Why do cancer patients get Cachexia?

Cachexia (Wasting Syndrome) Cancer

Cachexia is a syndrome (multifactorial) with an exceptional effect on a patient’s life quality, which is associated with less response to antitumor therapy.

The main features (clinical) of cachexia include:

  • Involuntary weight loss (progressive) due to the reduction of SMM or skeletal muscle mass with or without adipose tissue depletion.
  • By some properties, starvation is also a characteristic of cachexia.

Cachexia can lead to functional impairments (progressive).

The generic definition of cachexia applies to all cachexia types, which includes Low BMI and weight loss. At least three additional criteria are also necessary, such as fatigue, abnormal biochemistry, low hemoglobin or low albumin, low FFM (fat-free mass), and a decrease in the strength of body muscles.

Cachexia is the presence of weight loss for at least 5% of the body mass during the last six months or BMI less than 20 kg/m2 or sarcopenia.

Cachexia is the most common symptom in chronic conditions as cancer, multiple sclerosis, HIV, and chronic renal failure.

How does cachexia affect the body?

Cachexia is a multifactorial syndrome. Cachexia causes systemic inflammation, reduced intake of food, and altered metabolism, which leads to a decrease in muscle mass and reduction of the body weight. The exact mechanism of cachexia is still unknown. Cachexia emerges in terms of neuroendocrine or cytokine-driven changes.  These changes include the intake of food and adipocyte lipolysis (fat breakdown). Altered synthesis or degradation of skeletal and hepatic muscle protein is another cause of cachexia.

Mechanism of cachexia is an integrated physiological response which mediates by inflammation. Inflammation is a unifying mechanism for a cluster of problems.

These problems include:

  • anorexia,
  • sleep disturbance,
  • fatigue,
  • mood alterations,
  • anhedonia,
  • fever,
  • depression,
  • hyperalgesia,
  • a decrease in social interaction,
  • cognitive impairment,

According to recent studies, inflammation can play a significant role in:

  • Increasing adipose tissues lipolysis
  • Muscle proteolysis.

Cachexia leads to:

  • Insulin resistance
  • Inflammation
  • Hypogonadism
  • Anorexia disorder (an eating disorder)

A decrease in skeletal muscle mass is due to an increase in catabolic factors as:

  • Cytokines,
  • Glucocorticoids,
  • ROS (reactive oxygen species),
  • PIF (proteolysis inducing factor),
  • UPS (ubiquitin-proteasome system)

Along with it, skeletal muscle mass decrease also depends upon less anabolic factors as:

  • Satellite cells
  • IGF-1 (insulin-like growth factor 1).

How does cachexia affect cancer treatment?

In cancer patients, cachexia can lead to increased muscle loss, the altered image of the body, and changes in physical functions. A healthy immune system and body health are necessary for interventions of cancer. Cachexia causes a decrease in calorie intake, a decrease in muscle strength, and increased fatigue in cancer patients. These factors make a patient unable to tolerate treatments. That’s why it is essential to treat cachexia in cancer patients before giving interventions.

In advanced cancer stages, calorie intake is less to support the body’s metabolic demands.

How are doctors currently treating cachexia?

Currently, there are no standard guidelines for treating cachexia. Doctors are trying to treat cancer cachexia in two ways.

  1. General treatment
  2. Nutritional interventions

General treatment:

After the treatment of reversible metabolic problems and nutrition impact symptoms, doctors reassess and treat the patients.

In general, doctors recommend the patients to eat frequent, small, calorie-dense foods. Health care facilities also provide the appropriate psychosocial support for patients suffering from body alterations and weight loss.

Doctors often recommend the liquid nutritional supplementation as a replacement for regular meals. In the case of advanced diseases, doctors counsel patients and their families that an increase in calorie intake cannot reverse the underlying cachexia or anorexia.

Nutritional interventions:

Doctors refer the cancer patients to nutritionists for having useful information. Studies for nutritional interventions showed mixed results. According to a study, they treated colorectal cancer patients with nutritional support, which increased patients’ caloric intake, improved quality of life, and functional status.

Patients suffering from this disorder require high energy. Several amino acids, micronutrients, and vitamins are beneficial for treating cachexia patients.

Supplementation with glutamine:

This supplementation is essential in cancer patients. According to clinical data, glutamine supplementation helped in less weight loss among patients who were undergoing radiation therapy.

Dosage of L-carnitine (about 4 g per day) is effective in patients suffering from cachexia and advanced pancreatic cancer. Patients who have cancer already have low levels of serum carnitine, which leads to a decrease in nutritional intake.

Improvement in these levels can improve quality of life, increase weight, and improve the survival of the patient.

Supplementation with the amino acids:

Supplementation with the amino acids is another effective nutritional intervention. According to studies, 14 g of amino acid supplementation increases anabolic potential in cancer patients.

DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid), and omega-3fatty acids are effective in patients suffering from cancer cachexia. According to recent studies, supplementation with omega-3 fatty acids is more effective for giving potential benefits to the patients.

Does every cancer patient suffer from cachexia?

Not every cancer patient suffers from cachexia. Cachexia is frequently present in patients with lung cancer, while it rarely persists among patients with breast cancer. Cachexia related to cancer does not occur in the earlier stage of cancer. Rather it is seen in metastatic disease or advanced tumors.

In advanced stages, the prevalence of cachexia is higher. According to an estimate, about 50 to 80 percent of the patients suffer from cancer cachexia. It can account for more than 20% of the deaths among cancer patients.

When was cachexia first discovered?

Cachexia is known to be an eating disorder for a long time before. Different scientists gave definitions of cachexia.

  • Hippocrates in (c. 460–377 BC) linked some symptoms with cachexia.
  • Herbert French also defined the term cachexia in 1912.
  • Chambers Encyclopaedia defined cachexia in 1901.

Name some famous people that died from cachexia and cancer?

Some famous people who suffered deaths from cancer and cachexia were:

  • Farrah Fawcett (from February 2, 1947 – June 25, 2009). She died due to anal cancer, which affects one in 5000 people. She had a complaint of recurrent cancer after one year of initial treatment.
  • Sydney Pollack (from July 1, 1934 – May 26, 2008). He died of stomach cancer. Doctors diagnosed cachexia in the later stages of his cancer.
  • Tony snow (from June 1, 1955 – July 12, 2008). He battled with colon cancer in the year 2005. He also died from the remission of cancer after two years of initial cancer treatment.
  • Eartha Kitt (from January 17, 1927 – December 25, 2008). This legendary star died due to colon cancer. She was diagnosed with colon cancer in the year 2006 while she died due to cachexia and anemia in the year 2008.
  • David Bowie (from January 8, 1947 – January 10, 2016). He was a renowned English actor and songwriter. He died of liver cancer in the end stages.

Conclusion:

Cachexia is a disorder that commonly develops in patients who have cancer. Several factors contribute to cancer cachexia. In earlier stages, it is reversible through nutritional interventions. In advanced stages of cachexia, it is sometimes impossible to reverse the damage. Not all patients who have cancer have cachexia. Patients with advanced stages of cancer or malignant disease suffer from cachexia. Cachexia can affect the treatment of cancer by causing body fatigue, a decrease in immunity, and anemia. Early identification of cachexia is vital for cancer interventions in patients.