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Cachexia in Cancer
Aka: Cachexia in Cancer, Anorexia in Cancer, Wasting Syndrome in Cancer, Anorexia-Cachexia Syndrome, Cachexia in Terminally Ill Patients, Cancer Related Cachexia, Cancer Cachexia
- See Also
- Unintentional Weight Loss
- Pathophysiology
- Results in wasting of body fat and Muscle
- Cytokine elevations related to Wasting Syndromes
- Interferon
- Tumor Necrosis Factors
- Symptoms
- No appetite (Anorexia)
- Unintentional Weight Loss (Cachexia)
- Fatigue (see Fatigue in Cancer)
- Differential Diagnosis
- See Unintentional Weight Loss
- Chronic organ failure
- Serious chronic infection
- AIDS
- Evaluation: Identify and treat reversible causes
- Chronic Pain
- Mouth condition
- Dry Mouth
- Chemotherapy related Oral Mucositis
- Diminished gastrointestinal motility
- Constipation
- Reflux Esophagitis
- Infection
- Oral Candidiasis
- Oral Herpes Simplex infection
- Management: Nutrition
- Background
- Wasting is not reversed by improved nutrition
- Aggressive alimentation may increase discomfort
- Management
- Small Frequent Meals
- Avoid blended, pulverized foods
- Avoid parenteral nutrition
- Patient eats what they want
- Avoid dietary restriction (diabetics eat ice cream)
- Avoid foods with unpleasant odor
- Educate families that wasting is not inadequate care
- Families can offer care in alternative ways
- Moisten patient's lips or mouth with sponge
- Offer massage
- Read or play soft music for patient
- Management: Medications
- General
- Discontinue medication if no benefit in 2-6 weeks
- Main options
- Megestrol acetate (Megace) 200 mg PO q6-8 hours
- Dexamethasone (Decadron) 2 to 20 mg PO qAM
- Dronabinol (Marinol) 2.5 mg PO bid to tid
- Medroxyprogesterone acetate
- Experimental: Androgens
- Oxandrolone (Oxandrin)
- Nandrolone (Durabolin)
- Other options
- Macrolide antibiotics
- Cyproheptadine
- Hydrazine sulfate
- Cannabinoids
- References
- MacDonald (2003) J Am Coll Surg 197:143-57 [PubMed]
- McCann (1994) JAMA 272:1263-6 [PubMed]
- Nelson (2000) Semin Oncol 27:64-8 [PubMed]
- Ross (2001) Am Fam Physician 64(5):807-14 [PubMed]