Cancer Cachexia Management Strategies

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Cancer Cachexia Management Strategies
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Review Date 2/12 O-0537
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Agenda

1. What is cancer cachexia?
2. Prevalence
3. Strategies to manage cachexia

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Cancer Cachexia Defined

• A complex metabolic syndrome associated with
  underlying illness and characterized by the loss
  of muscle with or without loss of fat mass

Braun TP, Marks DL. Pathophysiology and treatment
of inflammatory anorexia in chronic disease.
Journal of Cachexia, Sarcopenia, and Muscle.
20101135-145.
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Causes of Cachexia

• Tumor-induced response that causes an increase in
  proinflammatory cytokines
• Results in a breakdown in skeletal muscle
• Chronic inflammatory state

Dodson S, Baracos VE, Jatoi A, et al. Muscle
wasting in cancer cachexia clinical
implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 201162265-279.
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Results of Cachexia

• Weight loss
• Anorexia
• Muscle wasting
• Altered immune function
• Fatigue

Dodson S, Baracos VE, Jatoi A, et al. Muscle
wasting in cancer cachexia clinical
implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 201162265-279.
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Results of Cachexia (contd)

• Physical disability
• Diminished quality of life
• Poor treatment outcomes
• Increased toxicity with chemotherapy
• Reduced survival

Dodson S, Baracos VE, Jatoi A, et al. Muscle
wasting in cancer cachexia clinical
implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 201162265-279.
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Cycle of Malnutrition
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Cascade of Cachexia

• Cancer Diagnosis
• Tumor-Induced Inflammation

IL-6
IL-6
INF
TNF
Increased protein catabolism Decreased protein
anabolism Decreased calorie intake Increased
insulin resistance Increased lipolysis Increased
REE
ILinterleukin, REEresting energy expenditure,
TNFtumor necrosis factor Dodson S, Baracos VE,
Jatoi A, et al. Muscle wasting in cancer
cachexia clinical implications, diagnosis, and
emerging treatment strategies. Annu Rev Med.
201162265-279.
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Managing Cachexia

• Increases in protein and calories alone will not
  halt the catabolic processes responsible for
  cachexia

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Managing Cachexia (contd)

• Targeted nutrition therapy that might prove
  beneficial
• Eicosapentaenoic acid (EPA), an omega-3 fatty
  acid
• ß-hydroxy-ß-methylbutyrate, found in Juven and
  Ensure Clinical Strength

Argilés JM, Olivan M, Busquets S, López-Soriano
FJ. Optimal management of cancer
anorexia-cachexia syndrome. Cancer Manag Res.
20102227-38.
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Managing Cachexia (contd)

• Pharmacological agents
• Appetite stimulants, such as Megace
• B2 antagonists, such as Symbicort, that increase
  protein deposition
• Thalomid, which targets proinflammatory
  cytokines
• Oxandrin, which promotes the anabolic process

Dodson S, Baracos VE, Jatoi A, et al. Muscle
wasting in cancer cachexia clinical
implications, diagnosis, and emerging treatment
strategies. Annu Rev Med. 201162265-279.
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Summary

• May need targeted nutrition therapy or
  medications to treat cancer cachexia