Cancer cachexia? Have you heard this term before? I wrote an article for dietitians on this topic for the March 2020 NHD magazine and as this is such an important topic I wanted to share this with you too!
You may have heard of the term 'cachectic' which is often used to describe someone who has lost a lot of muscle or fat and appears 'wasted'. This can also occur in other conditions too such as HIV, kidney disease and congestive heart failure but we will be focusing on cancer cachexia.
What is cancer cachexia?
The word ‘cachexia’ comes from the Greek terms ‘Katos’ and ‘hexis’ which means ‘poor physical state’.
Cancer cachexia is a complex condition that causes weight, muscle and fat loss by effecting the way your body uses energy. Cancer cachexia is a type of malnutrition (a condition that happens when your diet does not contain the right amount of nutrients) but the difference here is that there is also increased inflammation in the body.
When does it occur?
Cancer cachexia doesn’t affect everyone and it varies depending on the type of cancer. It is more common in some cancers such as cancer of the pancreas, stomach, head and neck and blood cancers and tends to be associated with more advanced cancers which maybe are not responding to cancer treatments. As it is a complex condition it can be tricky to diagnose and identify. However, the general criteria is:
Weight loss more than 5% over the last 6 months
Or
BMI (body mass index) of less than 20kg/m2 and weight loss of more than 2%
Or
Muscle loss and weight loss more than 2%
Stages of cancer cachexia
There are 3 stages of cancer cachexia: Pre-cachexia, cachexia and refractory cachexia.
Not all patients will experience all stages; the risk of moving through the stages depends the cancer type and stage, presence of inflammation, reduced food intake and response to anticancer treatment. The latter stages of cancer cachexia is difficult to treat so it’s really important to tell your health professional if you are losing weight or not eating well so support can be given early. Prevention is always better!
Loss of appetite in cancer cachexia
Losing your appetite is very common when you have cancer and undergoing treatment. It can be due to lot of reasons such as side effects of the treatments, the emotional and mental burden of cancer and generalised fatigue. Interestingly patients who have cancer cachexia also experience changes in hormones that regulate hunger. This makes it really hard to eat as it feels like your appetite has been ‘switched off’.
Complex changes in the body
As mentioned already cancer cachexia is not the same as simple weight loss and poor appetite cancer tumours have many effects on the body which not just limited to the area the tumour is located. Cancer tumours disrupts other parts of the body and produce different factors which can cause inflammation in the body. This means that your body often needs more nutrition during this time because it is working so hard to overcome these processes.
How can we help in cancer cachexia?
The goal for all people with cancer is that they aim to keep their weight stable and eat as well as they can. What about if you are overweight?
This is a common question and even if you are overweight we recommend that you keep your weight stable during cancer treatment.
Now isn’t the time to be losing weight! (read more about this here).
Aiming for a stable weight is my one of the first goals I set with all my clients as we know it means you will have a better response to treatment and recover quicker. Working with a dietititan will support you with making the most of appetite, provide tips to add additional nutrition easily and suggest foods or supplements to meet your nutritional needs. Being active is also thought to have many benefits and help to preserve muscle in cancer cachexia.
There is also growing research in different medications for managing cancer cachexia. One area of research is in eicosapentaenoic acid (EPA) an omega-3 fatty acid. EPA been recommended in advanced cancer patients undergoing chemotherapy who are at risk of weight loss or already malnourished. Please note this should be discussed with your medical team and under medical supervision.
Summary:
Cancer cachexia is a complex condition which can cause many changes in the body but remember it doesn’t affect all people with cancer. The first warning signs are losing your appetite and losing weight so if you notice this ask for help and speak to a dietitian.
If you are experience changes to your appetite or weight and would like support book your free call to discuss with me. We can create a plan to support you.
If any Dietitians/ nutritional professionals would like to read the health professional version of this article you can find it here NB. Nutrition Health professionals will need to sign up and then you will receive a password to access the magazine
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