131IN - Development of rational therapeutic strategies for patients with pre-cachexia and cachexia through the integration of oncology and palliative care...

Date 30 September 2012
Event ESMO Congress 2012
Session ESMO-MASCC Joint symposium: Integration between medical oncology and supportive care: Two sides of the same coin
Topics Palliative Care
Presenter Florian Strasser
Authors F. Strasser
  • Oncology And Palliative Medecine, Cantonal Hospital, 9007 - St.Gallen/CH


Nutritional issues are frequent but underestimated in advanced, incurable cancer patients (pts), impacting patients' tolerability of anticancer treatment, quality of life, physical (and social) function, effective health services use and family members. The new cancer cachexia framework (Fearon & Strasser, Lancet Oncology 2011) separating simple starvation from cachexia, facilitates the development of both effective nutritional, multimodal and tailored treatments. Collaborative, international efforts and EU-funding made this framework possible. Cachexia is defined by muscle loss relevantly impacting physical function, which is not reversible by nutrition only, and is caused by a combination of dysregulated eating ability and a dysbalanced catabolic and anabolic metabolism. To identify such pts in clinical practice, monitoring of % weight loss in the last 6 months and asking pts about appetite and eating shall become a standard procedure. The clinical assessment will diagnose cachexia, then classify pts for the phase (pre-cachexia, cachexia, refractory cachexia), main domains (stores, intake, potential, performance), and severity. Currently a consensual cachexia assessment is developed involving various professional groups. For pre-cachexia and cachexia there is currently no established therapeutic intervention. Clinical trials investigating increase of nutritional intake (oral, enteral, parenteral) focus on patient populations having simple starvation. For cachexia treatment a multimodal approach is mandatory, tackling in a combined strategy its main causes of decreased eating ability, catabolism, decreased anabolism, and impaired neuro-muscular function. Preclinical studies and several clinical trials document the potential of such interventions. A sentinel next step however, is the conduct of well powered, multimodal phase III trials in pre-cachexia and cachexia. For refractory cachexia, efforts concentrate to characterize these pts and develop psychosocial and other symptom alleviating interventions. Currently guidelines on treatment are updated, applying the procedures of ESPEN. Educational initiatives emerge. All these efforts mandate collaboration of professionals and working groups of involved societies (e.g., EAPC-RN, ESPEN, MASCC, ESMO PCWG, SCWD).


F. Strasser: Unrestricted grants: Celgene (NCT01127386), Fresenius (http://www.surveymonkey.com/s/XBT6HQW.). Participation BYM338 trial (NCT01433263). Occasional Advisor: Baxter, Danone, Fresenius, Helsinn, Novartis, X-Biotech.