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Anorexia and Cachexia

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In pancreatic patients undergoing surgery, 6% of body weight ... Loss of taste due to therapy, both irradiation. and chemotherapy. Dysphagia ... – PowerPoint PPT presentation

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Title: Anorexia and Cachexia


1
Anorexia and Cachexia
  • Eating reflects social interaction
  • ECOG--54 had wt loss pre tx
  • Wt loss most common
  • in gastric cancer-87
  • in lymphoma-31
  • Seen in 85 of advanced cancer patients

2
Wt loss in cancer
  • Seen in 50 of 3,000 patients by DeWys
  • 60 of patients with lung cancer
  • 39 of patients undergoing surgery
  • In pancreatic patients undergoing surgery, 6 of
    body weight
  • In unresectable pancreatic patients, 14 of body
    weight

3
Pathophysiology of anorexia/cachexia
  • Not simply use of calories by tumor vs. host
  • TNF/Cachetin, other cytokines responsible
  • Cachexia caused by
  • decreased food intake
  • metabolic abnormalities

4
Loss of appetite
  • Loss of taste due to therapy, both
    irradiationand chemotherapy
  • Dysphagia
  • Pain in head and neck region
  • Depression

5
Chronic nausea
  • Autonomic insufficiency
  • Delayed gastric emptying
  • Metabolic abnormalities
  • Bowel obstruction
  • Constipation
  • Increased intracranial pressure

6
Objective testing
  • Weight--
  • Weight loss of 10 over 6 months poor prognosis
  • Physical exam--muscle wasting, strength
  • Calorie counts
  • Serum albumin

7
Goals of Therapy
  • Aggressive nutritional support may be
    counterproductive
  • Relief of hunger and anxiety of starvation
  • In advanced disease, hydration may befor family
    comfort

8
Pharmacologic Management of Anorexia/Cachexia
  • Megesterol acetate
  • Dose response--Loprinzi, 800 mg/day optimal
  • higher doses caused fluid retention
  • Corticosteroids
  • Benefit may be transient
  • No change in objective measures

9
Pharmacologic Management of Anorexia/Cachexia,
Part II
  • Cannabinoids
  • Increase appetite
  • Stabilize wt loss
  • Hydrazine
  • Controlled trials show no benefit
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