Cancer Cachexia: Shall we talk about this?

If you or someone you know has cancer, you may have noticed that over time, their body has become thinner and even looks different. Many people think that this is just a part of the cancer or a side effect of the treatment. That may be true to some extent. However, this condition can sometimes be something deeper, a condition called cancer cachexia . Let's talk about this in more detail today, because it affects the quality of life of cancer patients and their response to treatment.

What is Cancer Cachexia?

Simply put, cancer cachexia is a severe wasting syndrome caused by cancer. This is when you lose a significant amount of skeletal muscle and body fat . It's not just about losing weight, but also the muscle that provides strength. This weight loss can change your appearance, cause you emotional discomfort, and even make it difficult to cope with cancer treatment. It can also affect your quality of life and sometimes interfere with your ability to cope with cancer.

Experts say that this condition affects about 50% of cancer patients. Also, it can be seen in about 75% of people whose cancer has spread, that is, in Stage IV cancer. Sadly, this condition is responsible for 25% of cancer deaths.

Although this condition can occur with any type of cancer, it is especially common in people with these types of cancer:

• Colorectal cancer
• Lung cancer
• Melanoma, a type of skin cancer
• Pancreatic cancer

Although doctors cannot completely cure cancer cachexia, treatments try to increase the amount of food you eat, especially focusing on high-protein, high-calorie foods .

What are the symptoms of cancer cachexia?

The main and most obvious symptom of this condition is losing more than 10% of your total body weight over the past 6 to 12 months . This includes both muscle and fat. Apart from that, there may be several other symptoms:

• Extreme fatigue and weakness: You may feel like you don't have enough energy to do your daily tasks, take care of your family, or even do your personal chores. It's like you're lifeless.
• Muscle wasting: Doctors also call this muscle wasting or muscle atrophy . This is the loss of muscle mass and muscle wasting.
• Anorexia: This is when you lose all desire to eat, you don't feel hungry. Sometimes you don't even want to think about food. But this is different from the eating disorder called anorexia nervosa that we've heard about.
• Anemia: You may develop anemia because your body, in response to inflammation, releases a protein that affects the production of red blood cells.
• Frequent infections: Cancer cachexia can weaken your immune system, making it less able to fight off disease. This can make you more likely to get infections.

Why does this cancer cachexia occur?

There are several reasons for this. Cancer speeds up your metabolism . This means that your body needs more energy from food. At the same time, cancer and cancer treatments can also reduce your appetite. The result is that you eat less when your body needs more nutrients.

Here are some reasons that specifically affect this situation:

• Certain types of cytokines: Cytokines are chemicals that control how and when our immune system responds to invaders like viruses. In cancer cachexia, your immune system releases certain types of cytokines. These cause inflammation, which increases the rate at which your body breaks down fat and muscle. Cancers also cause inflammation, and these cytokines can exacerbate that inflammation.
• Cancer symptoms and side effects: Pain, nausea, and vomiting caused by cancer can make you eat less. Also, having cancer can make you feel depressed and lose your appetite.
• Side effects of cancer treatment: Things like surgery, radiation therapy , chemotherapy , and some opioid painkillers can cause difficulty swallowing or interfere with the body's ability to absorb nutrients.
• Insulin resistance: This means that your muscle and fat cells do not respond properly to insulin. This insulin resistance, which occurs in cachexia, can lead to increased muscle wasting.
• Increased protein turnover: Protein turnover is the process by which old proteins in your cells are replaced with new proteins. This happens through protein degradation . In cancer cachexia, proteins in cells break down too quickly for new proteins to replace them. This also causes muscle wasting.

What are the complications of cancer cachexia?

This condition can even be life-threatening. Consider, for example, cachexia, which is the main cause of death in 20% to 25% of patients with metastatic solid tumors, such as lung or prostate cancer, when the cancer spreads to other parts of the body.

Other complications can include:

• Impact on cancer treatment: Your body needs muscle and fat to recover from cancer treatment. Losing these can affect your ability to receive cancer treatment. You may even lose the strength to endure the treatment.
• Mental health issues: Being diagnosed with cancer cachexia may mean you only have months to live. This knowledge can make you feel very anxious and depressed.
• Impact on family and friends: This condition can also put a strain on your relationships with family and friends. Not only can you feel sad when you see changes in your body, but your caregivers may also be more concerned about your health. Studies have shown that when family members see these symptoms, they may force the patient to eat, even out of love, which can lead to unnecessary conflict and increase the already stressful situation.

Imagine, when a family member is thin due to cancer and can't eat, it's normal to insist, "Please eat a little more, please eat this too." But that can be even more stressful for the patient.

