1. Cancer Cachexia Management Strategies Provided Courtesy of RD411.com Where health care professionals go for information Review Date 2/12 O-0537

2. 2 Agenda 1.What is cancer cachexia? 2.Prevalence 3.Strategies to manage cachexia

3. Cancer Cachexia Defined A complex metabolic syndrome associated with underlying illness and characterized by the loss of muscle with or without loss of fat mass 3 Braun TP, Marks DL. Pathophysiology and treatment of inflammatory anorexia in chronic disease. Journal of Cachexia, Sarcopenia, and Muscle. 2010;1:135-145.

4. Causes of Cachexia Tumor-induced response that causes an increase in proinflammatory cytokines: –Results in a breakdown in skeletal muscle –Chronic inflammatory state 4 Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265-279.

5. Results of Cachexia Weight loss Anorexia Muscle wasting Altered immune function Fatigue 5 Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265-279.

6. Results of Cachexia (cont’d) Physical disability Diminished quality of life: –Poor treatment outcomes –Increased toxicity with chemotherapy Reduced survival 6 Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265-279.

7. 7 Cycle of Malnutrition Eat Less Lose Weight Lose Strength CYCLE OF MALNUTRITION Tire Out Quickly Too Tired to Cook Too Tired to Eat

8. Cascade of Cachexia 8 Cancer Diagnosis Tumor-Induced Inflammation Increased protein catabolism Decreased protein anabolism Decreased calorie intake Increased insulin resistance Increased lipolysis Increased REE TNF IL-6 INF IL=interleukin, REE=resting energy expenditure, TNF=tumor necrosis factor Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265-279.

9. Managing Cachexia Increases in protein and calories alone will not halt the catabolic processes responsible for cachexia 9

10. Managing Cachexia (cont’d) Targeted nutrition therapy that might prove beneficial: –Eicosapentaenoic acid (EPA), an omega-3 fatty acid –ß-hydroxy-ß-methylbutyrate, found in Juven ® and Ensure ® Clinical Strength 10 Argilés JM, Olivan M, Busquets S, López-Soriano FJ. Optimal management of cancer anorexia-cachexia syndrome. Cancer Manag Res. 2010;22:27-38.

11. Pharmacological agents: –Appetite stimulants, such as Megace ® –B2 antagonists, such as Symbicort ®, that increase protein deposition –Thalomid ®, which targets proinflammatory cytokines –Oxandrin ®, which promotes the anabolic process 11 Managing Cachexia (cont’d) Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265-279.

12. Summary May need targeted nutrition therapy or medications to treat cancer cachexia 12