Anorexia-cachexia

Question 1

What is anorexia-cachexia?

Answer 1

A multi-factorial syndrome (of involuntary weight loss) defined by an **ongoing loss of skeletal muscle mass **(with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support. It leads to progressive functional impairment. .

Question 2

What is the pathophysiology of anorexia-cachexia?

Answer 2

Its pathophysiology is characterizedby a negative protein and energy balance** driven by a variable combination of reduced food intake and abnormal metabolism**

Question 3

Tumor interactions with the immune system elicits a panoply of what type of molecules?

Answer 3

Pro-inflammatory molecules

Question 4

What are examples of anorexia-cachexia symptoms/signs?

Answer 4

1) Weight loss
2) Anorexia
3) Fatigue
4) Depression
5) Early satiety
6) Reducted function

Question 5

What biological features may you see in a patient with anorexia-cachexia?

Answer 5

1) Markers of chronic inflammation
Raised CRP; Elevated neutrophil : lymphocyte ratio
2) Immune cell activation
3) Low albumin
4) Low testosterone (men)
5) Tumour and immune cell production of catabolic effector molecules

Question 6

In anorexia-cachexia syndrome what signals are amplified within the CNS that generates inflammation?

Answer 6

Cytokine signals

Cytokine signals are amplified within the CNS, generating** inflammation** that, in turn, initiates and sustains alterations in the activity of neuronal populations that regulate appetite, metabolism and body weight.

Question 7

List 5 potentially reversible psychological factors that contribute to anorexia-cachexia.

Answer 7

1) Anxiety
2) Depression
3) Family distress
4) Spirtual distress
5) Social isolation

Question 8

What oral issues may contribute to anorexia-cachexia?

Answer 8

1) disturbed taste or smell
2) dentures
3) mouth sores
4) thrush
5) dry mouth

Question 9

What gi issues may contribue to anorexia-cachexia?

Answer 9

1) gastric reflux
2) early satiety
3) nausea and vomiting
4) obstruction
5) constipation
6) diarrhea
7) malabsorption (pancreas, fistula)

Question 10

What 5 metabolic issues may contribute to anorexia-cachexia?

Answer 10

1) Diabetes
2) adrenal insufficiency
3) hypogonadism
4) thyroid insuffficiency
5) low testosterone

Question 11

What cancers are more likely to cause cachexia?

Answer 11

1) Pancreas
2) Lung
3) Upper gastrointestinal tumours

Question 12

Name 3 assessment tools for anorexia-cachexia

Answer 12

1) The Functional Assessment of Anorexia Cachexia Therapy (FAACT)
2) QLQ-CAX24 (Cancer cachexia specific questionnaire)
3) Patient-Generated Subjective Global Assessment (PG-SGA)- scores pt-reported food intake, wt loss and sx impacting on food intake with pt estimation of function

Question 13

What 2 biological markers show an inflammatory state?

Answer 13

1) CRP
2) inc in neutrophils & dec in lymphocytes

Question 14

What biological marker strongly correlates with severity of cachexia and bodes a poor prognosis?

Answer 14

Elevated CRP

Question 14

What are some strategies around meals for patients with anorexia-cachexia?

Answer 14

If pts find odours problematic, cook elsewhere/serve cold dishes
Serve small portions
More frequent meals
Sparkling water prior to eating may help reduce bitter or metallic taste

Question 15

Are there specific dietary ;supplements which can be used in anorexia-cachexia syndrome?

Answer 15

Omega-3 fatty acids MAY stabilize or improve appetite, food intake, lean body mass and body weight.

The specific elements are DHA and EPA.

OMega-3 fatty acids reduce formation of inflammatory eicosanoids.

Question 16

TRUE or FALSE

To date, no approved agents improve muscle mass or function.

Answer 16

TRUE

Question 17

Appetite stimulants

What is the main disadvantage to using corticosterois as an appetite stimulant?

Answer 17

1) Increase muscle breakdown

Dexamethasone is a potent inducer of muscle catabolism

Question 18

What progestational agent is most commonly used to boost appetite?

Answer 18

Megestrol acetate

Question 19

What causes the wt gain when a patient takes mestrole acetate for appetite stimulation?

Answer 19

Fat accumulation

Question 20

What is the difference between starvation and anorexia- cachexia?

Answer 20

Starvation is characterized by a slowing down of metabolism in response to reduced food intake.

In cachexia syndrome, weight loss and protein and lipid breakdown proceed rapidly even if caloric intake is optimal.

Question 21

Name 4 inflammatory cytokines

Answer 21

1 Tumor Necrosis factor (TNF),
2 interleukin-1
3 interleukin-6
4 protein cachexia factor

Question 22

What could you consider prescribing for early satiety?

Answer 22

metoclopramide

Question 24

When may artificial nutrition be appropriate?

Answer 24

Cachetic patients with therapy responsive tumor
Swallowing problem due to obstructing but potentially resectable or treatable tumor (localized head and neck cancer in which weight loss is due to decreased oral intake and no cachexia syndrome)
Pre-operative treatment of malnutrition in surgcally resectable tumor
Malabsorption syndrome in a patient with controllable or localized disease