Cancer Cachexia

What is cancer cachexia?

Cancer cachexia is a wasting syndrome that leads to weakness, fatigue, and loss of skeletal muscle (also called sarcopenia) and fat. Unlike malnutrition, it cannot be reversed with nutrition support alone. Cancer cachexia must be treated with medicines and is hard to reverse once it starts. Cancer cachexia is most common in people with advanced cancer. 

There are three stages of cancer cachexia: 

• Pre-cachexia. In this stage, you may have appetite loss and weight loss. Treatments for cachexia are most likely to be effective at this stage. Your doctor and dietitian will discuss how to improve your symptoms or prevent them from getting worse.
• Cachexia. You may move from pre-cachexia to cachexia depending on the type and stage of your cancer, how you respond to cancer treatment, and your eating habits. In the cachexia stage, you may lose interest in eating and continue to lose weight and muscle. Other symptoms include fatigue and reduced strength.
• Refractory cachexia. In this stage, you have severe muscle loss and continue to lose weight. Refractory cachexia affects many people with advanced cancer that is not responding to cancer treatment.

What causes cancer cachexia?

Will Ponsegromab Be a Game Changer for Cancer Cachexia?

In a clinical trial, the drug helped people with the wasting syndrome gain weight and muscle.

Scientists don’t fully understand how cachexia occurs in people with cancer. But they think that inflammation is the main cause. Increased metabolism, insulin resistance, and hormone changes may also play roles.

Inflammation

Inflammation can cause appetite loss, loss of muscle and fat, changes in how the body uses nutrients, decreased eating, and increased metabolism. Lab tests show that certain cancers, such as breast, ovarian, and esophageal cancer, can cause inflammation in the body.

Changes in metabolism

Some cancers can change your metabolism, or how your body uses carbohydrates, protein, and fat from food. Changes may include rapid breakdown of protein and fat stores in the body, causing muscle and fat loss. An increased metabolism also means your body uses more energy. This makes it harder for your body to meet its energy and protein needs, leading to weight loss and possible cachexia. 

Not all people with cancer have an increased metabolism. But it is common in those with head and neck, lung, and pancreatic cancers and cancers of the upper digestive tract.  

Insulin resistance

People with cancer may have insulin resistance. Normally, after you eat food, insulin tells your cells to allow glucose (sugar) to move from your blood into your cells. But with insulin resistance, the cells no longer respond to insulin. When your cells can’t respond to insulin, glucose can’t enter your cells and it builds up in your blood, causing high blood sugar (a condition called hyperglycemia). And when glucose cannot get into your cells, it is not available to be used by the cells for energy. This can lead to weight loss and possible cachexia.

Changes in hormones

Cancer cachexia may also be caused by a change in hormones, chemical messengers that tell your cells what to do. Two groups of hormones are linked with cancer cachexia: catabolic and anabolic hormones. Catabolic hormones break down tissue, and anabolic hormones build tissue. In cancer cachexia, your body has more working catabolic hormones than anabolic hormones. This imbalance leads to muscle breakdown, making cancer cachexia worse.  

Symptoms of cancer cachexia

The most common symptoms of cachexia are:

• weight loss, including loss of muscle and fat
• appetite loss
• fatigue
• weakness

These symptoms can have many causes and may not be a sign of cachexia. It’s important to talk with your doctor if you notice these changes. Your doctor can help you manage them and decide if other tests are needed.

Ways to prevent cancer cachexia

Spotting and treating malnutrition early is the best way to prevent cancer cachexia. Talk to your doctor about regular nutrition screenings during treatment to see if you are at risk of malnutrition and cancer cachexia. Learn more at Weight Changes, Malnutrition, and Cancer.

Ways to manage cancer cachexia

You need the help of many types of health care providers to manage cachexia.

Your doctor may prescribe medicines such as appetite stimulants and anti-inflammatory drugs. They might refer you to a registered dietitian who can suggest nutrition supplement drinks, such as Ensure or Boost. Dietitians can provide nutrition counseling and education for you and your caregivers. If you need it, dietitians oversee nutrition support such as tube feeding (enteral nutrition) and IV nutrition (parenteral nutrition). Learn more about tube feeding and IV nutrition at Nutrition During Cancer Treatment.

Your doctor might refer you to physical therapy. Physical therapy can help improve strength and endurance. Getting stronger can help you move better and take part in daily activities, which can help improve your quality of life. 

If swallowing becomes an issue, your doctor can refer you to a speech therapist. If mouth sores or other mouth problems are getting in the way of eating and drinking, your doctor may suggest you see a dentist. Learn more about managing mouth problems during cancer treatment at Mouth and Throat Problems During Cancer Treatment.

Getting support for cancer cachexia

Support from family and friends. Cachexia can make you feel tired and unable to do your daily activities. Reach out to your family and friends to help with meal planning, grocery shopping, cooking, and cleaning. Your family and friends will want to know how to help you. If people offer help, accept it. 

Support from your health care providers. Be sure that your doctor knows about problems you are having. Your doctor can prescribe medicine and refer you to other health care providers as needed.

Support for caregivers. It is normal to feel distress when a loved one has cachexia. You might be upset about their weight loss, loss of physical function, and changing appearance. 

There may be days when your loved one does not want to eat or drink. Offer gentle support rather than pushing your loved one to eat. Ask the doctor for referrals to a dietitian and physical therapist to help your loved one with cachexia. Meet with them together so you know how best to help your loved one. 

Learning about cachexia can help you know what to expect, which can ease your distress. Learn more about getting support at Support for Caregivers of Cancer Patients.

Cancer cachexia often happens at the end of life. To prepare, it might help to talk with the doctor or nurse about what to expect during this time. Learn more at Advanced Cancer.