Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

Abstract

Cancer cachexia is a syndrome characterized by weight loss with accompanying loss of muscle and/or fat mass and leads to impaired patient function and physical performance and is associated with a poor prognosis. It is prevalent in older adults with cancer; age-associated physiologic muscle wasting and weakness, also known as sarcopenia, can compound deficits associated with cancer cachexia in older adults and makes studying this condition more complex in this population. Multiple measurement options are available to assess the older patient with cancer and cachexia and/or sarcopenia including anthropometric measures, imaging modalities such as Dual X-ray absorptiometry (DEXA) and Computed Tomography (CT), muscular strength and physical performance testing, and patient-reported outcomes (PROs). A geriatric assessment (GA) is a useful tool when studying the older patient with cachexia given its comprehensive ability to capture aging-sensitive PROs. Interventions focused on nutrition and increasing physical activity may improve outcomes in older adults with cachexia. Efforts to develop targeted pharmacologic therapies with cachexia have not been successful thus far. Formal treatment guidelines, an updated consensus definition for cancer cachexia and the development of a widely adapted assessment tool, much like the GA utilized in geriatric oncology, could help advance the field of cancer cachexia over the next decade.

Exosomal circular RNA sorting mechanisms and their function in promoting or inhibiting cancer (Review)

“…Additionally, this type of exosome can participate in white adipose tissue browning and affect cancer cachexia (8), a syndrome characterized by weight loss due to muscle and/or fat loss. Cancer cachexia results in functional impairment, decreased physical ability and it is associated with a poor prognosis (89). The same mechanisms have been reported in other studies (90,91).…”

The Acute Effects of 5 Fluorouracil on Skeletal Muscle Resident and Infiltrating Immune Cells in Mice

“…The absolute reduction in macrophage number rather than relative changes in abundance remains relevant given the physiological importance of the overall immune response in repair and remodeling (59,(66)(67)(68)(69)(70). The mean age of cancer patients is ~65yrs and overlapping sarcopenic and cachectic factors along with chemotherapy may contribute to disrupted skeletal muscle immune regulation (71).Disrupted skeletal muscle repair associated with changes in macrophages has been reported with aging (38), cancer (70), and chemotherapy (53).The effects of aging on skeletal musclemacrophages has demonstrated that reloading aged skeletal muscle had a blunted hypertrophy response associated with a lower number of M1-like macrophages at baseline and blunted M1-like macrophage in ltration (early) and M2-likemacrophage transition (late) (38).Surprisingly, while in ammation is a hallmark of cancer cachexia associated with muscle weakness and fatigue (72,73), total macrophage number was reduced in damaged muscle of C26tumor-bearing mice compared to a non-cachectic tumor-bearing control (70). Additionally, macrophages were shown to regulate skeletal muscle signal transducer and activator of transcription 3 (STAT3) -downstream target of IL-6 and key regulator of skeletal muscle mitochondrial homeostasis and proteostasis(73-77)-during pancreatic cancer cachexia(78).Further work is needed to understand these potentially overlapping mechanisms with cancer and chemotherapy on skeletal muscle immune cells.…”

1H-NMR Based Serum Metabolomics Highlights Different Specific Biomarkers between Early and Advanced Hepatocellular Carcinoma Stages

“…If the metabolic shift is a consequence of decreased glucose metabolism or increased amino acid demands remains to be investigated. On the other hand, it is well known that cachexia, causing ongoing muscle loss, is an event that accompanies cancer [64]. Finally, this study identifies a range of possible markers, whose serum levels might be indicative of HCC prognosis.…”