What is Cachexia?

Many people with cancer experience weight loss at some point during the course of their disease. Weight loss can be an early sign of an undiagnosed tumor. For some people, this early and unintended weight loss is the condition that prompts an initial doctor visit. For others, weight loss occurs only as the cancer and its treatment advance. Weight loss is evident in 31% to 87% of people with cancer, depending on tumor type.2 Such weight loss is associated with poor outcomes for cancer patients—reduced response to therapy, more complications and infections, lower quality of life, and reduced survival. Most cancer patients are particularly troubled by reduced strength and loss of functional abilities, conditions that markedly lower their quality of life.3

An imbalance between nutritional needs and requirements can lead to cancer-induced weight loss, which may progress and ultimately result in refractory cachexia and death.5 People with solid tumors—as in lung and gastrointestinal cancer—are likely to develop this type of weight loss.4 Unintended weight loss in cancer patients is different from other types of weight loss (e.g., starvation or depression-associated weight loss) because it cannot be reversed by intake of additional calories.6-8 In patients with cancer-associated weight loss, metabolism of nutrients is altered. As a result, trials of conventional therapy for cancer-induced weight loss have demonstrated little weight gain, and few or no improvements in functional ability, quality of life, or survival.9-11

Cachexia and unintended weight loss are due largely to metabolic changes in the cancer patient’s body.12,13 Cachexia is initiated when proinflammatory cytokines and other catabolic factors, such as proteolysis-inducing factor (PIF) and lipid-mobilizing factor (LMF), are released in tissues and in circulation. These cytokines and catabolic factors are produced by the tumor or by the host in response to the tumor.13-15 Therapy for weight loss in cancer patients should therefore target these specific inflammatory triggers and their resultant metabolic abnormalities.

Cachexia is associated with inflammation. Tumors and also the body’s immune response to tumors create substances that cause inflammation. This inflammation causes many complications.

There are three stages of cachexia—precachexia, cachexia, and refractory cachexia. Not all people will progress through all three stages. Your risk of progression depends on your tumor type and stage, amount of weight loss, presence of inflammation, and severity of anorexia. The earlier you take action, the better.

Cachexia can cause reduced tolerance to anticancer therapy. As part of a complete treatment plan, nutrition plays an important role in therapy tolerance.

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