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The
EPEC-O
TM
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPECTM Project with major funding
provided by NCI, with supplemental funding provided by the Lance Armstrong
Foundation.
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EPEC – Oncology
Education in Palliative and End-of-life Care – Oncology
Module 3b
Symptoms –
Anorexia / cachexia
Anorexia / cachexia . . .
Cachexia – wasting syndrome

 Lean tissue

 Performance status

Altered resting energy expenditure

 Appetite
. . . Anorexia / cachexia
Cachexia
Starvation
Lean tissue

Fat mass


Impact of feeding
-
++
-
Anorexia / cachexia
Epidemiology

Incidence varies with site

Incidence increases with stage
Anorexia / cachexia
Impact




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≥ 5% weight loss and poor prognosis
Trend toward lower chemotherapy
response rates
Anorexia and poor prognosis
 QOL, function
Affects caregivers
MacDonald N, et al. J Am Coll Surg, 2003.
Dewys WD, et al. Am J Med, 1980.
Loprinzi CL, et al. JCO, 1994.
Key points
1. Pathophysiology
2. Assessment
3. Management
Pathophysiology


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Chronic inflammation
Metabolic changes
Lipolytic / proteolytic substances
Hormonal changes
Role of neurotransmitters
Cytokine impact on hypothalamus
Todorov P, et al. Nature, 1996.
Todorov P, et al. Cancer Research, 1998.
Zigman JM, et al. Endocrinology, 2003.
Balkwill F, et al. Lancet, 2001.
Assessment

Appetite / weight loss history
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Identify reversible causes

Physical signs of wasting

Biochemical markers

Radiographic studies as indicated
… Assessment
Reversible causes of weight loss



Psychological
factors
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Malabsorption

Pain

Endocrine

Comorbid
conditions

Social / economic
Mucositis
Nausea / vomiting

Constipation

Early satiety
Management . . .

Treat comorbid conditions

Educate, support

Favorite foods / nutritional
supplements / counseling

Treat reversible causes (eg, early
satiety, mucositis)
Anorexia / cachexia
what does not work

Feeding (enteral or parenteral)
ACP. Ann Int Med, 1989.
Ovesen. J Clin Oncol, 1993.
Management of anorexia

Dexamethasone

Megestrol acetate

Tetrahydrocannabinol (THC)

Androgens
Loprinzi CL, et al. JCO, 1999.
Von Roenn JH, et al. 2003.
Moertel CG, et al. Cancer, 1974.
Management of cachexia

Investigational
Anabolic steroids
Omega-3-fatty acids
Amino acids
NSAIDs
Multi-vitamins
Exercise
Von Roenn JH, et al. ASCO, 2003.
Jatoi A, et al. ASCO, 2003.
Fearon KCH, et al. Gut, 2003.
McMillan DC, et al. Br J Ca, 1999.
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Summary
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Use comprehensive
assessment and
pathophysiology-based therapy
to treat the cause and improve
the cancer experience