Cancer cachexia

Overview

• Pancreatic cancer is the archetype: 85 percent of patients meet the classic definition of cancer cachexia (Hendifar 2019); 40.5 percent of 227 patients scheduled for resection were already cachectic, and their resection rate was 48.9 against 77.8 percent because metastases were found more often (Bachmann 2008); 73 percent of 94 advanced patients were sarcopenic at baseline and 21 percent lost 10 percent or more of skeletal muscle by the first restaging scan (IMPACT study 2019).
• Malabsorption from exocrine insufficiency adds to cachexia in this cancer, so pancreatic enzyme replacement is part of the treatment (NICE NG85 1.6); fish oils are not recommended for weight loss in unresectable disease (1.6.3).
• Pancreatic cancer: weight loss has two causes that need separating, undigested food (too few pancreatic enzymes) and the cancer's own effect on appetite and muscle. Pancreatic Cancer UK says PERT can make a big difference and that you do not need a special diet; Cancer Research UK says eat little and often, choose high-calorie and high-protein foods, and ask the dietitian about prescribed supplement drinks.
• The ASCO cachexia guideline (Roeland 2020) recommends dietary counselling and says no drug is established for cancer cachexia; NICE NG85 says do not offer fish oils to manage weight loss in unresectable pancreatic cancer.
• Lung cancer: Cancer Research UK says the muscles that help with breathing can become weaker in some people with lung cancer, often because of cachexia, a complex change in the body causing loss of muscle and often fat, which is one reason breathlessness and weight loss travel together. NICE NG122 (1.18.1) says weight loss, loss of appetite, depression and difficulty swallowing should be managed by multidisciplinary groups that include supportive and palliative care professionals.