Cachexia

Is Cachexia a Sign of Dying?

By April 21, 2020 April 22nd, 2020 No Comments

The honest answer, until recently, is — yes. But saying something is a sign of death
sounds like it’s a fact, as if cachexia means certain death. There is no definitive
prevention or treatment of cachexia, so let’s just accept it and proceed to expiration. Or
could it be that we just have not figured out the pathology of cachexia yet — that is, how
it comes to exist in the body — and therefore we just can’t stop it yet?

That’s how we figure out diseases, right? Either by trial and error — testing certain
drugs to see if they work. Or by figuring out how the disease happens and interfering
with that.

So, perhaps the better question is: Is cachexia associated with death because it’s a
stigma of life-threatening disease? The answer is still a resounding yes. Doctors and
health care professionals still associate cachexia with death. And patients and their
families see it with their own eyes … and well, a person with advanced cachexia is
emaciated and looks like they are dying. It’s difficult not to make the association.

But there’s a growing number of researchers and doctors that believe that resigning
cachexia patients to a death sentence is BS. That sticking a patient’s cachexia under
the palliative care column once diagnosed is not good enough.

So, what is being done about it?

Why is Cachexia Associated with Death?
A 2013 study called the causes of Cachexia a “century-long uncertainty”. But cachexia
has been perplexing healers since ancient times. Long before cachexia was defined in
these last two decades, medical experts were recognizing cachexia in the late stages of
disease and identifying it as a sign of death. Hippocrates, the ancient physician and

philosopher, described a cachexia patient as having “a sharp nose, hollow eyes, sunken
temples. . . .”

Cachexia hsd a constellation of causes, such as, anorexia, inflammation, insulin
resistance, increased muscle protein breakdown, and how these causes play out
depends on the underlying disease, but not the disease alone. Cachexia can result from
many different diseases that have at least one thing in common: they are all life-
threatening. Cancer, diabetes, untreated AIDS, COPD, chronic heart failure, chronic
renal failure, and rheumatoid arthritis are just some of these diseases associated with
cachexia, with cancer cachexia being the most studied so far. According to leading
researchers, Stefan D. Anker and Stephon von Haeling, the most frequent cachexia
subtypes in order are COPD cachexia, cardiac cachexia, cancer cachexia, and
cachexia of chronic renal failure. They estimate that in industrialized nations, about 9
million people are affected by cachexia.

It’s almost as if the disease puts the patient on a Cachexia roadmap, where the
destination is basically the same, but the way it can take can vary. This could explain
why we still associate cachexia with death. From history until very recently, we have
only recognized cachexia in late stages, so it is associated with death. This lack of early
recognition has led to a lack of attention. Lack of attention has led to a lack of
understanding. Lack of understanding has led to a lack of treatment and a resolve to
continue to to equate cachexia with death. Like the disease itself, this cycle feeds on
itself.

Lack of Early Recognition of Cachexia
The emaciated description given by Hippocrates above, still persists as “first signs” for
doctors today. Some of the first signs of cachexia doctors look for are changes at the
temple of the head and the emergence of more prominent bone structures.

In a 2017 multinational survey of 742 oncology health care professionals (HCPs), 86%
defined cachexia as weight loss, with 46% throwing anorexia into the definition. Half of

the respondents said they would diagnose cachexia after 10% weight loss, 35% said
they would wait for a 15% to 20% loss, and 10% of these professionals said they would
wait for a weight loss >25%.

Pause for dramatic effect.

In 2008 (that’s 9 years prior to this study), official diagnostic criteria for cachexia was
developed by scientists and clinicians at an international conference in Washington,
D.C. The percentage of weight loss necessary to diagnose a patient with cachexia
is 5%. As you can see, most HCPs diagnose cachexia too late.

Lack of Attention to Cachexia
“We believe that cachexia requires more attention, not only by physicians and other
health care professionals, but also by the general public.” This is one of the reasons
Ander and von Haehling gave for starting their Journal of Cachexia, Sarcopenia, and
Muscle in 2011.

In 2015, Anker told Nature journal of science that the biggest challenge to the field of
cachexia is that it has to compete for funding and recognition with research into other
major diseases.

