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Talking about Cancer Cachexia is important

Cancer cachexia has a profound impact on patients and families. We know that cancer cachexia shortens survival, increases the side-effects of chemotherapy and decreases patients’ ability to complete treatment. In addition there are psychological and social effects that decrease patients and families quality of life. Loss of independence, loss of sensory pleasure, sense of helplessness, and conflict within the patient- family have been described. The loss of weight and effects on physical appearance can disturb femininity/masculinity, self-confidence, and sense of identity. There may also be conflict between family/patients and health care providers. Doctors may be so focused on treating the cancer that they create a perception that loss of appetite and weight are either unimportant or untreatable.

Patients and their families must be empowered to self-manage important aspects of cancer cachexia such as diet, physical activity and symptoms. This requires open and honest communication between patients/caregivers and their doctors, nurses, nutritionists, and between patients and their caregivers. Below are some of the questions patients and caregivers should be asking health care providers.

Will I develop cancer cachexia?
The frequency and severity of anorexia and cachexia vary depending on cancer type and stage. Some cancers such as esophageal or pancreatic cancer, cause poor appetite and weight loss in >80%. Lung cancer is another tumor that causes cachexia frequently (>65%). Those patients with breast cancer are less likely to develop cachexia (< 30%).

How do I know I have cancer cachexia?
Cancer cachexia occurs when there is weight loss of greater than 5%, often combined with a poor appetite and fatigue. A weight loss of greater than 5% compared to your usual weight is important. Survival and quality of life are affected and side-effects due to chemotherapy increase. Referral to a dietitian and treatment of symptoms that may be worsening your food intake are important. These symptoms can be treated effectively with the help of medications; they include severe pain, nausea, feeling full and bloated after just a few bites of food, constipation and depression. Requesting referral to a specialist palliative care team that are expert in the treatment of symptoms may be necessary.

What are some drug treatments for cachexia?
There are currently no approved specific medications for cancer cachexia in the United States. Some medications like corticosteroids (e.g. dexamethasone and prednisone), and megestrol acetate improve appetite in some people but do not increase muscle size or strength. They also have the potential for causing side-effects such as fluid retention, blood clots and low testosterone. It is important to discuss these side-effects with your doctor before starting a medication. Unfortunately other medications such as tetrahydrocannabinol have not been shown to be effective in cancer cachexia, even though they helped with appetite in HIV patients. There are promising new drugs in development for cachexia but they have not yet been approved for use.

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