Cachexia and the Role of Nutrition Flashcards
Which cancers are associated with highest rates of weight loss?
Cancers of the GI tract
Why is weight loss an important marker for disease?
Weight loss can cause a decrease in lean body mass.
Lean body mass is an indicator of functional tissue which indicates health status.
What is cachexia?
Extreme weight loss and muscle wasting.
What is the pathophysiology of cachexia?
Tumour produces:
- Lipid mobilising factor which breaks down adipose tissue
- Cytokines which cause anorexia (mimics leptin, downregulates ghrelin and neuropeptide Y) and increases basal energy expenditure
- Proteolysis inducing factor which causes muscle breakdown
Is cachexia associated with decreased caloric input?
No. Although cancer patients can experience a loss of appetite, the weight loss is primarily driven by metabolic changes caused by the presence of a tumour.
What are the psychological implications of cachexia?
Caregivers interpret lack of eating as failure of care.
- Many cultures believe eating is a demonstration of love and hope.
- Can cause strains between patient and family/caregivers.
Why is fatigue a significant consequence of cancer therapy and what is its relation to weight loss?
Fatigue –> patient cannot cook for themselves –> decrease baseline caloric intake
How does nausea/vomiting relate to weight loss?
Can cause aversion to foods which can decrease appetite.
How does physical impairment of swallowing cause malnutrition?
- Affects chewing and swallowing mechanisms
- Reduces saliva production
- Radiation/chemotherapy induced mucositis.
- Surgical interruption of swallowing mechanism.
How do physiological alterations cause malnutrition?
Tumour or therapy can cause malabsorption of food and affect GI motility (diarrhoea, vomiting, nausea)
How can nutritional therapy be achieved?
Supplemental feeding
Support
Pharmacological agents to combat anorexia
Nutraceutical agents to enhance immunity
How do you approach a patient requesting information about an ‘alternative’ diet?
Inform patient that while these diets are often written by highly educated/qualified individlas (MDs, PhDs) there is not a lot of evidence suggesting they are effective.
If diet does not interact with cancer therapy, then tell patient they can try it if they want to but make sure they aren’t cutting out key food groups and ensure they are aware of risks.
