What Causes Cachexia?

For many years, cachexia has eluded precise definition and treatment standards. Yet patients and their families continue to be devastated by it. In 2012, leading researchers, Stefan D. Anker and Stephon von Haeling, declared in their Journal of Cachexia, Sarcopenia and Muscle that cachexia is an “underestimated and underrecognised medical problem”.

Cachexia is a distressing consequence of major chronic illness, affecting 16–42% of people with heart failure, 30% of chronic obstructive pulmonary disease (COPD) patients, and up to 60% of those suffering from kidney disease. It can also affect people in late stages of chronic illnesses such as cystic fibrosis, rheumatoid arthritis, Alzheimer’s, and many others.

Until the last decade or so, this wasting disease was overlooked, as physicians and researchers focused their attention on the primary diseases, awkwardly failing to address cachexia with the patient until it was too late.

In a 2016 BMC Cancer article exploring the results of cachexia animal studies, researchers continued the lament over the cachexia problem, claiming, “Currently, an effective treatment is still lacking and the search for therapeutic targets continues.”

And in 2019, Anker and colleagues—while reporting on some promising developments from the 11th Cachexia Conference—admitted that it “remains a fact, however, that effective treatments of cachexia and wasting disorders are urgently needed in order to improve patients’ quality of life and their survival.”

It’s clear that it’s time to start talking about cachexia, and about how supplements like Cachexinol can help give patients a fighting chance.

The Cachexia Discussion

For a long time, doctors didn’t often bring it up. In fact, plans for cachexia support are still coming online, now that palliative care continues to become more integrated in the treatment of patients with chronic illnesses.

But cachexia is not new. During the 4th century BC, Hippocrates wrote that “the flesh is consumed and becomes water, … the abdomen fills with water, the feet and legs swell, the shoulders, clavicles, chest, and thighs melt away … The illness is fatal.”

But it took until 2006 for the medical field to start coming up with a formal definition for this wasting condition, which seems to be characterized by metabolic disorder with several possible contributing causes.

Among the cachexia issues stressed by doctors presenting at the 2019 MASCC Webinar on How to Run a Successful Cachexia Clinic, were:

  • The importance of making the case to patients, their families, oncologists, and other healthcare leaders.
  • Needed supportive care measures to address nutrition impact symptoms, diet, physical performance, etc.
  • Finding ways to engage patients early in their treatment.
  • Improving education and adherence to treatment regimens.

It’s important that patients with chronic illnesses, such as cancer and COPD, are informed early on about the possibility of cachexia, along with options like Cachexinol that could help give them a fighting chance against it.

In order to help make patients aware, this article will discuss the following areas that describe cachexia and its potential known causes:

  • What Is Cachexia?
  • What Are the Symptoms of Cachexia?
  • How Is Cachexia Diagnosed?
  • What Are the Stages of Cachexia?
  • What Are Doctors Doing to Treat Cachexia?
  • How Are People Living with Cachexia?
  • What Are the Causes of Cachexia?

What Is Cachexia?

Cachexia has not been easily defined. Experts like Anker, meet regularly at cachexia-specific conventions and continually evolve the disease’s definition according to latest research and assessments.

Anker, von Haeling, and Ebner, in their latest report, define cachexia as “characterized by progressive weight loss affecting different body compartments, particularly muscle tissue and adipose tissue, although even bone mineral content may be affected.”

In one BMC Cancer article, researchers state that “The most important clinical feature of cachexia is the excessive wasting of skeletal muscle mass.”

But it’s important to understand that cachexia is more than weight loss—it’s an involuntary weight loss that does not respond to traditional treatment methods. A cachexia care article in the journal, Current Opinion in Palliative and Support Care, reminds us that cachexia can’t be fully reversed by traditional nutritional support. It’s not like malnutrition, which can be reversed with adequate food.

In one cachexia study, researchers called it a disheartening state in which “all you can eat is yourself”.

According to Dr. Alfred Goldberg of the Harvard University School of Medicine, what cachexia boils down to is “a host response that’s evolved to fight fasting, injury, or disease.” We’ll look at this further when we discuss causes of cachexia, but Dr. Goldberg’s definition helps to explain the “involuntary” aspect of the disease. The body may be responding in a defensive manner—one that is detrimental to the patient.

