Cancer anorexia-cachexia syndrome: current issues in research and management

CA Cancer J Clin. Mar-Apr 2002;52(2):72-91. doi: 10.3322/canjclin.52.2.72.

Abstract

Cachexia is among the most debilitating and life-threatening aspects of cancer. Associated with anorexia, fat and muscle tissue wasting, psychological distress, and a lower quality of life, cachexia arises from a complex interaction between the cancer and the host. This process includes cytokine production, release of lipid-mobilizing and proteolysis-inducing factors, and alterations in intermediary metabolism. Cachexia should be suspected in patients with cancer if an involuntary weight loss of greater than five percent of premorbid weight occurs within a six-month period. The two major options for pharmacological therapy have been either progestational agents, such as megestrol acetate, or corticosteroids. However, knowledge of the mechanisms of cancer anorexia-cachexia syndrome has led to, and continues to lead to, effective therapeutic interventions for several aspects of the syndrome. These include antiserotonergic drugs, gastroprokinetic agents, branched-chain amino acids, eicosapentanoic acid, cannabinoids, melatonin, and thalidomide--all of which act on the feeding-regulatory circuitry to increase appetite and inhibit tumor-derived catabolic factors to antagonize tissue wasting and/or host cytokine release. Because weight loss shortens the survival time of cancer patients and decreases performance status, effective therapy would extend patient survival and improve quality of life.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anorexia / diet therapy
  • Anorexia / drug therapy*
  • Anorexia / etiology
  • Anorexia / metabolism*
  • Cachexia / diet therapy
  • Cachexia / drug therapy*
  • Cachexia / etiology
  • Cachexia / metabolism*
  • Carbohydrate Metabolism
  • Digestive System / physiopathology
  • Humans
  • Leptin / metabolism
  • Lipid Metabolism
  • Neoplasms / complications
  • Neoplasms / metabolism*
  • Neoplasms / physiopathology
  • Neuropeptide Y / metabolism
  • Proteins / metabolism
  • Syndrome

Substances

  • Leptin
  • Neuropeptide Y
  • Proteins