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http://www.ncbi.nlm.nih.gov/pmc/article ... 48525title
In summary, based on current views on the cachexia syndrome in cancer patients, we put forward the following recommendations:
Wasting is a predictable event in many cancer patients, readily diagnosed by assessment of weight, change in appetite, and food intake. Often these patients will also have anemia and low albumin, with a concomitant increase in C-reactive protein. The above simple assessments should form a consistent part of the record of all advanced cancer patients.
Use a systematic formal guide to rule out treatable secondary causes of wasting.
At the onset and throughout the course of illness, offer patients nutritional counseling (they should have access to a nutrition team with a special interest in wasting disorders), encourage them to take part in a rehabilitation program tailor made for their needs and abilities, and consider the use of specific nutraceutical and pharmacologic interventions. Follow-up visits should not only note careful evaluation of antitumor therapy and tumor volume, but also regular assessment of symptom control, weight, appetite, and function.
Take careful note of the full medication profile of patients who are wasting. These might include drugs that could have a favorable effect on cachexia (cardiac agents such as the statins, ACE inhibitors) and other agents that may be deleterious (e.g. herbal medications laced with corticosteroids).
Testosterone status should be established in cancer patients with the cachexia syndrome. If clearly reduced, physiologic testosterone supplementation should be considered after discussion with the patient.
Patients must be assured of a reasonable intake of amino acids. Protein-containing foods are indicated and rich sources of both essential and nonessential amino acids will support any anabolic potential.
Clinical researchers should be more cognizant of the work of their colleagues in sports medicine, AIDS, and geriatrics. Learning from their enterprises, further studies on creatine and supraphysiologic amounts of amino acids with a particular role in protein synthesis should be conducted. Similarly, the role of supraphysiologic doses of anabolic agents, in combination with nutrients and compounds that control muscle proteolysis, should receive high priority.
There are few, if any, negative exercise trials. Patients should be encouraged to keep active or take part in tailored exercise programs, and studies on nutritional and pharmacologic agents should incorporate the potential additive effects of exercise.
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