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Cachexia

Cachexia comes from the Greek words kakos and hexis, meaning “poor condition”. This involves extreme body wasting and malnutrition. There is also weight loss and loss of appetite. Cachexia develops from an imbalance between food intake and energy consumption. People who suffer from advanced cancer and AIDS are often seen with this type of condition. Often, the results are debilitating. Patients often suffer from chronic nausea and constipation. Incidence

Not all cancer patients would exhibit cachexia. For example, patients with advanced stage of breast cancer would less likely manifest cachexic symptoms compared to patients whose lungs or pancreas have been invaded by cancer. Furthermore, patients who suffer from cancer of the blood will less likely display wasting compared to clients with myelodysplastic syndromes, or those involving rare blood disorders.

Cause

Chemicals such as tumor necrosis factor, interleukin-1 and interleukin-6, and interferon have been identified to produce cachexia. Other causes that are looked into are metabolic abnormalities including invasion of the gastrointestinal tract by tumor. Hormonal changes, malabsorption, taste change, medications, pain, psychological factors, and infection have also been identified as factors contributing to cachexia manifestation.

One way to diagnose cachexia is to determine if a 5-pound weight loss has occurred in the previous 2 months or if the client has an approximate daily intake of calories that is fewer than 70 calories per kilogram of body weight. If the patient is obese, a weight loss of 10% may be indicative of cachexia.

Signs and symptoms

Manifestations of cachexia include fatigue and weakness (asthenia), impaired immunity or susceptibility to infections, body fat loss and muscle loss, intolerance to glucose, fluid retention or edema, chronic nausea, constipation, and vitamin deficiencies.

Management

Interventions can vary depending on the contributing factors and the tolerance of the patient to suggested treatments. Progestational (hormonal) agents are more aggressive compared to replacement of dietary supplements and can improve appetite by up to 80%. This often results to weight gain.

At maximal doses, progestational agents have shown to increase weight. Examples of these agents include megestrol acetate (Megace) 160 mg three times daily. Other pharmacologic treatments that are suggested include corticosteroids, medications that have omega-3 fatty acids and branched-chain amino acids, dietary supplements, and cannabinoids.

Hypercaloric feeding by total parenteral nutrition (where solutions containing lipids, vitamins and minerals serve as total nutritional replacements) has been shown to result to weight gain. However, the increase in weight was only primarily due to fat accumulation and not increase in lean mass.

Appetite stimulants are more effective than hypercaloric feeding in increasing weight; however this also is due to fat accumulation.

Anabolic therapies are agents that promote protein synthesis while preventing its breakdown. Growth hormones and anabolic steroids have been used in patients with cancer, AIDS, and chronic obstructive pulmonary disease (COPD) and have shown to have positive results. Anabolic steroids have been widely used in end-stage renal disease.

Exercise training has been found to have beneficial effects when combined with growth hormone therapies in older adult patients and HIV-infected patients.

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