CACHEXIA Flashcards
What can cause weight loss in cancer pt?
Cancer cachexia - metastatic disease, pro-inflammatory state, higher metabolic rate
Protein-calorie malnutrition
Hyperglycaemia
Pain
Gastric stasis
Anxiety can exacerbate it
Family dynamics - e.g. family member putting pressure on eating
What is cachexia?
A complex change in the body that causes you to lose weight despite eating normally
Defined as >5% unintentional weight loss
Anorexia + wasting + fatigue
Assessment for cachexia?
Assess gap of usual-> current weight, speed of weight loss, weight loss corrected for fluid retention or obesity, deficits for specific nutrients
Intake- assess anorexia, early satiety, n&v, disturbances of taste/smell, other GI symptoms, % of normal intake, dietary diary for 1-2 days
Assess tumour catabolic activity using CRP
Assess performance status i.e. what effect does it have on their life? - this is a poor prognostic sign
How could we identify cachexia in a pt with obesity?
Possible with CT - unsure if this is actually done
What are we trying to achieve by managing cachexia?
Aim is to increase lean body mass - weight gain due to fluid/fat is unhealthy;Paul
Improve function and QOL
Improve survival
Non-drug interventions for cachexia?
Counselling
Relaxation training
High resistance exercise may help build muscle mass
Diet - increase intake
Nutritional counselling?
Encourage smaller, frequent, more nourishing meals
Good posture for eating and drinking
Exercise between means
Create a pleasant environment for meals
Encourage pt to eat their food preferences
Consider supplements if unable to consume recommended easily amount of vitamins + minerals
Drugs that may be used for cachexia?
Short courses of corticosteroids (increases appetite for 1-2 weeks but wont actually affect muscle mass)
Megestrol
Medroxyprogesterone
Cannabinoids - not used currently!
NSAIDs - as may reduce pro-inflammatory cytokines
EPA - fish oil
Anamorelin
Why is cachexia important?
Important prognostic factor - bad sign
A cause of death
A cause of morbidity
Important for cancer and many other chronic conditions e.g. HIV, TB, COPD, HF, stroke
Patients are more symptomatic
Treatment delays as more time needed to recover from treatment toxicity
Lower response rate to treatment
What % of cancer deaths are attributed to cachexia and its consequences?
30%
How is cachexia different to starvation?
Starvation is when the body provides a normal response to reduce oral intake. There is preferential mobilisation of fat but sparing of skeletal muscles. Basal metabolic rate decreases = a survival mechanism. If you feed someone they will get better
Cachexia is pathological driven by systemic inflammation. Equal mobilisation of fat + muscle. Increases basal metabolic rate and increased protein breakdown. If you feed them you have only fixed half the problem and wont see benefits without fixing the actual cancer/cause
Systemic effects of cytokines on the body to cause cachexia?
Muscles: protein breakdown
Fat: increased fat loss
Glucose stores: new glucose production
Brain: reduces appetite
What are the 3 clinical stages of cachexia?
Precachexia: weight loss <5%. Anorexia and signs of metabolic change e.g. alterations in appetite
Cachexia: weight loss >5%, often reduced food intake and systemic inflammation
Refractory cachexia: <3 months expected survival
Role of dietitian in cachexia?
Perform a complete nutritional assessment
Provide information and support in order to maximise nutritional intake and manage symptms such as nausea nd taste changes
Optimise macronutritinet and micronutrient intake to support functional capacity and QOL
Help patient and their family to understand cachexia and to take conscious control of eating habits
Role of PT in pt with cachexia?
Carry out complete assessment of physical status
Develop a personalised plan to meet specific pt needs
Provide a home exercise program to maximise results
Educate pt about the important of physical activity in optimising functioning and OOL - use it or lose it
