Weight and Appetite Loss in Cancer

Weight and appetite loss in cancer patients, referred to as the cancer anorexia-cachexia syndrome, is a complex, multifactorial syndrome, defined by an ongoing loss of skeletal muscle mass, with or without loss of fat mass, which cannot be fully reversed by conventional nutritional support, and may lead to progressive functional impairment. It is a hypercatabolic state in the context of chronic inflammatory response best described in the setting of cancer but can also be seen in other advanced chronic illness. Cancer cachexia occurs in approximately 50% of cancer patients, and in 80% of those with advanced cancer. It impacts adversely on function, treatment tolerability and treatment response, and health service utilization, but most importantly, dignity, sense of self, quality of life, and survival. The pathophysiology of cancer cachexia is complex and multifactorial. It is characterized by a negative protein and energy balance, driven by a variable combination of reduced food intake, increased resting energy expenditure, and net loss of lean tissue. The best approach to weight and appetite loss among cancer patients is a multimodal therapy, in which a personalized combination of pharmacologic and nonpharmacologic treatments is implemented. This chapter will provide an overview of the cancer anorexia cachexia syndrome as relevant to the practice of clinicians of all disciplines managing cancer patients.

Virtual Teaming: Leveraging Team Science Sense-Making During COVID-19

Individuals with cancer anorexia cachexia syndrome (CACS) experience multifaceted distress. To address CACS patient concerns regarding their experience of care, our cancer center established a specialized CACS clinic in 2016. We applied the team science principle of the team mental model (TMM) to support development of an effective interprofessional collaborative CACS care team. In 2020, cessation of CACS clinic in-person visits during coronavirus disease 2019 (COVID-19) threatened the viability of the entrenched TMM and once again jeopardized the patient experience of care. We present a case-based vignette as a representative composite of patient experiences to illustrate the challenges. A 48-year-old female was referred to our CACS clinic for pancreatic cancer-associated appetite and weight loss during COVID-19. To reduce risk of infection, in-person clinic visits were curtailed. When informed about the resulting need to defer the CACS assessment, the patient and her spouse expressed concern that postponement would adversely affect her ability to undergo anticancer treatments or achieve beneficial outcomes. To minimize delays in CACS treatment and optimize the patient experience of care, we applied the team science principle of sense-making to help the team rapidly reformulate the TMM to provide interprofessional collaborative CACS care via telemedicine. The sense-making initiative highlights opportunities to examine sense-making within health care teams more broadly during and after the pandemic. The application of sense-making within interprofessional cancer care teams has not been described previously.

Association between Growth Differentiation Factor-15 (GDF-15) Serum Levels, Anorexia and Low Muscle Mass among Cancer Patients

The pathophysiology of cancer anorexia is complex and serum biomarkers, including growth and differentiation factor(s) (GDF), may be modulated. We explored the association(s) between GDF-15 serum levels and anorexia and, secondarily, with low muscle mass and body weight loss in cancer patients. We considered gastrointestinal and lung cancer patients (CP) and healthy BMI-matched controls. The FAACT-questionnaire was administered to diagnose anorexia and we calculated the L3-SMI by CT scan to assess low muscularity, setting their cutoff values at the lowest tertile. GDF-15 serum levels were assessed by ELISA. We enrolled 59 CP and 30 controls; among CP, 25 were affected by gastrointestinal and 34 by lung cancer. Anorexia was present in 36% of CP. Gastrointestinal CP resulted more anorexic compared to lung CP (p = 0.0067). Low muscle mass was present in 33.9% of CP and L3-SMI was lower in gastrointestinal compared to lung CP (p = 0.049). The GDF-15 levels were higher in CP vs. controls (p = 0.00016), as well as in anorexic vs. non-anorexic CP (p = 0.005) and vs. controls (p < 0.0001). Gastrointestinal CP showed higher GDF-15 levels vs. lung CP (p = 0.0004). No difference was found in GDF-15 between CP with low muscle mass and those with moderate/high muscularity and between patients with body weight loss and those with stable weight. Our data support the involvement of GDF-15 in the pathogenesis of cancer anorexia. The mechanisms of action of GDF-15 in cancer should be further clarified also regarding the changes in muscularity.

Cachexia and anorexia in cancer; a systematic review

The treatment strategy for cancer cachexia is based on the cachexia stage of the cancer and its phenotypes, therefore interventions and expected outcomes vary. In order for the patient to get the most out of the treatment, it should be done based on the mechanism of intervention and the quality of life of patients should be addressed, including aspects of rehabilitation and reduction of the patient’s suffering using a multidisciplinary team. Given the importance of the subject, the present study aims to investigate cachexia and anorexia in cancer. From the electronic databases, PubMed, Cochrane Library, Embase, Web of Sciences have been used to perform a systematic literature until 2020. Therefore, a software program (Endnote X8) has been utilized for managing electronic titles. Searches were performed with mesh terms. This review recommended that clinicians establish an interaction between cancer anorexia-cachexia syndrome (CACS) treatments and chronic pain treatments and choose the best treatment option.