Cancer Cachexia: All Bones and No Meat
David Hui, MD MSC FRCPC, and Egidio Del Fabbro, MD
How often do anorexia and cachexia occur in patients with advanced cancer?
The frequency and severity of anorexia and cachexia vary widely by tumor type and stage. Poor appetite is almost universal among patients with esophageal or pancreatic cancer, with >80% reporting anorexia despite a good performance status. Approximately 40% of oncology outpatients being treated for solid tumors have severe weight loss of >10%. Up to 30% of breast cancer and acute leukemia patients enrolled in clinical trials experienced weight loss, while 60% of lung and 85% of gastric and pancreatic cancer patients reported weight loss.1
What is cancer cachexia?
Cancer cachexia is “a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterized by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism.”2 A distinction is made between three stages of cachexia. Precachexia is defined as weight loss ≤5%, anorexia, and metabolic change. Cachexia is defined as either weight loss >5%, BMI <20 and weight loss >2%, or sarcopenia and weight loss >2%. Refractory cachexia is defined as variable degree of cachexia, procatabolic state and disease not responsive to anticancer treatment, low performance score, and <3 months of expected survival.