Comprehensive Cancer Centers take a look at cachexia, a complex, severe, and little-known metabolic condition commonly associated with chronic illnesses like cancer.
The team at Comprehensive Cancer Centers understands that cancer patients deal with many challenges during their cancer journeys. One challenge that many might not know about is Cachexia, a complex and severe metabolic condition commonly associated with chronic illnesses like cancer, heart failure, chronic kidney disease, and chronic obstructive pulmonary disease (COPD).
Cachexia can cause weightlessness and a decrease in muscle mass and can have very quick and negative effects on people with cancer. There is some good news regarding the condition; though, as new clinical trial results, published in The New England Journal of Medicine, suggest that there could soon be the first Food and Drug Administration-approved medication for the condition.
Characterized by rapid weight loss, muscle wasting, and fatigue, cachexia significantly impacts a patient’s quality of life and can complicate the management of underlying diseases. Unlike general weight loss, it is often involuntary and not reversible by simply increasing caloric intake. It is a multifaceted condition that disrupts normal metabolic processes and has wide-ranging effects on the body.
What Do I Need to Know About Cachexia?
Cachexia is a syndrome that leads to the severe wasting of body tissues, particularly skeletal muscle, and often includes fat loss. This condition can affect people with chronic illnesses and is more than just weight loss—it’s a debilitating condition that affects both physical and mental health. Cachexia can reduce the effectiveness of treatments, increase the risk of infections, and shorten lifespan.
Patients experiencing cachexia often face extreme fatigue, loss of appetite, and systemic inflammation. Unlike weight loss due to reduced calorie intake, it involves a combination of factors, including a loss of muscle protein synthesis, increased inflammation, and changes in the body’s metabolic functions. The weight loss associated is often irreversible through normal nutritional support, making it a challenging condition to treat.
Cachexia is closely linked to the body’s inflammatory response to chronic illness. The exact causes vary depending on the underlying disease, but several key mechanisms contribute to its onset.
Inflammation is a key driver of the condition in chronic diseases. Conditions such as cancer, heart disease, and kidney disease trigger the immune system to produce inflammatory cytokines, including TNF-α (tumor necrosis factor-alpha), IL-6 (interleukin-6), and IL-1. These inflammatory markers interfere with muscle protein synthesis and increase protein breakdown, leading to muscle wasting.
Cachexia is also characterized by altered metabolism, especially an increase in catabolism (breakdown of tissues). Muscle tissue is broken down for energy, which is not typical in a healthy individual. The body’s response to chronic illness often disrupts normal energy production and fat storage, making it difficult for patients to gain or maintain weight.
Chronic diseases often lead to a reduced appetite, a condition known as anorexia, which can exacerbate the progression of cachexia. This lack of appetite, combined with changes in metabolism, leads to inadequate calorie and protein intake. This lack of nutrition accelerates muscle loss and makes the body more susceptible.
In cancer patients, tumors can secrete substances that disrupt normal cellular function and promote wasting. These substances can interfere with muscle and fat storage and create an environment in which the body starts to consume its own tissues.
The symptoms of are distinct and often severe, affecting a patient’s physical appearance, energy levels, and quality of life. These include:
- Severe Weight Loss: Cachexia causes a significant loss of body weight, including muscle and fat. Unlike ordinary weight loss, the weight lost is very difficult to regain.
- Muscle Wasting: The breakdown of muscle tissue leads to a loss of strength and reduced physical function. This symptom can make daily tasks challenging, significantly impacting the patient’s independence.
- Fatigue and Weakness: Cachexia leads to constant fatigue, and even small physical activities become exhausting. This fatigue is not improved by rest and affects the patient’s ability to engage in normal activities.
- Loss of Appetite: Anorexia, or loss of appetite, is common in cachexia. Patients often feel full quickly or have no interest in eating, making it difficult to get the calories they need.
- Systemic Inflammation: Elevated inflammatory markers can lead to other health issues, including fevers, increased susceptibility to infections, and exacerbation of underlying disease symptoms.
- Anemia: Many patients develop anemia, which contributes to the feeling of fatigue and further weakens the body’s ability to fight off illness.
