
  • IL-1
  • IL-6

Treatment

• Dietary Counseling
• Appetite Stimulants:
  • Progesterone Analogs:
    • Megestrol Acetate (Megace)
    • Medroxyprogesterone Acetate
  • Dexamethasone (Steroid) – Generally Only Considered for Patients with Short Anticipate Life Expectancy (Days-Weeks)
  • *Palliative with No Survival Benefit
• Other Pharmacologic Considerations (Inconclusive Benefit):
  • Olanzapine
  • Mirtazapine
  • Androgens
• No High-Quality Evidence to the Efficacy of Inhaled Marijuana or Ingested CBD Oil – Generally Recommended Against