Cancer cachexia

Abstract

Cachexia is a common cause of morbidity and mortality in patients with advanced cancer. It is characterised by numerous metabolic abnormalities including inefficient substrate utilisation, alterations in the balance of energy intake and expenditure and the acute-phase protein response. These changes seem to be driven by pro-inflammatory cytokines, alterations of the neuro-endocrine axis and tumour-derived catabolic factors. This results in the loss of both fat and lean tissue. Trials of conventional nutritional supplements in patients with cancer cachexia have failed to show any benefit in terms of weight gain or quality of life and this may be because the ongoing metabolic abnormalities prevent the efficient use of additional calories supplied. A variety of pharmacological agents have been studied in an attempt to normalise these metabolic changes with only limited success. However, it is possible that the combination of an agent to normalise the metabolic milieu along with the provision of additional nutritional support may have the potential to reverse cachexia in advanced cancer.

Bioelectric impedance spectroscopy underestimates fat-free mass compared to dual energy X-ray absorptiometry in incurable cancer patients

“…Weight loss in cancer patients is common, being seen in the majority of patients with gastric, pancreatic, lung, prostate and colon cancer (Barber et al, 1999).…”

“…Patients with progressive cancer often suffer from weight loss (Barber et al, 1999;Bosaeus et al, 2001). Although the mechanisms underlying this cachexia are not yet fully understood, systemic inflammation, elevated energy metabolism and insufficient dietary response to elevated energy expenditure may contribute to its development (Barber et al, 1999;Fordy et al, 1999;Bosaeus et al, 2001).…”

“…Although the mechanisms underlying this cachexia are not yet fully understood, systemic inflammation, elevated energy metabolism and insufficient dietary response to elevated energy expenditure may contribute to its development (Barber et al, 1999;Fordy et al, 1999;Bosaeus et al, 2001). Body composition changes in cancer patients have been reported to be different from those seen in simple starvation and are associated with shortened survival (Barber et al, 1999). Thus, it is important to assess the body composition in these patients to evaluate nutrition status and response to therapy.…”

Computational modeling of cancer cachexia

“…Involuntary weight loss is a hallmark of advanced cancer and culminates in severe depletion of skeletal muscle and adipose tissue [1][2][3][4]. This condition, called cachexia, is a significant factor leading to poor quality of life, high mortality and morbidity rates, and poor treatment response in cancer patients [5,6].…”

Biological stoichiometry of tumor dynamics: Mathematical models and analysis

“…However, such considerations are dreadfully important clinically. If left to complete its normal course, the competition between tumor and host leads to a generalized wasting syndrome of the host's body called cachexia, which occurs in about half of all cancer patients (Tisdale 1997, Barber et al 1999).…”