How do doctors diagnose cancer cachexia?

Your oncologist and/or palliative care team will examine you physically. They may ask you to fill out a questionnaire about your eating habits, and may also perform tests to measure your overall fitness and muscle strength.

In addition, a CT scan or DXA scan may be recommended. This DXA scan measures the amount of lean tissue in your arms and legs. It can give the oncologist an idea of ​​your muscle mass. The results of these tests will help the doctor determine the stage of the disease.

What are the stages of cancer cachexia?

There are three main stages of cancer cachexia:

• Pre-cachexia: In this stage, you are losing weight despite eating well. However, you have not lost more than 5% of your total body weight in the past 6-12 months. If you are obese, this weight loss may not be noticeable, but tests show that metabolic changes have occurred and you are losing muscle along with fat.
• Cachexia: You have lost more than 5% of your body weight in the past 6-12 months, or you have lost more than 2% of your body weight and your body mass index (BMI) is less than 20kg/m². Tests may show signs of muscle wasting and inflammation.
• Refractory cachexia: At this stage, you have lost more than 20% of your normal weight and your BMI is less than 27 kg/m² (this may seem high, but it is severe when combined with significant weight loss). Your weight loss can make you look very unwell and make you less able to cope with cancer treatments. In some cases, cancer treatments may even stop working.

What are the treatments for cancer cachexia?

Your treatment will primarily focus on ways to improve nutrition . For example, your cancer team and palliative care team may recommend things like:

• Eat well: Focus on eating small meals and snacks that are high in calories, fat, and protein . Eating smaller meals will help you get more calories. Talk to your nutritionist about which foods will help you get the most out of every bite you eat. They may suggest adding things like cheese, butter, nuts, and skim milk to your diet.
• Try supplements: Ask your oncologist or nutritionist about nutritional supplements that you can drink or eat between meals. These can provide extra nutrition.
• Get some exercise: Light exercise can help slow down muscle loss, but this should only be done under medical advice.
• Rely on your medical team: Your palliative care team can help you with things like mental health and spiritual support. That support is invaluable at this time.

Are there medications to treat cachexia?

Not at this time. Although research shows that a drug called megestrol acetate can increase appetite and help you gain weight, the U.S. Food and Drug Administration (FDA) has not approved it for the treatment of cancer cachexia. In some cases, your doctor may prescribe a short-term course of corticosteroids .

What can someone with cancer cachexia expect?

It really depends on your situation. That is, what stage of cachexia you are in, what stage of cancer you are in. For example, if you have pre-cachexia, making changes to what you eat can slow down the rate at which you lose fat and muscle. But, unfortunately, even if you increase the amount you eat, you cannot completely stop the loss or regain the lost muscle and fat.

If you have advanced cancer and cachexia, or cachexia that does not respond to treatment (refractory cachexia), your oncologist may say that you are nearing the end of your life. If you are being treated for cachexia, your medical team can give you the best information about what to expect.

What is the life expectancy of someone with cancer cachexia?

Life expectancy varies from person to person. Although cancer cachexia usually affects people with advanced cancer, you can develop pre-cachexia symptoms at any stage of your cancer. If that happens, you can live with complications like cancer and cachexia for years. However, research suggests that having refractory cancer cachexia, which is a form of cancer that doesn't respond to treatment, reduces your chances of surviving cancer by about 30%.

Cancer cachexia occurs because the disease causes your metabolism to use energy from food more quickly than normal. In addition, cancer and cancer treatments can prevent you from eating properly. As a result, your weight and muscle mass can decrease significantly, affecting your appearance (and your self-esteem), your energy levels, and your quality of life.

Although there is no specific medical treatment for cancer cachexia, there are things you can do to help manage its symptoms. If you are experiencing this, ask your cancer care team for help. They understand the challenges of living with cancer cachexia and will do everything they can to help you manage them.

The most important things to remember (Take-Home Message)

• Cancer cachexia is not a part of the cancer itself, but a separate condition that needs to be managed. If you or a loved one is experiencing weight loss, loss of appetite, or extreme fatigue, talk to your doctor about it.
• Nutrition is very important. Eating small, frequent meals that are high in calories and protein, and seeking medical advice about nutritional supplements can help manage this condition.
• You are not alone. There are oncologists, nurses, nutritionists, and palliative care teams to help you on this journey. Get their support.
• Mental health is also very important. Along with physical changes, depression can also occur. Talk to your medical team about this and get the necessary support.

Fighting cancer is not easy. It's hard to cope with other challenges like these. However, with the right awareness and support, these challenges can be overcome.

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