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The importance of early detection of cancer cachexia

Cancer cachexia, defined as an involuntary loss of muscle (and often fat) along with a decline in function, is a common complication of cancer. It is often associated with worse quality of life, fatigue and decreased response to therapy and it is also associated with lower survival. Unfortunately and in spite of its relevance, this diagnosis is often missed and cachexia goes untreated.

The medical team caring for patients with cancer traditionally has focused on the administration of therapies that can prolong survival or delay the progression of the disease. Nevertheless, there is a growing interest in expanding this scope to include the management of other symptoms that will have a clear impact on the quality of life of patients.

Management of pain and nausea, for instance, has dramatically improved quality of life in cancer patients over the last decades. Other symptoms, like cachexia or anorexia (decreased food intake and appetite) are now also being recognized by the research community as important symptoms. However, this has not yet translated into clinical practice.

From the perspective of the patient and their loved ones, cachexia and anorexia often are a source of anxiety as they are interpreted as ominous signs but these concerns not always are voiced during the visit to the doctor due to a number of reasons: anxiety or fear during the visit, or the expectation that the doctor should be the one bringing this issue up for discussion.

It is important for both the medical team and the patient and his family to discuss this issue early in the course of the disease and even if cachexia is not yet present in patients who are considered to be at risk. Discussing this issue will probably relieve some of the anxiety but most importantly it may change the management strategy. In all these cases a visit with a registered dietitian is indicated in order to ensure that patients are getting adequate nutrition and the medical team should explore other causes of anorexia and cachexia that could be treated (for instance, an overactive thyroid, a side effect of certain drugs such as pain pills, uncontrolled nausea, pain, dental issues, etc). Also, and although no drug treatment is approved for the treatment of cachexia at this point, there may be clinical trials with drugs in development that these patients may be interested in. Other resources available for patients are found on the right-hand side.

Jose M. Garcia

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