Jose Garcia, a clinical researcher focused on wasting disorders at the Michael
E. DeBakey Veterans Affairs Medical Center in Houston, Texas, expressed in the same
article, “I’m a little bit worried that if we don’t see a successful clinical trial in the next five
years, the dollars from the pharmaceutical industry to develop a treatment will go
somewhere else.”

If we continue to think of cachexia as just a part of the death process for the 9 million
people suffering from it, then his worries are probably justified.

Lack of Understanding of Cachexia

The lack of understanding of cachexia, like the causes of cachexia themselves, spring
from a variety of reasons. For one, only recently was cachexia defined in the mid 2000s,
and since then the definition has continued to be refined. It’s difficult to institute a
standard when criteria keep evolving. But it appears that knowledge of cachexia will
continue to develop, which means HCPs must stay on top of it.

It’s apparent from the previously mentioned 2017 survey of HCPs that defining and
diagnosing cachexia is not well understood. Lead author and professor in the
department of medicine at Sapienza University of Rome in Italy, Maurizio Muscaritoli,
MD, says, “The recent definition, classification, and diagnostic criteria for cancer
cachexia clearly describe cancer cachexia as spectrum of conditions, ranging from
pre‐cachexia, to cachexia, and refractory cachexia.”

In a nutshell, that means that we don’t have to wait until a patient is dying to determine
that they have cachexia.

How to Deal with Cachexia
“…treatment of cachexia should not be considered peculiar of palliative care medicine.”
—Maurizio Muscaritoli, MD

Palliative care is important. According to the World Health Organization (WHO), it is “an
approach that improves the quality of life of patients and their families facing the
problem associated with life-threatening illness, through the prevention and relief of
suffering by means of early identification and impeccable assessment and treatment of
pain and other problems, physical, psychosocial and spiritual.”

Where in there does it say consider a problem a sign of death and don’t treat it? In fact,
it says “early identification” and “impeccable assessment and treatment”.

Palliative care is an approach, not a place where we assign patients with the cachexia
mark of death. Yes, cachexia patients need palliative care, but what cachexia patients
need most — like with any other disease — is to not be cachexia patients. There’s only
one way to begin to do that: Stop treating cachexia like a death sentence and get on
with finding a novel approach to preventing and treating it.

New Ways to Stop Cachexia
“Many oncologists think that a cachectic patient is a profoundly wasted and almost
moribund patient. Cachexia is not to be seen as unavoidable, but rather as a partially
preventable cancer comorbidity.” —Maurizio Muscaritoli, MD

To change the way health care professionals, patients and their caregivers, and the
public view cachexia — and not as a sign of death — it is going to take experts who
believe it is worth the resources to continue to seek out new solutions.

Many drugs have been tried in the treatment of cachexia along the way. Corticosteroids,
progestins, NSAIDs and thalidomide, to name a few, showed some improvement in
areas of cachexia, but often at the expense of side effects that outweighed the benefits.
Not good enough, since cachexia is already a complex condition that needs no more
wrenches thrown in.

Researchers believe it’s a novel solution that will change how we view and treat
cachexia. Cachexinol is one such next-generation treatment for cachexia.

Can Wasting Syndrome Be Reversed?
Mice with Cancer Cachexia Recover with Cachexinol
Cachexinol is a patent-pending curcumin-based formula that has two mouse studies
showing mice with cancer tumor-induced cachexia live for the full length of time and
regain weight.

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

Researchers are still studying exactly how Cachexinol works, but it’s believed to have
to do with immune function and metabolism, two of the major contributing causes of
cachexia.

When something new like Cachexinol comes along, that packages the therapeutic
benefits of a natural spice in a custom developed delivery package (liposome) and is
guaranteed to get it into the bloodstream … it’s important that patients, caregivers, and
their care team know and discuss it as an option moving forward.

You have the right to talk with your doctor about new options. Just like you have the
right, along with our researchers, to believe that cachexia is not just a sign of death, but
a treatable, reversible disease that with treatments like Cachenxinol can give patients a
fighting chance.