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7/30/2019 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.