Cachexia in the Cancer Patient

Author: Marisa Healy, BSN RN and Karen Arnold-Korzeniowski, MSN RN
Last Reviewed: October 03, 2022

What is cachexia?

Cachexia, also called cancer cachexia or cancer anorexia cachexia, is a wasting syndrome. This means your body loses fat and muscle due to a chronic disease, such as cancer. Cancer can cause chronic inflammation in your body that can lead to cachexia.

Cachexia happens when there is an imbalance in how your body metabolizes, or absorbs and uses, the food you eat. It causes severe weight loss, loss of appetite, weakness, and fatigue. It can also affect how your body handles cancer treatments you may be receiving. As cachexia progresses, you can have trouble doing basic tasks like bathing and grooming.

There are three stages of cachexia:

  • Precachexia – weight loss of less than 5% of your body weight.
  • Cachexia – weight loss greater than 5% of your body weight.
  • Refractory – when you have cachexia, your treatments are not managing your cancer, and you aren’t expected to live more than 3 months.

Not all patients with cancer will progress to all three stages of cachexia. Your risk of cachexia getting worse can depend on many things, like:

  • Your cancer type and stage.
  • How much food you are eating.
  • How much inflammation you have in your body.
  • Inactivity, or not being able to complete daily tasks.
  • Your cancer treatment not working or having side effects from treatment.
  • If you have had surgery and are not healing as you should.

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 are loss of appetite, no desire to eat, having no sense of taste, weakness, fatigue, electrolyte imbalance, anemia (low red blood cell count), and a weakened immune system (inability to fight infection).

What happens to a cachectic person?

Cancer itself, as well as poor nutrition, causes the body to use itself for energy. Your muscle and fatty tissue break down to provide the body with the energy it needs. This leads to fatigue and weakness, making it hard to do daily activities.

Body muscle and fat are important for healing and recovery from treatment. People with cachectic may not tolerate cancer treatments well. Cachexia also causes distress and anxiety. People often don’t look the same when they have cachexia, which can be upsetting to you and your caregivers.

How is cachexia treated?

Research is ongoing regarding the treatment of cachexia. The first step is to recognize the signs and symptoms of cachexia as soon as possible. Your provider will likely refer you to a registered dietician, who will teach you and your caregivers about ways to increase the number and quality of calories you are eating. Your dietician will likely suggest a high-protein, high-calorie, nutrient-dense diet. It is important to keep in mind that at times, no matter how much you eat, you may continue to lose or only maintain your weight.

Currently, there is no evidence of a specific medication that is useful in treating cachexia. Your provider may prescribe certain medications to help increase your body weight, such as a progesterone analogue (megestrol acetate [MA] and medroxyprogesterone [MPA]), or a corticosteroid. Both of these medications can increase your appetite, and steroids can also reduce inflammation in your body. However, it is not clear whether they help to prevent further weight loss or loss of function.

Some providers believe adding exercise or physical therapy to your treatment plan can help manage cachexia. While there is not strong evidence to support this, talk with your care team about whether adding an exercise regimen may help you.

When should I contact my provider?

Talk to your provider right away if you are losing weight without trying. It is important to keep track of your weight, appetite, nutrition, and ability to carry out daily tasks. If you notice changes in any of these things, call your care team. Cachexia is poorly understood, and you may be referred to a specialist for help. Research is still being done to learn more about cachexia and how to best treat it.

References

Advani, S. M., Advani, P. G., VonVille, H. M., & Jafri, S. H. (2018). Pharmacological management of cachexia in adult cancer patients: a systematic review of clinical trials. BMC cancer, 18(1), 1174. https://doi.org/10.1186/s12885-018-5080-4

Dhanapal R et al. Cancer cachexia. Journal of Oral and Maxillofacial Pathology. Sep-Dec 2011; 15(3):257-260.

Eric J. Roeland, Kari Bohlke, Vickie E. Baracos, Eduardo Bruera, Egidio del Fabbro, Suzanne Dixon, Marie Fallon, Jørn Herrstedt, Harold Lau, Mary Platek, Hope S. Rugo, Hester H. Schnipper, Thomas J. Smith, Winston Tan, and Charles L. Loprinzi. (2020). Management of Cancer Cachexia: ASCO guidelines. Journal of Clinical Oncology, 38:21, 2438-2453. DOI: 10.1200/JCO.20.00611

NCI. 2022. Treating Cancer Cachexia: Progress Looks Possible.

Ni, J., & Zhang, L. (2020). Cancer Cachexia: Definition, Staging, and Emerging Treatments. Cancer management and research, 12, 5597–5605. https://doi.org/10.2147/CMAR.S261585

Tazi EM and Errhani H. Treatment of cachexia in oncology. Indian Journal of Palliative Care. Sep-Dec 2010; 16(3): 129-137.

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