Research defines cachexia as not being treatable with conventional malnutrition treatments. Therefore, it will require nontraditional treatments. Cachexinol uses next-generation liposome technology to help patients gain nutrition in a whole new, powerfully effective way.

What Are the Symptoms of Cachexia?

It is believed that cachexia is already underway before symptoms present. Which illustrates even further the necessity of informing patients and loved ones of their risk for cachexia. Symptoms include:

  • Involuntary, unintentional weight loss
  • Skeletal muscle wasting
  • Anorexia/Loss of appetite
  • Lowered quality of life
  • Low levels of protein
  • High levels of inflammation
  • Reduced functional ability
  • Swelling or edema

In one cancer cachexia study, symptoms also included fatigue, anemia, abnormal metabolism, and poor tolerance to treatment.

How Is Cachexia Diagnosed?

In 2008, several scientists and clinicians came together in Washington, D.C. to form an agreed upon working definition of cachexia. During that conference, they came up with these diagnostic criteria for cachexia:

  1. Presence of a chronic disease;
  2. Loss of body weight greater than or equal to 5% within the previous 12 months or less; and
  3. Presence of at least three of the following: reduced muscle strength, fatigue, anorexia, low fat-free mass index, abnormal biochemistry, inflammation, anemia, low albumin

The National Cancer Institute posts these criteria for diagnosing cachexia in cancer patients:

  • Weight loss greater than 5% over the past 6 months; or
  • BMI less than 20 and any degree of weight loss greater than 2%;
  • Appendicular skeletal muscle index consistent with sarcopenia (another wasting syndrome) and weight loss of more than 2%

Methods for assessing patients can include measuring body mass index (BMI), lean muscle mass, food intake journals, and blood tests.

Recently, researchers developed a cachexia staging score (CSS) for advanced cancer patients in

order to clarify the three-level staging system:

  • Weight loss in 6 months (0-3)
  • A simple SARC-F questionnaire that assesses muscle function and sarcopenia (0-3)
  • ECOG performance status (0-3)
  • Appetite loss (0-2)
  • Abnormal lab tests (0-2)

The physician scores the patient for each category. The the combined score determines the patent’s category:

  • Non-cachexia (0-2)
  • Pre-cachexia (3-4)
  • Cachexia (5-8)
  • Refractory cachexia (9-12)

What Are the Stages of Cachexia?

According to a 2017 article in the Journal of Cachexia, Sarcopenia and Muscle, postulated stages of cachexia are:

  • Pre-cachexia: Weight loss less than or equal to 5%, anorexia, and metabolic change
  • Cachexia: Weight loss greater than or equal to 5%, or BMI less than 20 and weight loss greater than 2%; often reduced food intake; systemic inflammation
  • Refractory cachexia: Variable degree of cachexia; disease both procatabolic and nonresponsive to treatment; low performance score; less than three months expected survival

What Are Doctors Doing to Treat Cachexia?

Many researchers, palliative care experts, and clinicians with experience treating cachexia patients are sharing best practices through webinars, conferences, and published articles in science journals.

It’s important that doctors are aware that cachexia can develop gradually. Early signs of weight loss should be carefully screened throughout the illness. In 2017, the European Society of Clinical Nutrition and Metabolism issued evidence-based guidelines for nutritional care for cancer patients, suggesting the following steps to take action against cachexia:

  • Screen all patients with cancer for nutritional risk early in the course of their care regardless of body mass index and weight history
  • Expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure (REE) and physical function
  • Use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity

In a 2019 webinar put on by the Multinational Association of Supportive Care in Cancer (MASCC), experts presented practical information on how to set up and run a cachexia clinic within a cancer center. Speakers outlined objectives specifying ideal service and team structure, advocated for the importance of a cachexia clinic, presented brief assessments and basic management strategies, and recommended consideration for the most useful outcome measures.

A 2016 article by palliative care and cachexia experts recommends a “case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory.” Their multimodal approach, which they insist every member of the patient’s care team can contribute to, includes: assessing and managing nutritional impact symptoms like mouth sores or constipation; determining holistic needs for the patient and the family, which includes practical advice and education (a specialist visit is not always available or timely); patients should be supported and coached in self-management, and their family and social network should be taught to monitor health behaviors; encouraging patient adherence to their decided approach to care, reminding them that they are a part of the decision-making process. They suggest that “new requests or treatments should always be considered and introduced in line with the whole approach.”

