ESMO E-Learning: Pathophysiology and Management of Cancer Cachexia

Learning Objectives

  • To provide the definition of cancer cachexia and an update on underlining pathophysiology mechanisms
  • To provide an update on clinical features of cancer cachexia and approach to its diagnosis
  • To provide a practical approach on interventions to be considered in patients with cancer cachexia and under which circumstances
Title Duration Content CME Points CME Test
Pathophysiology and management of cancer cachexia 30 min. 51 slides 1 Take Test
Gioulbasanis Ioannis
Ioannis Gioulbasanis
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Cancer cachexia is a multifactorial syndrome characterised by weight loss and body composition alterations that cannot be restored by conventional nutritional support. The pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. Anorexia, increased resting energy expenditure, presence of systemic inflammation, activation of unprofitable biochemical circles, increased lipolysis and muscle wasting are all important features of the syndrome.

Cachexia is present in 80% of cancer patients at the end-stage of the disease. It is also a major cause of death in that setting. Frequency at diagnosis depends on the primary site of tumour, with the highest presence among patients with pancreatic, head and neck and lung cancers. Anorexia - reduced desire for food affects approximately 50% of cancer patients at diagnosis.

Muscular depletion under a certain cut-off is called sarcopaenia and is associated with a significant increase of morbidity and mortality, as well as decreased tolerance to therapy and quality of life. Normal ageing and other chronic conditions, diseases and medications may additionally contribute to sarcopaenia. Obese patients may also be sarcopaenic.

Timely diagnosis is important and should be based on nutritional screening questionnaires and body composition analysis (DEXA scan, CT images). Treatment of cancer cachexia should correct all reversible causes of reduced food intake, provide timely nutritional consultation/intervention, involve personalised exercise training programmes, appreciate the fact that there is no standard drug therapy and motivate patients to entry into clinical trials.

The medical professionals should appreciate a multidisciplinary approach in patients with cancer cachexia and understand that in patients under active antineoplastic treatment (pre-/cachectic stage) dietary counselling (with food and with or without oral nutritional supplements) and parenteral nutritional support should be offered,  while nutritional support is ineffective in end-stage cancer (refractory cachectic stage).

This E-Learning module is an excellent update on a frequently neglected aspect of malignant diseases and provides an overview on the magnitude of the problem, steps to be considered in diagnosis, understanding of pathophysiology mechanisms, and elaborates the treatment for cancer cachexia, including nutritional support, exercise and drugs (megestrol acetate, corticosteroids, omega-3 fatty acids, ghrelin and analogues, androgens and selective androgens Receptor modulators). The Module also covers special considerations for enrolment in cancer cachexia clinical trials.    

Last update: 02 August 2013

The author has reported no conflict of interest