Cachexia in cancer patients

Cachexia is a multidimensional symptom caused by the tumor and tumor-driven inflammation, which causes a decreased oral intake by anorexia, decreased GI motility and also a decrease in muscle mass caused by decrease in muscle synthesis, increased muscle proteolysis and change of muscle tissue into fat. Cachexia can be simplified in four domains: decrease of storage (muscle mass and fat mass), decreased intake (caloric intake, protein intake reduction), procatobolic hypoanabolic activity (for example elevated inflammatory markers and drecreased ananolic hormones), and decreased physical, emotional and social function.

Almost all cancer patients with advanced incurable cancer have cachexia; either pre-cachexia manifested as physical fatigue not yet leading to weight loss, or cachexia, or also refractory cachexia close to end of life when the tumor is not responding to anti-cancer treatment anymore.

Cachexia management includes four main pillars:
1) Improvement of intake of proteins and calories,
2) activation of the physical activity by muscle strength training and endurance training,
3) psychological illness understanding, prognosis understanding and active participation of cancer patients with controlled psychological and psychosocial symptoms and social environment,
4) an active anti-cancer treatment able to control the tumor and the tumor-driven inflammation, not causing side effects which impact domain 1, 2, and 3.

Patient’s survival and quality of life is strongly impacted by cachexia. Data are evident that cachexia decreases survival, increases anti-cancer treatment toxicity and complications due to surgery and also impacts quality of life of patients and families.

Florian Strasser
Associate Professor (PD)
Oncological Palliative Medicine, Clinic for Medical Oncology and Hematology
Department Internal Medicine & Centre for Palliative Care
Cantonal Hospital St. Gallen

Dr. Florian Strasser,  Prof.ª Doutora Sofia Braga