Being diagnosed with cancer is bad news, but tackling these hard core disorders becomes even more difficult when patients face the risk of being afflicted with an illness that adversely affects your appetite and body mass, eventually leading to death. One such fatal illness is ‘Cachexia’ or ‘Wasting syndrome’.
It is a multifactorial syndrome leading to marked loss of body weight, fat and muscle tissue and characterized by asthenia, anorexia and anemia. It commonly affects people who are in the last stages of chronic diseases such as HIV AIDS, kidney disease, congestive heart failure and cancers.
This syndrome is highly prevalent in cancer patients and it is estimated that over half of the cancer patients develop cachexia syndrome. It significantly affects patients' quality of life and is associated with higher mortality and morbidity rates.
Despite a serious illness, it is largely underexpressed and often overlooked. Education and awareness of this untreatable illness is critical to reduce suffering and avoid additional complications for the both patient and their family members. Let’s discuss cachexia, its symptoms, risk factors, prevention and treatment in detail.
- What is cancer cachexia?
- What causes cancer cachexia?
- What are the stages of cancer cachexia?
- What are the major signs and symptoms?
- How can it be diagnosed in cancer patients?
- Is it treatable?
- Are there any complications?
What is cancer cachexia?
Cachexia often occurs in patients with malignant or advanced cancer. It is usually characterized by inflammation, negative protein and energy balance and an involuntary loss of lean body mass.
The International Consensus Statement on definition and classification of Cancer Cachexia published in Lancet Oncology established three criteria for diagnosis of wasting syndrome in cancer patients:
- Weight loss greater than 5% over last 6 months
- Any degree of weight loss greater than 2% and body mass index (BMI) less than 20
- Weight loss greater than 2% and appendicular skeletal muscle index consistent with sarcopenia
It is an insidious syndrome and associated with poor responses to chemotherapy and decreased survival. It is commonly observed in patients with pancreatic, lung, esophageal, gastric, colorectal, and head and neck cancer.
What causes cancer cachexia?
Cachexia occurs as a result of a complex process that involves several body organs and systems. The exact reason behind the development is still not clear. However, various mechanisms have been proposed in research studies which may contribute to the development of cachexia in cancer patients. These factors include:
- Disturbed homeostatic control of energy balance in cancer
- Increase in pro-inflammatory cytokine activity and systemic inflammation during cancer progression
- Reduced secretion of host anabolic hormones
- Altered host metabolic response with abnormalities in protein, lipid, and carbohydrate metabolism
- Symptoms of cancer or its treatments (eg, pain, nausea, vomiting, depression, and dysgeusia) disturbing food intake
- Loss of appetite
What are the stages of cancer cachexia?
In cancer patients, cachexia occurs in three stages:
- Pre Cachexia: weight loss of less than 5%, along with other symptoms such as impaired glucose tolerance or anorexia
- Cachexia: Weight loss greater than 5 % or other symptoms and conditions consistent with diagnostic criteria
- Refractory cachexia: Patients with cachexia who are no longer responsive to cancer treatment, have a low performance score, and have a life expectancy of less than 3 months
It is not essential that every cancer patient progresses through all the above mentioned stages. The risk of progression is dependent on various factors such as type and stage of cancer, systemic inflammation, food intake, physical activity and complications of anti-cancer therapy.
What are the major signs and symptoms?
The main symptoms of cancer cachexia are significant loss of body weight and muscle mass. Other secondary symptoms include:
- Muscle wasting
- Diarrhea or vomiting lasting for 30 days or more
- Fever lasting for several days
- Loss of appetite or anorexia
- Progressive weakness over a 30 day period
- Reduced energy levels and functional ability
- Extreme tiredness, fatigue and malaise
- Swelling or edema
- Discomfort and lack of motivation
How can it be diagnosed in cancer patients?
The symptoms of this illness are usually observed in the advanced or later stages of cancer but the process leading to the development of cachexia begins early after a cancer is diagnosed. Your oncologist or physician can diagnose cachexia through following measures:
- Body mass index (BMI) and lean muscle mass
- Blood tests include examination of white blood cell counts (WBC), serum albumin, transferrin levels, uric acid, and inflammatory markers, such as C-reactive protein (CRP).
- Screening tools such as the Malnutrition Universal Screening Tool (MUST)
Along with these measures, an evaluation of the stages and natural history of cachexia will help to make possible diagnosis as early as possible. Patients and his/ her family or caregivers should also keep a check on body weight changes occurring with time. Keeping a food diary can also help to prevent or reduce cachexia and its complications.
Is it treatable?
There is no specific treatment for cancer cachexia, due to the variable nature of wasting syndrome. Your physician or oncologist will identify and treat cachexia on a case to case basis due to the variable nature of wasting syndrome. However, a variety of lifestyle modifications and pharmacological treatment can help to reduce cancer associated with cachexia and its complications. It involves:
- Symptom management: Treatment of any physical symptoms that can lead to loss of appetite in cancer patients such as mouth sores, nausea, vomiting and gastroparesis can be helpful in treating cachexia
- Nutrition: Cancer patients often suffer from malnutrition, therefore you need to take care of nutritional requirements. Eat frequent small meals while focusing on calorie-dense foods, and nutritional supplements such as omega-3 fatty acids and amino acids, if required. But, nutritional supplements should not be used as a substitute to food products
- Physical activity: Studies have demonstrated that regular exercise can help to increase appetite and reduce the decline in muscle mass and inflammation observed in cancer patients with cachexia
- Appetite stimulants: It includes the use of various medications such as corticosteroids, medroxyprogesterone, testosterone and megestrol. These drugs have been used for stimulating cachexia in cancer patients, but their effects are unclear yet
- Investigational therapies: Various drugs have been investigated for their potential to treat wasting syndrome in cancer patients. It includes selective androgen receptor modulator, anabolic steroids, ghrelin, non steroidal anti-inflammatory medications, mirtazapine or olanzapine
Are there any complications?
It is a serious illness and can increase the chances of mortality in patients. It can lead to severe complications such as:
- Reduce the functional ability and quality of life of cancer patients
- Impaired treatment response
- Increase the propensity of severe infections due to reduced immunity
- Worsen the symptoms of underlying disease
- Decreases life expectancy
Weight loss is normal in healthy individuals, but it is a danger when it is more pronounced in cancer patients. It can be a sign of wasting syndrome, which if left untreated can lead to severe involuntary weight loss and muscle wastage. It is often underestimated and therefore can worsen the condition of the patient as well as caregivers.
There is no standard treatment for people with cachexia, but several combinations of drugs with nutritional interventions are used to treat this condition. But it is always better to prevent a disease rather than getting treatment in a severe stage. Cancer patients should keep a track of various changes in their body. An active lifestyle with balanced nutrition can significantly reduce the risk of getting cachexia in cancer patients.
Also read more about lifestyle modification a cancer patient should adopt.