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Cancer and Disordered Eating Behavior: The Issue of Anorexia

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Hidden and Lesser-known Disordered Eating Behaviors in Medical and Psychiatric Conditions

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Abstract

Altered eating behavior, intended as the reduction or loss of the desire to eat, represents a frequent symptom and one of the most common health-related problems, with clinical and psychological consequences in many cancer patients.

The pathophysiology of cancer anorexia is complex and involves different domains influencing eating behavior and affecting peripheral and/or central mechanisms.

Identifying patients at risk to develop anorexia remains a challenge for most physicians due to several reasons, including the different way each patient describes the anorexia symptoms (quantitatively and qualitatively) and due to the absence of widely accepted validated appetite assessment tools. In this light, the risk to underestimate this condition among cancer patients is high, and this may negatively impact on patient’s prognosis and quality of life.

Effective therapeutic options for cancer anorexia are still scanty, although some clinical trials were recently conducted to test the efficacy of novel promising molecules.

The correct identification of low appetite and impaired food intake in cancer may help physicians to implement tailored treatments aimed at avoiding the development of body weight loss and protein-energy malnutrition.

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References

  1. Laviano A, Koverech A, Seelaender M. Assessing pathophysiology of cancer anorexia. Curr Opin Clin Nutr Metab Care. 2017;20:340–5.

    Article  Google Scholar 

  2. Laviano A, Di Lazzaro L, Correia MITD. To feed or not to feed in ICU: evidence based medicine versus physiology-based medicine. Nutrition. 2017;38:6–7.

    Article  Google Scholar 

  3. Molfino A, Laviano A, Rossi Fanelli F. Contribution of anorexia to tissue wasting in cachexia. Curr Opin Support Palliat Care. 2010;4:249–53.

    Article  Google Scholar 

  4. Molfino A, Amabile MI, Muscaritoli M. Nutrition support for treating cancer-associated weight loss: an update. Curr Opin Support Palliat Care. 2018;12:434–8.

    Article  Google Scholar 

  5. Barajas Galindo DE, Vidal-Casariego A, Calleja-Fernández A, Hernández-Moreno A, Pintor de la Maza B, Pedraza-Lorenzo M, et al. Appetite disorders in cancer patients: impact on nutritional status and quality of life. Appetite. 2017;114:23–7.

    Article  Google Scholar 

  6. Cooper C, Burden ST, Cheng H, Molassiotis A. Understanding and managing cancer-related weight loss and anorexia: insights from a systematic review of qualitative research. J Cachexia Sarcopenia Muscle. 2015;6:99–111.

    Article  Google Scholar 

  7. Molfino A, Amabile MI, Laviano A. Anorexia in cancer: appetite, physiology, and beyond. In: Preedy VR, editor. Handbook of nutrition and diet in palliative care. 2nd ed. Boca Raton, FL: CRC Press; 2019.

    Google Scholar 

  8. Molfino A, Iannace A, Colaiacomo MC, Farcomeni A, Emiliani A, Gualdi G, et al. Cancer anorexia: hypothalamic activity and its association with inflammation and appetite-regulating peptides in lung cancer. J Cachexia Sarcopenia Muscle. 2017;8:40–7.

    Article  Google Scholar 

  9. Tsai VW, Brown DA, Breit SN. Targeting the divergent TGFβ superfamily cytokine MIC-1/GDF15 for therapy of anorexia/cachexia syndromes. Curr Opin Support Palliat Care. 2018;12:404–9. https://doi.org/10.1097/SPC.0000000000000384.

    Article  PubMed  Google Scholar 

  10. Borner T, Shaulson ED, Ghidewon MY, Barnett AB, Horn CC, Doyle RP, Grill HJ, Hayes MR, De Jonghe BC. GDF15 induces anorexia through nausea and emesis. Cell Metab. 2020;31:351–362.e5. https://doi.org/10.1016/j.cmet.2019.12.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Baracos VE, Martin L, Korc M, Guttridge DC, Fearon KCH. Cancer-associated cachexia. Nat Rev Dis Primers. 2018;4:17105. https://doi.org/10.1038/nrdp.2017.105.

    Article  PubMed  Google Scholar 

  12. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95.

    Article  Google Scholar 

  13. Wallengren O, Lundholm K, Bosaeus I. Diagnostic criteria of cancer cachexia: relation to quality of life, exercise capacity and survival in unselected palliative care patients. Support Care Cancer. 2013;21:1569–77.

    Article  Google Scholar 

  14. Laviano A, Inui A, Marks DL, Meguid MM, Pichard C, Rossi Fanelli F, Seelaender M. Neural control of the anorexia-cachexia syndrome. Am J Physiol Endocrinol Metab. 2008;295:E1000–8. https://doi.org/10.1152/ajpendo.90252.2008.

    Article  CAS  PubMed  Google Scholar 

  15. Ezeoke CC, Morley JE. Pathophysiology of anorexia in the cancer cachexia syndrome. J Cachexia Sarcopenia Muscle. 2015;6:287–302.

