Audit of symptoms and prescribing in patients with the anorexia–cachexia syndrome

Andrew, Inga; Kirkpatrick, Graeme; Holden, Keith; Hawkins, C. Morton

doi:10.1007/s11096-008-9192-9

Cited by 10 publications

(13 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most common therapeutic interventions were metoclopramide (74/94, 79%), both for early satiety and nausea, laxatives for constipation (68/78, 87%), antidepressants for mood disorders (51/63, 81%), and zinc for dysgeusia (20/42, 48%). Loss of appetite was rated the most severe of the symptoms assessed by the ESAS (median 7, Q1-Q3, [4][5][6][7][8][9] Adrenal insufficiency (0/101, 0%), hypothyroidism (4/113, 4%), and vitamin B12 deficiency (3/107, 3%) were found infrequently (Table 3). No patients were identified with uncontrolled diabetes mellitus (fasting glucose > 200 mg/dL) or hypercalcemia (corrected calcium > 10.5 g/dL).…”

Section: Resultsmentioning

confidence: 99%

“…Identifying these causes of secondary cachexia (SC) may be an important component of cachexia management because effective, inexpensive therapies are available for symptoms even though they often appear to be underused. 9 Some secondary nutrition impact symptoms (S-NIS) such as nausea, depression, and pain can decrease caloric intake and add a ''starvation'' component to the catabolic process typically associated with cachexia. In addition, potentially reversible metabolic abnormalities that are easily identified by laboratory tests thyroid stimulating hormone (TSH), serum vitamin B12, testosterone, and cortisol) may also decrease appetite and/or lean body mass.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Outcomes and Contributors to Weight Loss in a Cancer Cachexia Clinic

Fabbro

Hui

Dalal

et al. 2011

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: Cancer cachexia is considered intractable, with few therapeutic options. Secondary nutrition impact symptoms (S-NIS) such as nausea may further contribute to weight loss by decreasing nutrient intake. In addition, treatable metabolic abnormalities such as hypogonadism, vitamin B12 deficiency, hypothyroidism, and hypoadrenalism could exacerbate anorexia and muscle wasting in patients with cancer cachexia. We determined the frequency and type of contributors to appetite and weight loss, and the effect of the cachexia clinic on clinical outcomes. Methods: Review of 151 consecutive patients referred to a cachexia clinic. All received dietary counseling and exercise recommendations. Assessments included weight, body mass index (BMI), S-NIS, resting energy expenditure by indirect calorimetry, serum thyroid stimulating hormone (TSH), cortisol, total testosterone, and vitamin B12. Results: Median weight loss in the 100 days before referral was 9% (4%-13%); median BMI at presentation was 20.8. Median number of S-NIS was 3 (2-4), most commonly treated by metoclopramide, laxatives, and antidepressants. Forty-one percent (24/59) of patients were hypermetabolic and 73% (52/71) of males hypogonadic, whereas hypoadrenalism (0/101, 0%), hypothyroidism (4/113, 4%), and low vitamin B12 (3/107, 3%) were uncommon. Poor appetite and weight loss before referral (r ¼ 0.18, p ¼ 0.036) were associated with increased S-NIS (r ¼ 0.22, p ¼ 0.008). Appetite improved ( p < 0.001) and 31/92 (34%) of patients returning for a second visit gained weight. Conclusions: Patients had a high frequency of multiple S-NIS, hypogonadism, and hypermetabolism. A combination of simple pharmacological and nonpharmacological interventions improved appetite significantly, and increased weight in one third of patients who were able to return for follow-up. Cachexia clinics are feasible and effective for many patients with advanced cancer.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes and Contributors to Weight Loss in a Cancer Cachexia Clinic

Fabbro

Hui

Dalal

et al. 2011

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…Three symptoms were specified to investigate management strategies: dry mouth, early satiety and poor appetite, all identified as the most common complaints in an audit of patients with advanced cancer and ACS (91%, 74% and 70%, respectively) [1]. The questionnaire identified the lack of standardisation of treatment of these symptoms, with some wide variations in answers.…”

Section: Discussionmentioning

confidence: 99%

“…The questions were initially defined as a consequence of early experience of the Durham Cachexia Project and were adapted following the pilot study [13]. The three key symptoms chosen to capture information about management were identified as the most common complaints reported by patients in a previous audit [1].…”

Section: Methodsmentioning

confidence: 99%