“There’s actually quite a bit of debate about what the clinical definition of cancer cachexia is, but in its simplest definition of cachexia in this case is cancer-induced body weight loss. You can have cachexia in other diseases, for heart failure or renal failure, but it's basically tumor-induced metabolic derangement that leads to inflammation and often anorexia, which produces body weight loss,” ONS member Teresa Zimmers, PhD, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about cancer cachexia.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

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Episode Notes

Complete this evaluation for free NCPD.
Oncology Nursing Podcast™ episodes:
ONS Voice articles:
ONS course: Introduction to Nutrition in Cancer Care
ONS Nutrition Learning Library
ONS Symptom Intervention Resource: Anorexia
American Society of Clinical Oncology (ASCO) Cancer Cachexia Guidelines
Cachexia Score screening tool
Cancer Cachexia Network
Cancer Cachexia Society
Malnutrition Screening Tool
Patient Generated Subjective Global Assessment
Society on Sarcopenia, Cachexia, and Wasting Disorders

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Highlights From This Episode

“Anorexia is often a component of cancer cachexia. In fact, some people call it cancer-induced anorexia, cachexia syndrome, because the tumors produce factors that act on the hypothalamus and hindbrain to produce, among other things, anorexia, but not just anorexia, you know, feelings of misery, anhedonia, wanting to withdraw from social interactions, but definitely altered desire to eat and altered taste of food.” TS 5:32

“Cachexia is most common, you know, where it’s been examined, in patients with upper GI cancers. You could think of those as risk factors for cachexia. So that includes, of course, head and neck cancer, esophageal, gastric, pancreatic, liver and biliary cancers. It’s also found to be very prevalent among patients with any kind of metastatic cancer and very frequent in patients who are hospitalized for their cancer. But beyond that, about half of patients with non-small cell lung cancer also experience cachexia.” TS 8:21

“I’ve been told by oncologists that cachexia is frequent in patients with certain rare cancers like ocular melanoma, small cell lung cancers, but generally speaking, cachexia is underrecognized. Most people have in their minds this picture of someone who’s sort of end-stage cachexia, that’s emaciated. And in fact, most patients, or many patients in the U.S. at least, arrive with a cachexia diagnosis and may be overweight or even indeed obese, but that does not mean that they don’t have cachexia.” TS 8:54

“I have tremendous respect for our nurses who take care of patients, and all of them have their preferred screening tools. There is no single accepted or mandated approach to diagnosing or treating someone with cancer cachexia. And I should say that I didn’t mention a widely accepted definition for cancer cachexia in the field, a diagnostic criterion, is weight loss of greater than 5% in the prior six months—and this is unintentional weight loss. TS 11:05

“I hear from family members all the time about how this was actually the most distressing part of their loved one’s cancer journey because it’s something so visible. And also, so much of our relationships happen over meals. And what I’ve heard time and time again is that telling someone that there is a word for this, cachexia, and explaining that it is the tumor—right, it’s the cancer that’s causing this appetite loss—would have helped because there tends to be a lot of conflict over meals, you know, a lot of guilt on sides when it comes to eating and trying to prepare meals that are appetizing for the person with cancer.” TS 22:24

“I think that we don’t often think about how much the cachexia itself affects the cancer treatment outcomes. The presence of weight loss correlates with treatment toxicity. Chemotherapy is often dosed on body surface area. Patients who have very low muscle, for example, experience greater toxicities, and maybe we should be dosing based on lean muscle mass. Patients with cachexia have poor outcomes after surgery. And actually, patients with cachexia don’t respond to immunotherapy, which of course has been transformative for cancer care. So, treating cachexia may actually enable patients to respond better to all of their cancer interventions.” TS 28:45

Episode 343: Cancer Cachexia: How to Support Your Patients 32:45 Share

The Oncology Nursing Podcast

What is Cancer Cachexia?

Anorexia and Cancer Cachexia: More Than Just Loss of Appetite?

Which Cancers Are Most Associated with Cachexia?

Cachexia in Rare Cancers and Its Underrecognition

Diagnosing Cancer Cachexia: A Lack of Standardized Criteria?

The Emotional Impact of Cachexia on Families

How Does Cachexia Affect Cancer Treatment Outcomes?

Shownotes Transcript

Episode 343: Cancer Cachexia: How to Support Your Patients