A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life

Parmar, Monica P.; Vanderbyl, Brandy L.; Kanbalian, Mary; Windholz, Tamara; Tran, Anh-Thi; Jagoe, R. Thomas

doi:10.1136/bmjspcare-2017-001382

Cited by 39 publications

(35 citation statements)

References 45 publications

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“…Effective multimodal care is predicated on a seamless integration of symptom management, psychosocial support, nutritional support, and rehabilitation. There is relatively little research evaluating the efficacy of these combined interventions and their ability to simultaneously improve symptoms, distress, food intake, body weight, physical function, and QOL [39,[56][57][58][59][60]. The most encouraging data comes from clinical observational studies [39,44].…”

Section: Integration Of Palliative Supportive and Nutritional Carementioning

confidence: 99%

Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members

Amano

Baracos

Hopkinson

2019

Critical Reviews in Oncology/Hematology

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Advanced cancer patients with cachexia and their families can suffer from eating-related distress. This complex entity encompasses patients' struggle to nourish themselves, emotional and social consequences of their inability to maintain food intake, and profound disturbance in family relationships. With evidencebased nutritional care, as well as symptom management to enable food intake, cachexia can be mitigated to some degree. In addition, patients and families require psychosocial support and education to understand and cope with this condition. Only by taking an integrated approach can health care teams alleviate eatingrelated distress, improve quality of life (QOL), reduce interpersonal conflicts, and alter perceptions of nutritional neglect for patients and families. However, few studies have investigated eating-related distress among patients and families. The aim of this narrative review is to describe what is known about eating-related distress and the roles of integrated palliative, supportive, and nutritional care in improving QOL of patients and families.

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Section: Integration Of Palliative Supportive and Nutritional Carementioning

confidence: 99%

Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members

Amano

Baracos

Hopkinson

2019

Critical Reviews in Oncology/Hematology

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“…Thus, we cannot exclude the possibility of referral bias, for example, perhaps patients with more severe or refractory weight loss and related symptoms are more likely to be referred by their treating oncology teams. Whilst it is certainly possible that the frequency or severity of barriers identified in this study cohort is not truly representative of all advanced cancer patients with cachexia, the demographic, nutritional, and oncological characteristics of this patient group were very similar to other larger cohorts that we have reported on over the last 5 years, suggesting that the results are at least representative of the wider CNR‐JGH patient population. The patients studied include a mix of cancer types with a predominance of lung and gastrointestinal cancers.…”

Section: Discussionmentioning

confidence: 67%

Defining barriers to implementation of nutritional advice in patients with cachexia

Nasrah

Borch

Kanbalian

et al. 2019

J cachexia sarcopenia muscle

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Background Cancer cachexia is a multidimensional wasting syndrome and a reduced dietary intake is both common and strongly correlated with degree of weight loss. Many patients with cachexia do not achieve recommended dietary intake even after nutritional counselling. Prior reports suggest this is likely due to barrier symptoms, but other potential contributory factors have not been studied in detail. Methods Dietitian‐assigned barriers to successful nutritional intervention were recorded at each visit in all patients attending a multidisciplinary clinic for management of cancer cachexia. The barriers were grouped into 15 categories and classified as either symptom‐related or not symptom‐related. In addition, symptom scores, dietary intake, and weight change were recorded. Results Data on 94 new patients showed that 89% of patients had at least one major barrier. Four of the five most common barriers and 65% of all barriers identified were not symptom‐related. Over sequential visits the specific barrier(s) in any one patient changed approximately 50% of the time. However, the presence of barriers did not render patients refractory to nutritional intervention and with intervention from the CNR‐JGH team, mean dietary intake increased significantly. Conclusions In advanced cancer patients with cachexia, non‐symptom‐related barriers to nutritional intervention are more common than symptom‐related. Barriers are dynamic, and repeated careful evaluation over time is required to achieve optimal impact with nutritional intervention in cancer cachexia. Members of the multidisciplinary team need appropriate expertise to address the barriers identified and achieve optimal results with nutritional intervention.

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“…22 There is a need to detect cancer-related cachexia early, and have a multimodal approach, to maintain function for as long as possible. 23…”

Section: Discussionmentioning

confidence: 99%

Predictors and trajectory of performance status in patients with advanced cancer: A secondary data analysis of the international European Palliative Care Cancer Symptom study

et al. 2018

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Background:Performance status, a predictor of cancer survival, and ability to maintain independent living deteriorate in advanced disease. Understanding predictors of performance status trajectory could help identify those at risk of functional deterioration, target support for independent living and reduce service costs. The relationship between symptoms, analgesics and performance status is poorly delineated.Aim:The aim of this study is to determine whether demographics, analgesics, disease characteristics, quality-of-life domains and C-reactive protein predict the trajectory of Karnofsky Performance Status (KPS) in patients with advanced cancer.Design:The study design is the secondary data analysis of the international prospective, longitudinal European Palliative Care Cancer Symptom study (ClinicalTrials.gov: NCT01362816). A multivariable regression model was built for KPS area under the curve per day (AUC).Setting and participants:This included adults with advanced, incurable cancer receiving palliative care, without severe cognitive impairment and who were not imminently dying (n = 1739).Results:The mean daily KPS AUC (n = 1052) was 41.1 (standard deviation = 14.1). Opioids (p < 0.001), co-analgesics (p = 0.023), poorer physical functioning (p < 0.001) and appetite loss (p = 0.009) at baseline were explanatory factors for lower KPS AUC. A subgroup analysis of participants with C-reactive protein data (n = 240) showed that only C-reactive protein (p = 0.040) and physical function (p < 0.001) were associated with lower KPS AUC.Conclusion:This study is novel in determining explanatory factors for subsequent functional trajectories in an international dataset and identifying systemic inflammation as a candidate therapeutic target to improve functional performance. The effect of interventions targeting physical function, appetite and inflammation, such as those used for cachexia management, on maintaining functional status in patients with advanced cancer needs to be investigated.

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A multidisciplinary rehabilitation programme for cancer cachexia improves quality of life

Cited by 39 publications

References 45 publications

Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members

Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members

Defining barriers to implementation of nutritional advice in patients with cachexia

Predictors and trajectory of performance status in patients with advanced cancer: A secondary data analysis of the international European Palliative Care Cancer Symptom study

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