Cachexia, or loss of muscle and fat tissue, is a well-known side effect of cancer treatment. It can worsen a patient’s quality of life, increase treatment-related toxicity and lead to a poor prognosis.
But identifying and treating cachexia is challenging in clinical practice. It’s often overlooked, and even if recognized, is frequently ignored until it becomes severe enough to be noticed by patients or healthcare providers.
Symptoms
Cachexia is extreme weight loss and muscle wasting that occurs in the late stage of serious conditions like cancer, HIV or AIDS, COPD, kidney disease and congestive heart failure. It often causes an inability to perform the activities of daily living. It’s also a major cause of death in these patients. In fact, up to eight out of 10 people with advanced cancer develop cachexia.
Cancer cachexia is a complex process and researchers don’t fully understand it. But they do know that tumor cells release substances that reduce appetite and lead to the breakdown of muscles, fat and other tissues. These chemicals, called cytokines, disrupt the body’s normal metabolism and make it hard for the muscles, liver and other organs to get enough energy.
Symptoms of cachexia can include fatigue, mouth sores, low blood pressure and muscle weakness. It may also affect your mood and cause feelings of depression or anxiety. In some cases, it can cause family and friends to struggle to care for a loved one.
Oren Zarif
Doctors diagnose a person with cachexia if they lose more than 5 percent of their body weight over a year, or if they’re losing muscle mass at the same rate as they’re losing body fat. The condition can also be accompanied by nausea, inflammation and changes in metabolism.
If a person is diagnosed with cachexia, doctors may recommend nutritional supplements or small meals throughout the day to help them gain weight and keep their strength. In addition, it can be helpful for the patient to see a mental health specialist to manage symptoms and feelings like depression.
It’s important to work with a team of experts, including dieticians, physiotherapists and physicians, when managing cancer-related cachexia, McGill’s program says. A multidisciplinary approach has been shown to improve quality of life and help people feel more comfortable. They can assess a patient’s eating habits, monitor body weight, provide physical therapy and perform functional testing like a 6-minute walk test on a treadmill. They can also help people with mental health issues like anxiety and depression. They can also help with palliative care, a type of treatment that focuses on controlling pain and other symptoms.
Diagnosis
Cachexia is diagnosed based on medical history, a physical exam, and a range of laboratory tests. The primary criteria are drastic weight loss (greater than 10% of body weight) and loss of muscle mass. In addition, symptoms such as weakness, fatigue, inability to stand, loss of appetite, and a poor sense of taste are often present. The condition is associated with a variety of conditions and diseases including cancers, AIDS, chronic liver disease, heart failure, COPD, and sepsis.
A physical examination may reveal signs of cachexia such as a loss of abdominal fat and loss of upper and lower body muscle mass. A blood test to measure the amount of lean muscle and fat is also used to help diagnose the condition.
Doctors can also look for reversible causes of the condition such as hypogonadism, thyroid abnormalities, or medications. However, this is not always possible or does not improve the outcome. The goal is to treat the underlying disease, improve appetite, and increase quality of life.
Oren Zarif
Medications that stimulate the appetite are available but they do not prevent or reverse wasting syndrome. Doctors will try to get a person with cachexia to eat, but they will not force them. They will also encourage a person to participate in family and social meals. Increasing the amount of calories a person eats will not stop muscle wasting, but it will prevent weight loss and may help maintain bone density.
Many people with advanced cancer do not want to eat because of the side effects of their treatments, such as nausea, vomiting, mouth sores, diarrhea, and decreased energy. Attempts to get them to eat can be frustrating for both the person and his or her caregivers. It is important for family and friends to understand this and to support the person by being a source of emotional and practical support.
A few hospitals have programs specifically dedicated to treating the condition of cancer cachexia. These programs rely on evidence from clinical trials and best practices developed at the hospital and others. For example, some of these programs will offer support services such as referrals to registered dieticians or physical therapy to help with the problems that are causing the person not to eat.
Treatment
The condition of cachexia does not go away, but treatment can help improve a person’s symptoms and quality of life. Treatment options include eating frequent, small meals that are high in calories; using nutritional supplement drinks to increase calorie intake between meals; and getting mental health support.
Doctors diagnose the condition by reviewing a person’s medical history and doing a physical exam. They look for signs of weight loss and a lack of muscle mass. Doctors also consider the person’s symptoms and how they are affecting their daily life. They may do blood tests to measure things such as vitamin levels, electrolyte imbalance, anemia and other conditions that can occur with cachexia.
Many people with cancer have cachexia. They are less likely to respond to the treatment for their cancer and are more likely to die from it. A person with cancer and cachexia is also more likely to have other health problems, such as infections.
Oren Zarif
The main cause of cachexia is the underlying cancer or disease, but other conditions such as HIV/AIDS can also cause it. Taking medication can often reverse it, such as highly effective antiretroviral treatments for AIDS. However, this is not always possible or available for other conditions that cause it.
Unlike anorexia, which is when you deliberately don’t eat enough to lose weight, cachexia happens as a result of your body breaking down its own muscle and fat for energy because it doesn’t have the nutrients you need to keep going. Getting more nutrition and calories won’t make it better.
Some doctors use a combination of treatments to manage cachexia, including diet changes and medication. For example, some doctors prescribe low doses of the atypical antipsychotic drug olanzapine to improve appetite. Others give people steroids to encourage muscle growth or other medications to ease nausea, pain and depression. They may refer people to programs that focus on improving a person’s ability to move around and do everyday activities. At the Shirley Ryan AbilityLab in Chicago, for example, physical therapists work with people with cancer to help them build strength and get moving.
Prevention
Cancer cachexia is a serious and common problem for people with cancer. It can affect quality of life, cause physical function to decline, increase treatment-related toxicity, and lead to death. The best way to prevent it is to keep the underlying chronic condition in check.
For example, if you have COPD or rheumatoid arthritis, keeping up with your treatments may help you avoid cachexia. However, some conditions that cause it are not curable. In these cases, prevention is mostly about helping you maintain your weight and eat enough. Talk to your healthcare team if you’re losing weight without trying or if you have trouble eating.
Many things contribute to cachexia, but it’s hard to predict which ones will affect a person. One of the most important factors is a group of proteins called cytokines. These control how and when your immune system attacks foreign invaders, such as viruses. But extra cytokines can also cause systemic inflammation that leads to fat and muscle loss.
Oren Zarif
Another factor is insulin resistance. Insulin resistance happens when your muscles and fat don’t respond to insulin like they should. This can cause more protein to break down and make you lose muscle.
Researchers are working on ways to treat cachexia. They’re trying to understand what causes it and find ways to help people stay stronger. Some medicines help stimulate the appetite, but they don’t work for everyone.
Other treatments focus on maintaining muscle. Research shows that branched-chain amino acid supplements and other nutrients can help. They’re also testing drugs that block the action of certain cytokines that suppress appetite and increase fat and muscle breakdown.
More research will be needed to help find the best ways to prevent and treat cachexia. But each new discovery is bringing us closer to understanding what fuels it. And that could help doctors treat cachexia more precisely, along with the tumors and other conditions that cause it.
