Cancer cachexia: Pathophysiology and association with cancer-related pain

Abstract

Cachexia is a syndrome of unintentional body weight loss and muscle wasting occurring in 30% of all cancer patients. Patients with cancers most commonly leading to brain metastases have a risk for cachexia development between 20 and 80%. Cachexia causes severe weakness and fatigue and negatively impacts quality and length of life. The negative energy balance in cachectic patients is most often caused by a combination of increased energy expenditure and decreased energy intake. Basal metabolic rate may be elevated due to tumor secreted factors and a systemic inflammatory response leading to inefficiency in energy production pathways and increased energy demand by the tumor and host tissues. A growing body of research explores physiological and molecular mechanisms of metabolic dysregulation in cachexia. However, decreased energy intake and physical functioning also remain important contributors to cachexia pathogenesis. Pain associated with metastatic malignancy is significantly associated with inflammation, thus making inflammation a common link between cancer pain and cachexia. Pain may also influence appetite and food intake and exacerbate fatigue and functional decline, potentially contributing to cachexia severity. Cancer pain and cachexia often occur simultaneously; however, causal relationships remain to be established. Appropriate assessment and treatment of pain in advanced cancer patients may positively impact nutrition status and physical functioning, slowing the progression of cachexia and improving quality and length of life for patients.

Effects of Senna alata Extract on the Hematological and Biochemical Alterations in Rats Exposed to Carcinogen

“…Patients presenting to primary care with weight loss are at higher risk of having cancer than patients without recorded weight loss 20 . The negative energy balance in cachectic patients is usually as a result of increased energy expenditure and decreased energy intake 21 .…”

Relevance of Dietary Supplement Use in Gastrointestinal-Cancer-Associated Cachexia

“…Cancer cachexia is characterized by the co-occurrence of decreased energy intake and increased energy expenditure, leading to a negative energy balance. The primary contributors to reduced energy intake are loss of appetite (anorexia), dysphagia, pain, fatigue, and depression or anxiety [20]. Increased energy expenditure is caused by tumor metabolism, systemic inflammation, and decreased energetic efficiency due to metabolic dysregulation [20].…”

“…The primary contributors to reduced energy intake are loss of appetite (anorexia), dysphagia, pain, fatigue, and depression or anxiety [20]. Increased energy expenditure is caused by tumor metabolism, systemic inflammation, and decreased energetic efficiency due to metabolic dysregulation [20]. The negative energy balance, in turn, leads to insulin resistance and oxidative stress, which further facilitate inflammation.…”

Patient Willingness to Use Digital Health Technologies: A Quantitative and Qualitative Survey in Patients with Cancer Cachexia

“…As stated by the American Society of Clinical Oncology (ASCO) Cancer Cachexia Treatment Guidelines, cachexia is a multifactorial syndrome characterized by loss of appetite, weight, and skeletal muscle, leading to fatigue, functional impairment, increased treatment-related toxicity, poor quality of life, and reduced survival occurring in 30% of all cancer patients. 1 , 2 The definition of cachexia changed over time with early definitions concentrating on body weight, physical performance, and patient function. 2 The current diagnostic criterion for cachexia, agreed on by a panel of international experts through a Delphi consensus process in 2011, is weight loss >5% in 6 months, or weight loss >2% in individuals who are already depleted as evidenced by body mass index (BMI) <20 kg/m² or skeletal muscle mass (sarcopenia).…”