Practice Consideration
Cancer Cachexia Syndrome
Cancer cachexia is a multifactorial syndrome experienced by some cancer patients. It manifests in an ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutrition support.(1) The pathophysiology is characterized by a negative protein and energy balance caused by reduced food intake and increased metabolism.(1-3) Patients with cancer cachexia who are moderately hypermetabolic require ≥120 kJ (30 kcal) and 1.2 to 1.5 g protein per kilogram of body weight.(4,5) The normal requirement is 0.8 to 1.0 g per kilogram of body weight.(4)
References
1. Fearon K, Strasser F, Anker SD et al. Definition and classification of cancer cachexia: An international consensus. Lancet Oncol. 2011; 12: 489-495.
2. Fearon KC. Cancer cachexia and fat-muscle physiology. N Engl J Med. 2011; 365: 565-567.
3. Vanhoutte, G et al. Cachexia in cancer: What is in the definition? BMJ Open Gastro 2016: e000097. doi:10.1136/bmjgast-2016-000097.
4. Queensland Government: Nutrition Education Materials Online. Estimating energy, protein & fluid requirements for adult clinical conditions 2014; Accessed 16 January 2019, Available from: https://www.health.qld.gov.au/nutrition/resources/est_rqts.pdf
5. Bauer J, Ash S, Davidson W. et al. 2006. Eveidenced based guidelines for the nutritional management of cancer cachexia. Nutrition and Dietetics 63; 2:S5-S32.
6. Evans WJ, Morley JE, Argilés J, et al. Cachexia: a new definition. Clin Nutr 2008;27:793–9
7. Walston, J. Sarcopenia in older adults. Curr Opin Rheumatol. 2012 Nov:24(6): 623-627. doi: 10.1097?BOR.ob013e328358d59b
8. EORTC QLQ-C30. European Organization for Research and Treatment of Cancer (EORTC). Accessed 1 December 2017. Available from: http://groups.eortc.be/qol/eortc-qlq-c30.
There is no clear consensus on the criteria for cancer cachexia. The following table shows two different possibilities. Most recent research indicates that Evans et al's criteria are more closely linked to prognosis (forecast of future progression of the disease) than the previous definition by Fearon.(1)
| Fearon et al's Criteria(1) | Evans et al's Criteria(6) | Supporting Documentation |
|---|---|---|
| Weight loss greater than 5% in past 6 months without starvation |
Weight loss greater than 5% in past 12 months and underlying chronic disease | Nutrition Risk Screening (NRS) Patient Generated-Subjective Global Assessment (PG-SGA)* |
| AND/OR | OR | |
| Weight loss >2% and BMI <20 | BMI <20 | Nutrition Risk Screening (NRS) Patient Generated-Subjective Global Assessment (PG-SGA) |
| AND/OR | AND Three of the next five criteria |
|
| Abnormal biochemistry » C-Reative Protein > 5 mg/L » Heomoglobin <12 g/dL » Albumin <3.2 g/d |
Laboratory test results (standard blood test) | |
| Fatigue |
EORTC*** tiredness score ≥ 66.7 |
|
| Anorexia |
EORTC*** appetite loss: score ≥ 3 |
|
| Decreased muscle strength |
Hand grip strength (dynamometer) |
|
| Weight loss >2% and sarcopenia ** | Lean tissue depletion |
Bioelectrical Impedance Analysis (BIA)
» Male SMI <7.26 kg/m2 » Female SMI <5.45 kg/m2 |
| * | See Practice Consideration on PG-SGA |
| ** | A consensus of the clinical definition of Sarcopenia has not been reached. Many research studies use either muscle mass, muscle strength, or physical function measurements alone or in combination as markers for sarcopenia.(7) |
| *** | European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (EORTC QLQ-C30), which incorporates nine multi-item scales: five functional scales (physical, role, cognitive, emotional and social functioning), three symptom scales (fatigue, pain and nausea/vomiting) and a Global Health Status/Quality of Life (QoL) scale.(8) |
References
1. Fearon K, Strasser F, Anker SD et al. Definition and classification of cancer cachexia: An international consensus. Lancet Oncol. 2011; 12: 489-495.
2. Fearon KC. Cancer cachexia and fat-muscle physiology. N Engl J Med. 2011; 365: 565-567.
3. Vanhoutte, G et al. Cachexia in cancer: What is in the definition? BMJ Open Gastro 2016: e000097. doi:10.1136/bmjgast-2016-000097.
4. Queensland Government: Nutrition Education Materials Online. Estimating energy, protein & fluid requirements for adult clinical conditions 2014; Accessed 16 January 2019, Available from: https://www.health.qld.gov.au/nutrition/resources/est_rqts.pdf
5. Bauer J, Ash S, Davidson W. et al. 2006. Eveidenced based guidelines for the nutritional management of cancer cachexia. Nutrition and Dietetics 63; 2:S5-S32.
6. Evans WJ, Morley JE, Argilés J, et al. Cachexia: a new definition. Clin Nutr 2008;27:793–9
7. Walston, J. Sarcopenia in older adults. Curr Opin Rheumatol. 2012 Nov:24(6): 623-627. doi: 10.1097?BOR.ob013e328358d59b
8. EORTC QLQ-C30. European Organization for Research and Treatment of Cancer (EORTC). Accessed 1 December 2017. Available from: http://groups.eortc.be/qol/eortc-qlq-c30.
Updated January 16, 2019