Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆

Cachexia remains an underdiagnosed and undertreated, complex condition which includes ‘objective’ components (e.g. inadequate food intake, weight loss, inactivity, loss of muscle mass and metabolic derangements, inducing catabolism)1,2 and ‘subjective’ components (e.g. anorexia, early satiety, taste alterations, chronic nausea, distress, fa tigue and loss of concentration). Approximately half of all patients with advanced cancer experience cachexia. Comprehensive treatment requires a multitargeted and multidisciplinary approach aimed at evaluating the objec tive signs and relieving the symptoms. The primary goal is to meet the physiological and psychological needs of the pa tient. This includes providing energy, nutritional substrates and anabolic stimuli, as well as compassionate support to address dysfunctions associated with the emotional and social aspects of eating. Nutritional and metabolic interventions range from dietary counselling to pharmacological agents and parenteral nutrition (PN). The invasiveness of an intervention needs to be chosen and tailored, weighing the benefits and risks for each individual patient. This is of increasing importance with advancing disease and when approaching end of life. In this sense, nutrition is an essential component of supportive, rehabilitative and palliative care. During the patient’s trajectory towards end of life, however, the focus of nutritional care needs to change. During anticancer treatment, patients should be offered all available nutritional therapeutic options, if required, whereas during the last weeks of life, care should focus increasingly on immediate symptomatic relief. In general, if anticancer treatment is effective, this often results in an improvement in cachectic signs and symptoms, while ineffective anticancer treatment may increase catabolism and aggravate cachexia.