What is Cachexia?

Cachexia is a complex metabolic syndrome characterized by gradual loss of lean tissue or muscle mass with or without fat mass loss, often accompanied by anorexia, an inflammatory process, insulin resistance, and accelerated protein turnover. The amount of weight loss is often more than the amount explained by anorexia. Anorexia refers to a lack of appetite, and it is often, but not always, coupled with Cachexia. Cachexia isn’t only a kind of famine in which fat reserves take over as the primary energy source. Traditional nutritional supplementation is ineffective because cancer causes a shift in metabolism rather than an energy deficiency.

Cachexia results in weight loss and a higher risk of death. An increase in pro-inflammatory factors characterizes Cachexia. There is a reduction in quality of life, sensitivity to early surgical procedures, and a decrease in survival time 3). Excess cytokines are the main culprit. Excess myostatin, excess glucocorticoids, testosterone, and insulin-like growth factor-1 (IGF-1) insufficiency are other mediators.

Who is affected by Cachexia?

Cachexia is uncommon in cancer patients in the early stages, and Cachexia affects six out of ten persons with advanced cancer (60 percent). According to new research, patients with muscle wasting in Cachexia have worse exercise ability, strength, and quality of life.

Cachexia may be pretty unpleasant and make you feel very weak if you have advanced cancer. However, it isn’t solely linked to cancer. Aids, heart failure, pulmonary disease (Chronic obstructive pulmonary), chronic kidney disease, chronic liver disease, severe infections, osteoarthritis, and inflammatory responses to rheumatological conditions (e.g., rheumatoid arthritis, systemic lupus erythematosus (SLE), scleroderma, and polymyositis, among others) are all prevalent.

It might seem like you’re fading away if you lose muscle and fat. All of this might be made worse by the harmful effects of your cancer therapy.

Cachexia has several causes

Cachexia is a critical and underappreciated complication of a variety of illnesses, including –

• Cancer
• Failure of Organs
• Chronic heart failure, chronic renal disease, and chronic obstructive lung disease are all examples of chronic conditions.
• Tuberculosis and acquired immunodeficiency syndrome are two examples of infectious disorders (AIDS)
• Rheumatoid arthritis is an example of an inflammatory illness.

What Are Cachexia’s Stages?

Cachexia has three stages:

Precachexia: is a weight loss of less than 5% accompanied by anorexia or reduced glucose tolerance.

Cachexia: This stage is defined by a weight loss of more than 5% and other diagnostic criteria.

Refractory Cachexia: The patient is no longer responding to cancer therapy and has a shorter life expectancy.

Symptoms to Look Out For

Patients with Cachexia lose a lot of weight and muscle mass. Patients with the condition experience the following symptoms:

• Albumin levels are high.
• Inflammatory cytokines at high concentrations
• A BMI of less than 20% is considered obese.
• a body fat percentage of less than 10%
• They lost more than 5% of their body weight.
• Tiredness
• Not feeling well.
• Low energy consumption
• Swelling, usually in the ankles
• Appetite loss.
• Infections
• Any therapy has a poor response rate.
• a lower standard of living
• The consistent weight reduction
• Weakness

Diagnosis 

Cachexia is usually diagnosed using a combination of tests and examinations, such as the body mass index (BMI), which measures a person’s weight concerning their height; the muscle mass to body fat ratio; and blood tests. Cachexia is defined as a loss of lean tissue mass, including a weight loss of more than 5% of body weight in 12 months or less in the context of chronic disease or a BMI of less than 20 kg/m2 in the absence of chronic illness.

Cachexia must be carefully handled since it might influence a cancer patient’s capacity to endure and deal with therapies such as chemotherapy and its adverse effects. It may also lower a person’s quality of life since they will be unable to eat correctly or engage in everyday activities.

While it is impossible to reverse or control Cachexia entirely, some methods may be done to manage it and provide comfort and respite to the patient.

According to research, Cachexia is typically evident before any weight loss and before any symptoms are visible. Patients with cancer should undergo frequent screening for the disease so that treatment may begin as soon as possible.

What is the best way to deal with Cachexia?

Cachexia is treated with interventions that halt or reduce the loss of muscle mass, increase body weight and strength, offer nutritional assistance, treat the underlying illness condition with chemotherapy or immunotherapy, and improve quality of life.

The following are some of the therapy options:

Nutritional supplements and dietary advice

It recognizes that an energy shortage may lead to complications such as Cachexia. Hence, nutritional supplementation is a logical remedy; nevertheless, there is a lack of data to support the advantages of intensive nutrition in alleviating symptoms. It has been demonstrated to be effective in people recuperating from surgery and those undergoing chemotherapy. Both parenteral and enteric feeding address the patient’s nutritional deficiency.

Pharmacotherapy

Prokinetic: medicines are used to treat persistent nausea, anorexia, and early satiety sensations that might occur due to gastrointestinal symptoms.

Corticosteroids: They can aid with anorexia and weakness, but they have little impact on nutritional status and short-term effects. They also assist in reducing nausea and the amelioration of any neurological problems.

Progestogens

This was the first medication used to treat cancer cachexia. It aids in the improvement of patients’ appetite, calorie intake, and nutritional condition. These medicines have a metabolic action that causes an increase in hunger. However, these medications are often costly and may cause thrombotic events.

Cachexia prevention

Consult your oncologist as soon as possible if you have a substantial lack of appetite or weight loss. Some of the symptoms might be side effects of your cancer therapy and will go away with time; they don’t necessarily imply you have Cachexia. However, if you do, it is preferable to be identified early so that suggestions may be made to help you manage better with your illness. The following are examples of possible recommendations:

Food: A dietician from your cancer healthcare team can assist you in developing a nutrient-dense eating plan. Small, frequent, and calorie-dense meals are recommended in general. To prevent the adverse effects of refeeding syndrome, increase your food intake and calories gradually if you return to eating more.

Supplements that are nutritionally complete might be used to increase your nutrient intake if you aren’t receiving enough. There are a variety of accessories to choose from, depending on your medical requirements. Consult your dietician to determine which option is best for you.

Light exercise: Cancer therapy is often linked with fatigue and weakness. However, additional clinical data has emerged in favor of using a modest activity to alleviate these symptoms. As long as you can handle it, physical exercise may enhance your mood and wellness. Consult a clinical exercise expert or a physiotherapist to develop an exercise program that is appropriate for your fitness level.

Obtaining assistance: Don’t underestimate the importance of the social elements of eating. Eating a meal with a family member or friend or in a pleasant, relaxing atmosphere may assist in promoting appetite as well as social connection. Meeting new individuals may also be beneficial in social and emotional support.

Medication: Megestrol acetate and corticosteroids may assist with hunger and weight gain but not with survival or quality of life.