Cancer-associated malnutrition, cachexia and sarcopenia: The skeleton in the hospital closet 40 years later
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Date
2016-01-20
Authors
Ryan, Aoife M.
Power, Derek G.
Daly, Louise
Cushen, Samantha J.
Ní Bhuachalla, Éadaoin
Prado, Carla M.
Journal Title
Journal ISSN
Volume Title
Publisher
Cambridge University Press on behalf of The Nutrition Society
Published Version
Abstract
An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50â 80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20â 70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40â 60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.
Description
Keywords
Cancer , Cachexia , Sarcopenia , Quality of life , Malnutrition , Survival
Citation
Ryan, A. M., Power, D. G., Daly, L., Cushen, S. J., Ní Bhuachalla, É and Prado, C. M. (2016) 'Cancer-associated malnutrition, cachexia and sarcopenia: The skeleton in the hospital closet 40 years later', Proceedings of the Nutrition Society, 75(2), pp.199-211. doi: 10.1017/S002966511500419X
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Copyright
© 2016, the Authors. Published by Cambridge University Press on behalf of The Nutrition Society. This material is free to view and download for personal use only. Not for re-distribution, re-sale or use in derivative works.