Cancer cachexia
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj-2024-080040 (Published 23 October 2024) Cite this as: BMJ 2024;387:e080040- Michael S Yule, medical research fellow12,
- Leo R Brown, clinical research fellow3,
- Rachel Waller, patient advocate4,
- Stephen J Wigmore, regius chair of surgery3
- 1St Columba’s Hospice, Edinburgh EH5 3RW, UK
- 2Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh EH4 2XU, UK
- 3Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
- 4Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield S10 2HQ, UK
- Correspondence to: M S Yule michael.yule{at}ed.ac.uk
What you need to know
Cancer cachexia is defined as cancer related malnutrition in the presence of systemic inflammation
The prevalence of cancer cachexia varies among different cancer types, with pancreatic, hepatobiliary, and oesophagogastric cancer having notably high rates
Assess the patient for cancer cachexia in all healthcare interactions to allow for early intervention
Treatment requires a multi-modal approach aimed at increasing food intake, reducing muscle wasting, and improving function, alongside psychosocial support
Cancer cachexia is a complex syndrome characterised by tissue loss (fat, cardiac muscle, and skeletal muscle), decreased appetite (anorexia), fatigue, and reduced activity in patients with cancer (fig 1).1 It cannot be fully reversed with nutritional support alone and is caused by inflammation and metabolic dysfunction driven by the interaction between tumour and patient. Consequences include reduced efficacy of cancer treatment, poorer quality of life, and reduced survival.2 This article provides an update on cancer cachexia for healthcare professionals drawing on contemporary research and guidelines developed by the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO).
What is controversial about cancer cachexia?
The definition of cancer cachexia remains controversial. The role of inflammation is recognised as a key component; however, some argue that loss of skeletal muscle should be the defining feature. The first international consensus definition was published in 2011, and work is under way to update this. Lack of a clear consensus definition undermines the design of clinical trials.
How common is it?
Rates of cancer cachexia vary across different cancer populations (fig 2), with both tumour site and tumour stage key determinants of prevalence. Cachexia is less common in patients with breast, prostate, and skin cancers.3456 Cancers most strongly associated with the syndrome include pancreatic, hepatobiliary, and oesophagogastric. Up to 80% of patients with these cancers are affected.7
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