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Cancer cachexia: What it’s all about

The severe loss of weight, fatigue and weakness is a common symptom of advanced cancer. Here’s a look at its causes and what can be done about it.

Cachexia, which refers to the severe loss of weight, fatigue and weakness resulting from muscle atrophy, is one of the most common symptoms seen in people with advanced stages of cancer. According to Cancer Research UK, up to 60 per cent of such patients can develop some degree of cachexia. Those with early stages of cancer are usually not affected by this condition.

Also called wasting syndrome, cachexia is characterised by a loss of body fat and muscle mass as the patients find it harder to swallow or digest food or liquids, and lose their appetite even for foods they used to enjoy. As a result of the involuntary poor nutrition, cancer patients with cachexia can experience significant weight loss and end up very thin and malnourished.

The condition is caused by a number of factors. One primary cause is the body’s response to the tumour, which leads to a breakdown in normal body processes and functions, particularly, in absorbing nutrients, which in turn leads to weight loss and muscle wasting.

The main symptoms of cachexia include:

• Severe weight loss
• Progressive loss of fat and muscle mass
• Loss of appetite
• Nausea
• Extreme weakness and fatigue

Diagnosis and management

Cachexia is typically diagnosed through a combination of checks and tests, including the body mass index (BMI), which provides information about a person’s weight relative to his/her  height; the ratio of muscle mass to body fat; and blood tests. More formally, cachexia has been defined as a loss of lean tissue mass involving a weight loss of more than five per cent of the body weight in 12 months or less in the presence of chronic illness, or a BMI of less than 20 kg/m².

Cachexia needs to be addressed properly, as the condition can affect a cancer patient’s ability to tolerate treatments such as chemotherapy and to cope with the side effects. It can also diminish a person’s quality of life, as he/she would not be able to eat well or participate in daily, ordinary activities.

While it is difficult to reverse cachexia or control it completely, steps can be taken to manage it and bring the patient some comfort and relief.

Research has also suggested that cachexia is often present before any weight loss occurs and before any symptoms are noticeable. Cancer patients should thus go for routine screening for the condition, so that interventions can be introduced in the early stages.

Preventing cachexia

If you are experiencing a significant loss of appetite or weight loss, talk to your oncologist as soon as possible. Some of the symptoms may be the side effects of the cancer treatment you are undergoing, and may go away over time; they may not necessarily mean you have cachexia. However, if you do, it is better to be diagnosed early so that recommendations can be made to help you cope with the condition better. The recommendations may include:

Eating well:  A dietitian from your cancer healthcare team can help you develop an eating plan that is packed with essential nutrients. In general, it is good to eat small, frequent, and calorie-dense meals. And if you are returning to eating more, it is important to increase the food intake and calories gradually, to avoid the side effects of refeeding syndrome.

Nutritional supplements: Supplements that are nutritionally complete can be introduced to boost your nutrient intake if you are not getting enough of them. There are several types of such supplements to suit individual medical needs. Discuss with your dietitian to choose one that is most suitable for you. 

Light exercise: Fatigue and weakness are often associated with cancer treatment. But there has been more clinical evidence supporting the use of light exercise to manage these symptoms. Physical activity may help to improve your mood and wellbeing as long as you can tolerate it. Work with a clinical exercise specialist or a physiotherapist to tailor an exercise programme that matches your ability.

Getting support: Don’t overlook the value of the social aspects of eating. Eating a meal with a family member or friend, or having it in a pleasant, relaxed environment can help to stimulate both appetite and social interaction. Meeting people can also provide helpful social and emotional support. 

Medication: Certain medication such as megestrol acetate and corticosteroids may help increase appetite and weight, but not survival or quality of life.

Written by Kok Bee Eng