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Ann Oncol. 2014 Aug;25(8):1492-9. doi: 10.1093/annonc/mdu085. Epub 2014 Feb 25.

Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force.

Author information

1
Clinique de Genolier, Genolier, Switzerland.
2
Tumor Biology Center, Albert Ludwig's University, Freiburg, Germany.
3
Department of Medicine and Surgery, University of Milan, Milan, Italy.
4
School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK k.fearon@ed.ac.uk.
5
Hematology/Oncology Division, University of Vermont College of Medicine, Burlington, VT, USA.
6
Department of Oncology, Odense University Hospital, Odense, Denmark.
7
School of Healthcare Sciences, Cardiff University, Cardiff, UK.
8
Department of Oncology, Mayo Clinic, Rochester, MN, USA.
9
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
10
Department of Internal Medicine, Kantonsspital, St Gallen, Switzerland.

Abstract

BACKGROUND:

Weight loss and cachexia are common, reduce tolerance of cancer treatment and the likelihood of response, and independently predict poor outcome.

METHODS:

A group of experts met under the auspices of the European School of Oncology to review the literature and-on the basis of the limited evidence at present-make recommendations for malnutrition and cachexia management and future research.

CONCLUSIONS:

Our focus should move from end-stage wasting to supporting patients' nutritional and functional state throughout the increasingly complex and prolonged course of anti-cancer treatment. When inadequate nutrient intake predominates (malnutrition), this can be managed by conventional nutritional support. In the presence of systemic inflammation/altered metabolism (cachexia), a multi-modal approach including novel therapeutic agents is required. For all patients, oncologists should consider three supportive care issues: ensuring sufficient energy and protein intake, maintaining physical activity to maintain muscle mass and (if present) reducing systemic inflammation. The results of phase II/III trials based on novel drug targets (e.g. cytokines, ghrelin receptor, androgen receptor, myostatin) are expected in the next 2 years. If effective therapies emerge, early detection of malnutrition and cachexia will be increasingly important in the hope that timely intervention can improve both patient-centered and oncology outcomes.

KEYWORDS:

cancer cachexia; malnutrition; nutritional support; review; systemic inflammation

PMID:
24569913
DOI:
10.1093/annonc/mdu085
[Indexed for MEDLINE]

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