When something new like Cachexinol comes along that can give a patient at risk for cachexia a preventative advantage against it, it’s important that the patient and their care team can discuss these possibilities and move forward together in their approach.

Cachexinol uses a proprietary liposome technology, developed by an award-winning chemist, that is clinically proven to increase nutrient absorption. It bypasses digestion, and therefore can often circumvent nutritional impact symptoms, like poor appetite and nausea.

How Are People Living with Cachexia?

More than 20% of cancer patients die for the direct or indirect consequences of cachexia, not cancer. “Living” with cachexia is practically an oxymoron. It is a wasting disease that devastates patients and families. That’s why it’s important to take preventative measures at the start of the diagnosis of a preventative illness, vigilantly assess the patient throughout, and explore new options like Cachexinol, which uses next-generation liposome technology to deliver essential nutrients.

In a 2015 article from the science journal, Nature, palliative-care researcher Susan McClement described the horror that patients and their families endure during the final stages of cancer cachexia. Loved ones will often spend last moments hovered over the bodies of emaciated patients, frustratingly and desperately trying to make them eat, believing it will help them fight the disease if they could just get the nutrition. Afterwards, they regret not spending more quality time.

Denis Guttridge, Ph.D. was recently interviewed in a Science Daily article. He’s a Hollings Cancer Center associate director of Translational Sciences, and one of the leading experts in the cachexia field. He is the chairman for the 2020 Cachexia Conference. In the article he spoke of meeting Patrick Swayze’s wife. Actor Swayze died in 2009 from pancreatic cancer and suffered from cachexia.

“I got the chance to speak with Patrick Swayze’s wife, and she shared with me how much of a fitness nut her husband was. She remembered that he would go in for his checkup and was always more concerned about why he was losing so much weight rather than the progression of his cancer, because maintaining a quality of life and his fitness was so important to him,” Guttridge told Science Daily.

This illustrates just how involuntary cachexia is for patients. Giving people a fighting chance against it from the start is crucial. Patients should ask their doctors about Cachexinol’s liposome technology that could offer them that fighting edge and support.

What Are the Causes of Cachexia?

The current consensus among experts seems to be that what causes cachexia is a kind of metabolic mutiny that may be triggered by a number of causes brought on by a chronic, malignant illness. Remember Dr. Goldberg’s hypothesis that cachexia is “a host response that’s evolved to fight fasting, injury, or disease”? Goldberg believes the problem is that they’re unable to turn off this response the body has to the cancer, even when the patient is able to receive essential nutrients.

The NCI reports that inflammation is a central theme tied to cachexia. Inflammation is caused by an immune response to cancer, which produces cytokines. Cytokines can help fight tumors, but it’s believed they can also shift metabolism toward catabolism—the breakdown of muscles and fat, a kind of metabolic mutiny.

During this metabolic mutiny, a vicious cycle persists where energy is wasted, tumors might gobble up glucose and turn it to waste products, convert the waste back to glucose, all to feed the tumor again. Additionally, the energy producing mitochondria in muscle cells begin to malfunction.

The disruption of metabolism worsens things for muscle cells. Nitrogen starvation occurs in muscles. Then inflammation induces catabolism, destroying protein and committing muscle suicide. The result is wasting—cachexia. Additionally, cachexia triggers disruption in homeostasis of the brain, liver, gut, and heart. The brain, for example, begins to suppress appetite. On top of all of that, the side effects of cancer treatment tend to exacerbate cachexia.

Cachexinol: Giving Patients a Fighting Chance

It is obvious that cachexia is a perplexing disease that deserves more attention. But in the last decade, as palliative care is becoming more integrated into treatment for patients with chronic illness, cachexia is getting more focus from researchers, doctors, and patient care teams. And as patient-centered approaches are being implemented more and more, clinicians are becoming more aware and open to changing and trying new approaches to the prevention and management of cachexia.

Cachexinol is formulated with liposome technology, that allows for a new approach to help patients with chronic illnesses prevent and fight cachexia. Talk with your doctor about Cachexinol and how it may fit into your cachexia management plan.