Cancer Cachexia and Anorexia



Assessment, diagnostic criteria, management, and new therapy development in cancer – associated cachexia/anorexia are based on our understanding of the definition of this clinical problem. Efforts to define and develop diagnostic criteria for cancer cachexia are ongoing in the community of experts in clinical cancer cachexia research. Current conception of cancer cachexia underscores the central importance of skeletal muscle wasting and its consequent impairments of physical function as well as metabolic impairments (such as severe cancer treatment toxicity). Recognition of the complexity of cachexia is also of considerable importance, especially in its presentation with a variable combination of reduced food intake (with both primary and secondary etiologies) and abnormal metabolism (including tumor metabolism and host inflammation) in its underlying pathophysiology. These defining characteristics dictate a multifaceted assessment strategy focusing on muscle loss, food intake, nutrition impact symptoms, catabolic drivers including tumor burden, systemic inflammation, altered endocrine status, functional and psychosocial consequences, and estimation of survival. Cancer cachexia requires application of a multimodal therapy focusing on management of pain, other symptoms and inflammation, treatment of all reversible causes of low food intake, providing a supply of key essential nutrients, and exercise; this therapy entrains the expertise of a multidisciplinary team of health professionals as well as patients and their families.


Cancer Cachexia Distress Thermometer Skeletal Muscle Index Nutrition Impact Symptom Skeletal Muscle Wasting 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Evans WJ, Morley JE, Argilés J et al. Cachexia: a new definition. Clin Nutr. 2008;27(6):793–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Rolland Y, Czerwinski S, Abellan Van Kan G et al. Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives.J Nutr Health Aging. 2008;12(7):433–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Fearon KCH, Voss AC, Hustead DS; on behalf of the Cancer Cachexia Study Group. Definition of cancer cachexia: effect of weight loss, reduced food intake and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006;83:1345–50.PubMedGoogle Scholar
  4. 4.
    Bozzetti F, Mariani L. Defining and classifying cancer cachexia: a proposal by the SCRINIO Working Group. JPEN J Parenter Enteral Nutr. 2009;33:361–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Perry GS, Byers TE, Mokdad AH et al. The validity of self-reports of past body weights by U.S. adults. Epidemiology. 1995;6:61–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Nekolaichuk C, Watanabe S, Beaumont C. The Edmonton Symptom Assessment System: a 15-year retrospective review of validation studies (1991–2006). Palliat Med. 2008;22(2):111–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Ottery FD. Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition. 1996;12(1 Suppl):S15–9.PubMedGoogle Scholar
  8. 8.
    Tuinman MA, Gazendam-Donofrio SM, Hoekstra-Weebers JE. Screening and referral for psychosocial distress in oncologic ­practice: use of the Distress Thermometer. Cancer. 2008;113(4):870–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Doyle D, Hanks G, Nathan IC, Calman K (eds). Oxford Textbook of Palliative Medicine. Oxford University Press, Oxford; 2005.Google Scholar
  10. 10.
    Honnor A. Classification, aetiology and nursing management of lymphoedema. Br J Nurs. 2008;17(9):576–86.PubMedGoogle Scholar
  11. 11.
    Lieffers JR, Mourtzakis M, Hall KD et al. A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr. 2009;89(4):1173–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Prado CM, Lieffers JR, McCargar LJ et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Tan BHL, Birdsell LA, Martin L et al. Sarcopenia combined with overweight/obesity is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009;15(22):6973–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Prado CM, Baracos VE, McCargar LJ et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13(11):3264–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Prado CMM, Baracos VE, McCargar LJ et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009;15(8):2920–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Antoun S, Birdsell L, Sawyer MB et al. Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann Oncol. 2010;21(8):1594–98.Google Scholar
  17. 17.
    Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Seruga B, Zhang H, Bernstein LJ et al. Cytokines and their relationship to the symptoms and outcome of cancer. Nat Rev Cancer. 2008;8(11):887–99.PubMedCrossRefGoogle Scholar
  19. 19.
    McMillan DC. Systemic inflammation, nutritional status and ­survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Elter T, Stipanov M, Heuser E et al. Is physical exercise possible in patients with critical cytopenia undergoing intensive chemotherapy for acute leukaemia or aggressive lymphoma? Int J Hematol. 2009;90(2):199–204.PubMedCrossRefGoogle Scholar
  21. 21.
    Bayram I, Erbey F, Celik N et al. The use of a protein and energy dense eicosapentaenoic acid containing supplement for malignancy-related weight loss in children. Pediatr Blood Cancer. 2009;52(5):571–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Mazzotta P, Jeney CM. Anorexia-cachexia syndrome: a systematic review of the role of dietary polyunsaturated Fatty acids in the management of symptoms, survival, and quality of life. J Pain Symptom Manage. 2009;37(6):1069–77.PubMedCrossRefGoogle Scholar
  23. 23.
    Moreira-Pfrimer LD, Pedrosa MA, Teixeira L et al. Treatment of vitamin D deficiency increases lower limb muscle strength in institutionalized older people independently of regular physical activity: a randomized double-blind controlled trial. Ann Nutr Metab. 2009;54(4):291–300.PubMedCrossRefGoogle Scholar
  24. 24.
    Behl D, Jatoi A. Pharmacological options for advanced cancer patients with loss of appetite and weight. Expert Opin Pharmacother. 2007;8(8):1085–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Madeddu C, Macciò A, Panzone F et al.. Medroxyprogesterone acetate in the management of cancer cachexia. Expert Opin Pharmacother. 2009;10(8):1359–66.PubMedCrossRefGoogle Scholar
  26. 26.
    Pisanti S, Bifulco M. Endocannabinoid system modulation in ­cancer biology and therapy. Pharmacol Res. 2009;60(2):107–16.PubMedCrossRefGoogle Scholar
  27. 27.
    Hugh Jones T. What should I do with a 60 year old man with a slightly low serum total testosterone concentration and normal ­levels of serum gonadotrophins. Clin Endocrinol (Oxf). 2010;72:584–8.CrossRefGoogle Scholar
  28. 28.
    Bozzetti F, Arends J, Lundholm K et al. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr. 2009;28(4):445–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Mackenzie ML, Gramlich L. Home parenteral nutrition in advanced cancer: where are we? Appl Physiol Nutr Metab. 2008;33(1):1–11.PubMedCrossRefGoogle Scholar
  30. 30.
    Okamoto Y, Okano K, Izuishi K et al. Attenuation of the systemic inflammatory response and infectious complications after gas­trectomy with preoperative oral arginine and omega-3 fatty acids supplemented immunonutrition. World J Surg. 2009;33(9):1815–21.PubMedCrossRefGoogle Scholar

Copyright information

© Society for Imaging Informatics in Medicine 2010

Authors and Affiliations

  1. 1.Department of OncologyMcGill UniversityMontrealCanada

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