Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later

Abstract

An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

“…Previous studies have demonstrated that an increased level of CRP may be associated with poorer prognosis in patients with tumors, including ovarian cancer, penile cancer and non-small cell lung cancer (36)(37)(38). In addition, malabsorption and malnutrition may be associated with decreased survival time in various tumors, including esophageal squamous cell carcinomas and endometrial cancer (39,40). In a previous study, Alb was used to estimate nutritional status.…”

Bone Pain and Muscle Weakness in Cancer Patients

“…Cancer-related muscle loss is multifactorial, resulting in asthenia and functional impairment similar to that seen in patients with age-related sarcopenia as well that manifested by active muscle break-down. [87, 88] The common metabolic abnormalities to cancer cachexia and sarcopenia include altered hormone levels, elevated cytokines, increased insulin resistance, increased muscle proteolysis, elevated acute phase proteins, and altered nutrient utilization. [87] Many experts believe, however, that muscle loss in cancer is a more active process, mediated by a number of pro-inflammatory cytokines, as well as members of the TGFβ-superfamily including activins[89] and myostatin.…”

“…CT and DXA imagine can be used to quantify sarcopenia which correlates with clinical asthenia, fatigue, reduced tolerance to treatments, impaired QoL and reduced survival. [88]…”

Screening for low muscularity in colorectal cancer patients: a valid, clinic‐friendly approach that predicts mortality

“…Low skeletal muscle mass is common among cancer patients1, 2 and predicts surgical complications,3, 4, 5, 6, 7, 8, 9 treatment toxicity,10, 11, 12, 13, 14 poor quality of life, and reduced survival 9, 15, 16, 17. This accumulating evidence has prompted oncologists to identify skeletal muscle mass as an important biomarker for numerous adverse outcomes in cancer patients 18.…”