    Article  Google Scholar 

  16. Peixoto da Silva S, Santos JMO, Costa E, Silva MP, Gil da Costa RM, Medeiros R. Cancer cachexia and its pathophysiology: links with sarcopenia, anorexia and asthenia. J Cachexia Sarcopenia Muscle. 2020; https://doi.org/10.1002/jcsm.12528.

  17. Davis MP, Dreicer R, Walsh D, Lagman R, LeGrand SB. Appetite and cancer associated anorexia: a review. J Clin Oncol. 2004;22:1510–7.

    Article  CAS  Google Scholar 

  18. Muscaritoli M, Molfino A, Scala F, Christoforidi K, Manneh-Vangramberen I, De Lorenzo F. Nutritional and metabolic derangements in Mediterranean cancer patients and survivors: the ECPC 2016 survey. J Cachexia Sarcopenia Muscle. 2019;10:517–25. https://doi.org/10.1002/jcsm.12420.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Muscaritoli M, Molfino A, Lucia S, Rossi Fanelli F. Cachexia: a preventable comorbidity of cancer. A T.A.R.G.E.T. approach. Crit Rev Oncol Hematol. 2015;94:251–9. https://doi.org/10.1016/j.critrevonc.2014.10.014.

    Article  PubMed  Google Scholar 

  20. Muscaritoli M, Molfino A, Gioia G, Laviano A, Rossi Fanelli F. The “parallel pathway”: a novel nutritional and metabolic approach to cancer patients. Intern Emerg Med. 2011;6:105–12. https://doi.org/10.1007/s11739-010-0426-1.

    Article  PubMed  Google Scholar 

  21. Molfino A, Muscaritoli M, Rossi Fanelli F. Anorexia assessment in patients with cancer: a crucial issue to improve the outcome. J Clin Oncol. 2015;33:1513.

    Article  Google Scholar 

  22. Laviano A, Meguid MM, Inui A, Muscaritoli M, Rossi-Fanelli F. Therapy insight: cancer anorexia cachexia syndrome—when all you can eat is yourself. Nat Clin Pract Oncol. 2005;2:158–65.

    Article  CAS  Google Scholar 

  23. Rossi Fanelli F, Cangiano C, Ceci F, Cellerino R, Franchi F, Menichetti ET, et al. Plasma tryptophan and anorexia in human cancer. Eur J Cancer Clin Oncol. 1986;22:89–95.

    Article  CAS  Google Scholar 

  24. Stubbs RJ, Hughes DA, Johnstone AM, Rowley E, Reid C, Elia M, et al. The use of visual analogue scales to assess motivation to eat in human subjects: a review of their reliability and validity with an evaluation of new hand-held computerized systems for temporal tracking of appetite ratings. Br J Nutr. 2000;84:405–15.

    Article  CAS  Google Scholar 

  25. Arezzo di Trifiletti A, Misino P, Giannantoni P, Giannantoni B, Cascino A, Fazi L, et al. Comparison of the performance of four different tools in diagnosing disease-associated anorexia and their relationship with nutritional, functional and clinical outcome measures in hospitalized patients. Clin Nutr. 2013;32:527–32.

    Article  Google Scholar 

  26. Molfino A, Kaysen GA, Chertow GM, Doyle J, Delgado C, Dwyer T, Laviano A, Rossi Fanelli F, Johansen KL. Validating appetite assessment tools among patients receiving hemodialysis. J Ren Nutr. 2016;26:103–10. https://doi.org/10.1053/j.jrn.2015.09.002.

    Article  PubMed  Google Scholar 

  27. Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: Joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010;29:154–9.

    Article  CAS  Google Scholar 

  28. Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, et al. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget. 2017;8:79884–96. https://doi.org/10.18632/oncotarget.20168.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33:90–9.

    Article  Google Scholar 

  30. Abraham M, Kordatou Z, Barriuso J, Lamarca A, Weaver JMJ, Cipriano C, et al. Early recognition of anorexia through patient generated assessment predicts survival in patients with oesophagogastric cancer. PLoS One. 2019;e0224540:14.

    Google Scholar 

  31. Muscaritoli M, Rossi Fanelli F, Molfino A. Perspectives of healthcare professionals on cancer cachexia: results from three global surveys. Ann Oncol. 2016;27:2230–6.

    Article  CAS  Google Scholar 

  32. Antoun S, Morel H, Souquet PJ, Surmont V, Planchard D, Bonnetain F, et al. Staging of nutrition disorders in non-small-cell lung cancer patients: utility of skeletal muscle mass assessment. J Cachexia Sarcopenia Muscle. 2019;10:782–93. https://doi.org/10.1002/jcsm.12418.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017;36:1187–96.

    Article  CAS  Google Scholar 

  34. Molfino A, Amabile MI, Giorgi A, Monti M, D’Andrea V, Muscaritoli M. Investigational drugs for the treatment of cancer cachexia: a focus on phase I and phase II clinical trials. Expert Opin Investig Drugs. 2019;28:733–40. https://doi.org/10.1080/13543784.2019.1646727.