Cachexia has a profound impact on a patient’s life. The physical symptoms of cachexia not only make daily tasks challenging but also influence mental health. Patients with cachexia are more prone to depression, anxiety, and social withdrawal, often due to the visible effects of severe weight and muscle loss. Additionally, the loss of physical strength and energy reduces quality of life, leaving patients dependent on others for daily care.
Cachexia also complicates the treatment of the primary illness. For cancer patients, for instance, it can hinder the effectiveness of treatments like chemotherapy and radiation because the body is less able to tolerate these aggressive treatments. For heart disease and kidney disease patients, the strain on the body makes it difficult to recover from any treatments, and cachexia often increases hospitalization rates and reduces overall survival.
Diagnosing the condition involves evaluating weight loss, muscle mass, and clinical signs of malnutrition and inflammation. Diagnosis criteria for cachexia are not standardized universally, but there are common markers that healthcare providers assess:
- Unintentional Weight Loss: A weight loss of 5% or more within six months without changes in food intake or physical activity is a key indicator.
- Muscle Mass Reduction: Decreased muscle mass and strength are important factors in diagnosing cachexia. Tools like bioelectrical impedance analysis or dual-energy X-ray absorptiometry (DEXA) scans can measure muscle loss.
- Blood Tests: Blood work may reveal elevated inflammatory markers like C-reactive protein (CRP) or elevated cytokines (TNF-α and IL-6), which are common in cachexia.
- Functional Status: Physicians may assess functional capacity, fatigue levels, and other indicators of physical and cognitive decline.
Treatment Approaches for Cachexia
Treating the condition is complex because it involves managing multiple symptoms and underlying causes simultaneously. Effective treatment usually requires a combination of medical therapies, nutritional support, and physical rehabilitation. Some medications and lifestyle changes, including taking supplements and changing diets, have been developed specifically to manage symptoms of cachexia:
- Appetite Stimulants: Drugs such as megestrol acetate and corticosteroids are sometimes used to stimulate appetite in cachexia patients, though their effectiveness varies.
- Anabolic Agents: Medications that help increase muscle mass, such as anabolic steroids, can help slow muscle wasting, though they are not without side effects.
- Anti-Inflammatory Drugs: Medications that reduce inflammation, such as non-steroidal anti-inflammatory drugs (NSAIDs) or cytokine inhibitors, can help manage the inflammatory response associated with cachexia.
- High-Protein Diets: Protein helps support muscle tissue and may slow muscle wasting. Dietitians often recommend protein-rich foods or supplements to meet protein needs.
- Caloric Supplements: In some cases, calorie-dense supplements are provided to ensure patients get the nutrients they need even when their appetite is low.
- Enteral or Parenteral Nutrition: Feeding tubes or intravenous nutrition may also be used to supply essential nutrients.
Physical therapy, including resistance training and aerobic exercise, can help maintain or even increase muscle strength and improve physical functioning. Exercise can also boost appetite and reduce inflammation, which can contribute positively to treatment outcomes. However, exercise plans need to be carefully supervised to avoid injury and ensure that the intensity is appropriate for the patient’s physical condition.
Because the condition often occurs in patients with advanced illness, palliative care is important for improving quality of life. This approach focuses on symptom management, emotional support, and communication with family members about treatment goals. Pain management, counseling, and holistic therapies are valuable aspects of palliative care that can help patients live more comfortably.
Cachexia is challenging to treat because of its complex, multi-factorial nature. Conventional methods of weight management do not work, as it involves both metabolic dysfunction and a pronounced inflammatory response. Treatments such as increasing caloric intake or boosting protein are less effective than they would be in cases of malnutrition without an underlying disease.
Given the critical health issues caused by cachexia, Comprehensive considers it a positive step forward to see new treatments and interventions on the horizon as shared in the New England Journal of Medicine, and look forward to new therapies becoming available to help patients.
Comprehensive Cancer Centers Can Help
Physicians at Comprehensive Cancer Centers provide a variety of treatment options for cancer patients including screenings, treatment and access to clinical research. To schedule an appointment at Comprehensive, please call 702-952-3350.
The content in this post is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
