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.