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Introduction

Cancer Anorexia Cachexia is a debilitating and life threatening complication of cancer. Its poor prognosis has long been acknowledged, but a more complete picture on the impact of Cancer Anorexia Cachexia is emerging.1-3

Cancer Anorexia Cachexia is a debilitating condition that negatively impacts the prognosis and quality of life of cancer patients and their families. 6,7

A defining clinical feature of Cancer Anorexia Cachexia is involuntary and progressive weight loss. The available scientific literature indicates that weight loss in cancer is associated with more chemotherapy-related side effects, fewer completed cycles of chemotherapy, a reduction in response to therapy and decreased survival rates.1,4,5

Weight loss and fatigue are strongly and consistently associated with adverse quality of life, reduced functional abilities, more symptoms and shorter survival.8

In addition to its physical impact, Cancer Anorexia Cachexia has a marked psychological impact for both patients and their families.7

Relations between a cachectic patient and his friends and family can become difficult due to conflict over food and often patients report altered body image, which can impact their emotions and social functioning.9,10

Clinical burden

Cancer weight loss is associated with a reduced response to therapy and a higher occurrence of side effects. Indeed, weight loss negatively impacts response to chemotherapy and radiotherapy as well as increasing surgical risk.7 According to available data, reduced survival in patients with Cancer Anorexia Cachexia is most probably due to a decreased tolerance to anticancer treatments and an increased susceptibility to infection and other complications.11The negative outcomes associated with Cancer Anorexia Cachexia, therefore, appear to occur due to decreased treatment and increased toxicity, rather than alterations in the effectiveness of the therapy itself. Cancer patients without weight loss demonstrated a better chance of survival and a greater response to cancer therapy, suggesting that an effective treatment for cachexia may result in more positive outcomes.7

Several studies have provided evidence concerning the implications of weight loss for anticancer treatments.11

Dewys et al. identified weight loss of more than 5% prior to the onset of chemotherapy as the defining point for risk of poor response to therapy and shortened survival.12 A specific study performed in patients with lung cancer showed that subjects with weight loss more frequently failed to complete at least three cycles of chemotherapy and had decreased survival duration.5,10

Additionally, Andreyev et al. reported that in patients with gastrointestinal cancer and weight loss, chemotherapy doses were lower; those patients developed more frequent and more severe dose limiting toxicity, and received on average one month less chemotherapy.4

Another important aspect of cachexia is its impact on the patient’s quality of life. Quality of life among patients with Cancer Anorexia Cachexia is also negatively impacted due to weight loss, fatigue, reduced physical activity and performance status.13,14 According to data reported by Donohoe et al, when the impact of the various factors is related to self-rated quality of life scores, the proportions determined by weight loss and by nutritional intake are 30% and 20% respectively, compared to cancer location (30%), disease duration (3%), and stage (1%), and patients who continue to lose weight while receiving palliative chemotherapy suffer from a reduction in overall quality of life and performance scores compared to those whose weight loss stabilizes.15

Psychological and social consequences

Cachectic patients have to live with poor appetite and weight loss, and this can have a negative impact across psychological and social domains.16The psychological impact of the symptoms that present in Cancer Anorexia Cachexia includes distress, anxiety and a sense of helplessness, whereas the main social themes include social exclusion and conflict over food.16,20

Additionally, weight loss alters body image which can also have a negative psychological impact, and anorexia can reduce the social pleasure of sharing a meal with loved ones.2

Cancer Anorexia Cachexia can generate conflict between patients and families, as well as with health care providers.20

Cancer Anorexia Cachexia can generate negative emotions including conflict between patients and families, as well as with health care providers.21,22 Although caregivers may strongly believe that increased caloric intake can enhance a patient’s quality of life and prolong survival, patients often feel a significant level of eating-related distress when caregivers focus on offering food.15 Patients can end up feeling forced to eat, while caregivers on the other hand can feel at fault, therefore cajoling the patient to eat can become a source of great tension.9,16

Additionally, as Cancer Anorexia Cachexia advances, physical activity is impaired by the loss of muscle tissue, concentration is diminished by fatigue, and mood is dominated by lethargy and increasing indifference. For these reasons, patients can become isolated.11

Insights and perspectives

Several investigations have provided evidence that Cancer Anorexia Cachexia is associated with poor response to chemotherapy and reduced survival. However, due to its complex pathology and clinical presentation, cachexia may often go undiagnosed.6,23,24

Given the associated high morbidity and mortality, Cancer Anorexia Cachexia should receive far greater attention in clinical practice and nutritional issues, which are a contributory factor in the progression of the syndrome, should be taken into consideration from the beginning of the natural history of cancer.2,13

Additionally, much more attention should be given to the psychological impact of Cancer Anorexia Cachexia on both patients and their relatives. Literature reports evidence that neither patients nor family members perceive that health care providers appropriately acknowledge ongoing weight loss or offer viable options for intervention.21

Particularly, family members seem to desire a greater degree of communication with health care providers in order to better understand the underlying causes of the weight loss.15

Especially in advanced stages and with particular tumors (e.g. lung and pancreatic), the problem lies with the cancer more than any lack of appetite, but if this is not well understood, it can generate conflict between patients and their families. Clarification of what causes the disorder may thus relieve some of the burden on patients and the caregiver and dissipate conflict over food intake.9,15

Thus, it is important to recognize that cachexia is a condition that has profound implications for both patients and their families; improved communication with healthcare professionals about cause and consequence is of great importance to not only reduce the burden of disease but also provide better support during disease progression.7

References

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