Understanding & Management of Cancer Anorexia - Cachexia

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    Understanding andManagement ofCancerAnorexia and Cachexia

    dr. Didik Soediarto, SpB (K) Onk

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    INTRODUCTIONCancer cachexia is wasting syndromeassociated with the presence ofuncontrolled malignancy and usuallycharacterized by loss of appetite(anorexia), weight loss and weakness.

    The word cachexia is derived from the

    Greek words kakos meanin bad andhexis meaning condition.

    Cachexia should be suspected if aninvoluntary weight loss greater than 5percents of premorbid within six monthsperiods especially when combined withmuscle wasting.

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    Mechanism of Cancer Anorexia and Cachexia

    Cachexia occurs secondary as a result of functional

    ability to ingest or use nutrient. This can be related

    to mechanical interference in the gastrointestinal

    tract, such as obstructions or malabsorbtion, surgical

    intervention, or treatment related toxicity. And in

    patient receiving chemotherapy, radiotherapy,

    nausea, vomiting, tastes changes, stomatitis,

    diarrhea, can all contribute to weight loss.

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    Mechanism of Cancer Anorexia and Cachexia

    The psychologic state which often coexists with

    depression is bound to affect food intake.

    Increased concentration brain tryptophan and

    seroton n an t e presence o anorex a represent

    one potential mechanism for cancer anorexia and

    cachexia.

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    Mechanism of Cancer Anorexia and Cachexia

    Dearrangement in carbohydrate, glucose, protein,

    and fat metabolism occurred in patient with cancer

    anorexia cachexia. It is due to the production of

    pro n amma ory cy o ne, , , umornecrosis (TNF ), is a result of an immune

    response by macrophage and other immune fighting

    cels.

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    Mechanism of Cancer Anorexia and Cachexia

    In cancer anorexia cachexia, protein stores from

    skeletal muscle are commonly mobilized before fat

    and carbohydrate are depleted. The abnormal

    protein and fat catabolism seen in cancer cachectic

    patient may be causative of muscle and adipose

    tissue atrophy, diminished wound healing andincreased risk of infection.

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    Treatment of Anorexia and Cachexia

    The best way to treat cancer cachexia is to cure the

    cancer, but unfortunately this remain an infrequent

    achievement among adult with advanced solid

    tumor. ere ore t e next t erapeut c opt on s toincrease nutritional intake and to inhibit muscle

    wasting by manipulating the metabolic milieu

    outline above with variety of pharmacological

    agent.

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    Management Strategis Non Pharmacologic:1. Nutritional counseling for short period of time can

    improved the appetite and nutritional intakeresulting in decrease toxicities during cancertreatment. at ng sma er mea s more o ten ur ngthe day instead of the traditional three large mealsand to avoid drinking any liquid with meals as thisway give a sense of satiety that is not nutritional.Eat nutrition snack are high in caloric and protein.

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    Management Strategis

    Eat whenever feel hungry, try different food,

    sometimes a change in routine can make food

    more n eres n an emp n .

    Encouraging patient and family interaction

    and providing emotional, and education

    support maybe helpful.

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    Management Strategis2. Treatment of underlying causes

    Other symptoms related to cancer or treatment can addpoor appetite such as mouth sore, taste changes,fatique, depression, nausea, vomiting, dysphagia pain.

    3. Nutritional Supplements for boost calorie intake4. Artificial nutrition, this includes in enteral nutrition (tube

    feeding) or parenteral nutrition (nutrient delivered tothe body via a catheter into a vein in the arm or chest)

    5. Complimentary therapies / alternative therapy such asherbal supplement and meditation.

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    Management Strategis Pharmacologic1. Metoclopramide may use for early satiety to suppress gastroparesis

    due to disease or medication and for nausea vomiting.

    A daily dose of 10 mg to 20 mg.

    2. Corticosteroid include dexamethasone, prednisolone,methylprednisolone.

    The response is immediate but short lived, patient begin to feelbetter have increased appetite and energy but many site effects ifused for long time. Use of corticosteroid is recommended only forshort term benefit, or for patient with limited life expectancy.

    Prednisolone at a dose of 15 mg daily, dexamethasone 3 mg to be6 mg daily.

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    Management Strategis3. Progestational agent is synthetic analogues of progesterone.

    The most commonly use progestional agent is megesterol

    acetate (Megace) oral suspension particulary useful in patients

    with advanced disease improvement of appetite and quality

    of life.

    .

    4. Cyproheptadine is an anti serotonic drug with anti histaminicproperties that has been shown to have an appetite stimulant

    effect for patients anorexia.

    The accepted dose for weight gain is 8 mg four times a day.

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    Management Strategis5. Ondansetron and Granisetron have entered

    widespread clinical used as antiemetic for cancer

    chemotherapy.

    6. The other drugs for neutralizingmetabolicdisturbances as Pentoxyline andThalidomide are to inhibit TNF

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    ConclusionCancer cachexia has been understood as a result

    of mayor central nervous system and metabolic

    abnormalities due to combination of tumor by

    product and host cytokine release. The exact

    mec an sm o pat ogenes s o anorex a ancachexia are not well understood.

    Management symptom should begin with early

    counseling at initial disease diagnosis.

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    ConclusionWhether the cause of anorexia is a symptoms of

    disease or side effect of treatment it must be

    considered a serious matter both physically and

    psychologically.

    It is important for health care provider to monitor

    weight changes nutritional intake report and assess

    the physical appearances of the patients.