    Article  CAS  PubMed  Google Scholar 

  35. Abraham M, Kordatou Z, Barriuso J, Lamarca A, Weaver JMJ, Cipriano C, Papaxoinis G, Backen A, Mansoor W. Early recognition of anorexia through patient-generated assessment predicts survival in patients with oesophagogastric cancer. PLoS One. 2019;14(11):e0224540. https://doi.org/10.1371/journal.pone.0224540.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Temel JS, Abernethy AP, Currow DC, Friend J, Duus EM, Yan Y, et al. Anamorelin in patients with nonsmall-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials. Lancet Oncol. 2016;17:519–31.

    Article  CAS  Google Scholar 

  37. Fearon KC, Glass DJ, Guttridge DC. Cancer cachexia: mediators, signaling, and metabolic pathways. Cell Metab. 2012;16:153–66.

    Article  CAS  Google Scholar 

  38. Garcia JM. What is next after anamorelin? Curr Opin Support Palliat Care. 2017;11:266–71.

    Article  Google Scholar 

  39. Chasen M, Hirschman SZ, Bhargava R. Phase II study of the novel peptide-nucleic acid OHR118 in the management of cancer-related anorexia/cachexia. J Am Med Dir Assoc. 2011;12:62–7.

    Article  Google Scholar 

  40. Molfino A, Amabile MI, Monti M, Muscaritoli M. Omega-3 polyunsaturated fatty acids in critical illness: anti-inflammatory, proresolving, or both? Oxid Med Cell Longev. 2017;2017:5987082.

    Article  Google Scholar 

  41. Sánchez-Lara K, Turcott JG, Juárez-Hernández E, Nuñez-Valencia C, Villanueva G, Guevara P, et al. Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomised trial. Clin Nutr. 2014;33:1017–23.

    Article  Google Scholar 

  42. Mantovani G, Macciò A, Madeddu C, Gramignano G, Lusso MR, Serpe R, et al. A phase II study with antioxidants, both in the diet and supplemented, pharmaconutritional support, progestagen, and anti-cyclooxygenase-2 showing efficacy and safety in patients with cancer-related anorexia/cachexia and oxidative stress. Cancer Epidemiol Biomarkers Prev. 2006;15:1030–4.

    Article  CAS  Google Scholar 

  43. Ruiz Garcia V, Lopez-Briz E, Carbonell Sanchis R, Gonzalvez Perales JL, Bort-Marti S. Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev. 2013;3:CD004310. https://doi.org/10.1002/14651858.CD004310.pub3.

    Article  Google Scholar 

  44. Greig CA, Johns N, Gray C, MacDonald A, Stephens NA, Skipworth RJ, et al. Phase I/II trial of formoterol fumarate combined with megestrol acetate in cachectic patients with advanced malignancy. Support Care Cancer. 2014;22:1269–75.

    Google Scholar 

  45. Wang J, Wang Y, Tong M, Pan H, Li D. New prospect for cancer cachexia: medical cannabinoid. J Cancer. 2019;10:716–20.

    Article  CAS  Google Scholar 

  46. Brisbois TD, de Kock IH, Watanabe SM, Mirhosseini M, Lamoureux DC, Chasen M, et al. Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial. Ann Oncol. 2011;22:2086–93.

    Article  CAS  Google Scholar 

  47. Amano K, Baracos VE, Hopkinson JB. Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members. Crit Rev Oncol Hematol. 2019;143:117–23. https://doi.org/10.1016/j.critrevonc.2019.08.006.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    Alessio Molfino, Maria Ida Amabile, Giovanni Imbimbo, Antonella Giorgi & Maurizio Muscaritoli

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  1. Alessio Molfino
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  2. Maria Ida Amabile
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  3. Giovanni Imbimbo
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  4. Antonella Giorgi
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  5. Maurizio Muscaritoli
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Correspondence to Maurizio Muscaritoli .

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Editors and Affiliations

  1. Private Hospital "Salus" of Ferrara, University of Ferrara, Ferrara, Italy

    Emilia Manzato

  2. Formerly Sapienza University of Rome, Founding Editor of Eating and Weight Disorders, Campiglia Marittima, Livorno, Italy

    Massimo Cuzzolaro

  3. Experimental Medicine Department, Sapienza University of Rome, Editor-in-Chief of Eating and Weight Disorders, Roma, Roma, Italy

    Lorenzo Maria Donini

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Molfino, A., Amabile, M.I., Imbimbo, G., Giorgi, A., Muscaritoli, M. (2022). Cancer and Disordered Eating Behavior: The Issue of Anorexia. In: Manzato, E., Cuzzolaro, M., Donini, L.M. (eds) Hidden and Lesser-known Disordered Eating Behaviors in Medical and Psychiatric Conditions . Springer, Cham. https://doi.org/10.1007/978-3-030-81174-7_19

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  • DOI: https://doi.org/10.1007/978-3-030-81174-7_19

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