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Cachexia is a multifactorial metabolic syndrome that presents clinically as an involuntary loss of lean body mass, including progressive reduction of skeletal muscle and adipose tissues.1,2 Associated symptoms include functional impairment, fatigue, higher treatment-related toxicities, and lower quality of life. While common across many disease states, cancer cachexia has been associated with poor responses to chemotherapy, as well as decreased survival. Thus, the development of comprehensive guidelines for cancer cachexia is important for the standardization of therapy across various clinical care settings.1,2
The American Society of Clinical Oncology (ASCO) published clinical guidelines on the management of cachexia for adults with advanced cancer in the Journal of Clinical Oncology. Cochair of the guideline panel, Eric J. Roeland, MD, of Massachusetts General Hospital Cancer in Boston, and his coauthors, developed the evidence-based recommendations to advise frontline primary care practitioners who treat adult patients with advanced cancer and cachexia.
“Primary care practitioners may be the most accessible to patients with [cachexia] symptoms, and should be aware that we can address nutritional impact symptoms, such as pain, nausea, and depression, which [all] contribute to the syndrome,” guideline coauthor, Egidio Del Fabbro, MD, of the department of internal medicine at Virginia Commonwealth University in Richmond, told Hematology Advisor.
The panel established recommendations based on 3 different categories (Tables 1-3) of interventions used to treat cancer cachexia, including:
- Nutritional interventions
- Pharmacologic interventions
- Other interventions
| Table 1. Selected Recommendations by the ASCO Guideline Panel on the Management of Cancer Cachexia in Adults With Advanced Cancer: Nutritional Interventions2 | ||
| Intervention (strength of recommendation) | Benefits | Harms |
| Dietary counseling (moderate in favor) | Moderate | Low |
| Parenteral or enteral nutrition (routine use) (moderate against) | Low | Moderate to high |
| Omega-3 fatty acids (no recommendation) | Low | Low |
| Vitamins, minerals, and other dietary supplements (no recommendation) | Low | Low |
| Table 2. Selected Recommendations by the ASCO Guideline Panel on the Management of Cancer Cachexia in Adults With Advanced Cancer: Pharmacologic Interventions2 | ||
| Intervention (strength of recommendation) | Benefits | Harms |
| Progesterone analogs (moderate in favor) | Moderate | Moderate |
| Corticosteroids (moderate in favor) | Moderate | Moderate |
| Anamorelin (no recommendation) | Moderate | Low |
| Olanzapine (no recommendation) | Moderate | Low |
| Androgens (no recommendation) | Moderate | Low |
| Thalidomide (no recommendation) | Low | Low |
| NSAIDs (no recommendation) | Low | Low |
| Cyproheptadine (no recommendation) | None | Low |
| Cannabinoids (weak against) | None | Low |
| Melatonin (weak against) | None | Low |
| TNF inhibitors (moderate against) | None | Moderate |
| Hydrazine sulfate (strong against) | None | Moderate |
| Abbreviations: NSAIDs = nonsteroidal anti-inflammatory drugs; TNF = tumor necrosis factor. |
| Table 3. Selected Recommendations by the ASCO Guideline Panel on the Management of Cancer Cachexia in Adults With Advanced Cancer: Other Interventions2 | ||
| Intervention (strength of recommendation) | Benefits | Harms |
| Exercise (no recommendation) | Unknown | Unknown |
To read the detailed recommendations containing qualifying remarks, readers should refer to the full publication in the Journal of Clinical Oncology.
This article originally appeared on Hematology Advisor
