Part 8.1

Question 1

Benefits of assessing nutrition

Answer 1

1) Early identification of at risk individuals allows for early intervention

2) Helps designs appropriate nutrition support

3) Improved patient wellbeing, survival, immune function and reduced morbidity

4) Improves response to treatment

5) Cost effective for hospitals

Question 2

How does cancer impact nutritional status?

Answer 2

Tumor itself can secrete toxic substances

Host response to tumor can compromise nutritional status as well as the treatment itself

Question 3

Consequences of compromised health status

Answer 3

Reduced intake and altered metabolism

→ Malnutrition and weight loss

↓ quality of life, ↓ response to treatment, ↓ survival

Question 4

Cachexia definition

Answer 4

Complex metabolic syndrome associated with underlying illness and characterized by loss of muscle or with/without loss of fat mass
- preservation of fat is worse

Clinical feature: weight loss

50-80% prevalence of cancers

Question 5

Factors which contribute to muscle wasting

Factors contributing to fat loss

Factors contributing to weakness and fatigue

Answer 5

Anorexia, inflammation, insulin resistance, hypogonadism

Anorexia

Anemia - reduced muscle strength, VO2 max, and physical activity

Chronic illness as root cause

Question 6

Consequences of Both Types of Cachexia

Answer 6

Muscle wasting ↑ poor cancer-associated outcomes
- ↑ fatigue, ↑ treatment toxicity, ↓ response to tumor burden, ↓ performance, ↓ survival

Sarcopenia obesity: obesity with depleted muscle mass
- ~15% of patients with lung and gastro-intestinal tumors
- worse outcomes than individually obese or sarcopenic patients

Question 7

Pathophysiology of cachexia

Answer 7

Dual issues of metabolic change (due to inflammation and catabolism) and reduced food intake (anorexia)

Negative energy/protein balance due to:
1) Hypermetabolism or anorexia due to metabolic changes
2) Anorexia due to changes in ability to eat/dysphagia

Question 8

Stages of cachexia

Answer 8

Pre-cachexia: 5% or less weight loss, anorexia and metabolic change

Cachexia: Often reduced intake, systemic inflammation
1) More than 5% weight loss
2) BMI under 20 and more than 2% weight loss
3) Sarcopenia and > 2% weight loss

Refractory cachexia: Cancer disease is procatabolic and non-responsive to treatment
- low performance score
- < 3 months survival

Question 9

Clinical diagnosis of cancer cachexia

Answer 9

More than 5% weight loss over 6 months

BMI less than 20 with weight loss > 2%

Reduced appendicular muscular skeletal index as in sarcopenia + weight loss > 2%
- Males < 7.26 kg/m^2
- Females < 5.45 kg/m^2

Question 10

Anorexia and decrease in intake as a result of:

Prevalence in cachexia

Answer 10

GI problems: obstruction, malabsorption, constipation, early satiety and GI motility

Pain

Depression/anxiety

Radio and chemotherapy - nausea

Inflammation

Defective central regulation of appetite and food intake (hypothalamus)

Medications

Prevalence in > 50% of cachexia cases

Question 11

Nausea and chemosensory abnormalities as a consequence of antineoplastic therapies

Answer 11

Nausea:
- as a side effect of drugs
- abdominal disease, intracranial metastases, derangements, GI stasis

Distortion of taste and smell:
- hypersensitivity, persistent bad tastes, phantom smells, food aversions
- May also result from chronic nutrient deficiencies

Question 12

Treatment for cachexia

Answer 12

Requires a multi-modal approach:
↑ lean body mass
Predispose to a better response to an antineoplatistic therapy
↑ Immunocompetence
Symptom management
Managing nausea and GI track stasis to ↑ perception of wellbeing