What is anorexia?
- Reduced desire to eat
- may be reported as abdominal pain, gastric dumping, N/V, patient is trying to eat “regular” amounts
- may not be noticed if they are eating to satiety
- Primary - Hypothalamus fails to respond to orexigenic signals
- usually secondary to inflammatory process
What are some common symptoms leading to secondary cachexia?
- Early satiety
- Constipation
- N/V
- Depressed mood
- Dysgeusia
- Dysphagia
- Dry mouth
- Mucositis
- Dental pain
What is sarcopenia?
muscle wasting
What is malnutrition?
- Imbalance of energy or specific nutrients that leads to adverse effects on the body’s form or function
- Too little in OR too much out
- Protein is often the lacking nutrient
What is the technical definition of cachexia?
- Weight loss (predominantly sarcopenia)
- Protein catabolism
- Malnutrition
- Inflammation
- Underlying disease
- Exceeds the amount that can be accounted for by the increased needs of the disease
What are the two main contributing mechanisms that lead to cachexia?
- Metabolic change (hypermetabolic)
- Reduced food intake
What is the standard definition of Anorexia/Cachexia Syndrome (ACS)?
“a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment”
What are the three stages of Anorexia/Cachexia Syndrome (ACS)?
- Pre-cachexia
- <5% weight loss
- fatigue and weakness
- Cachexia
- >5% weight loss
- anorexia
- Refractory cachexia
- >10% weight loss
- often irreversible
- often indicates <3 month survival
What is the psychological burden of Anorexia/Cachexia Syndrome?
- Anxiety
- Helplessness
- Loss of control
- Body image concerns
What are the social consequences of Anorexia/Cachexia Syndrome?
- Caregiver distress
- Social exclusion
- Disruption of daily routines
- Conflicts over food
What are the underlying causes of Anorexia/Cachexia Syndrome?
- Constipation
- Changes in taste
- Dry mouth
- Nausea
- Depression
- Mucositis
- Dysphagia
- Dental pain
What are three pharmaceuticals used for treatment of Anorexia/Cachexia Syndrome?
- Methylphenidate (Ritalin)
- used as an antidepressant
- may increase lean body mass
- Dronabinol (marijuana-derivative THC)
- increase appetite and pleasure received from eating
- No change in GF/Cytokines
- Megestrol acetate
- Progestin analogue (mimics pregnancy)
- hypothalamic stimulation and down stream effects
- Adipose deposition
What is oral assisted feeding?
- Personal assistance (support, not cheerleading)
- Accommodating changing tastes
- Adaptive utensils
- Aromatherapy (ginger & lemon)
- Liberalizing diets
- let pt eat what he/she wants to!
What are some ways to educate the patient/family in the context of Anorexia/Cachexia Syndrome?
- Management of expectation for patient and family
- how do we want our loved one to live until they die
- Culture of feeding
- Love perceived as “doing everything”
- want them to die of natural causes
- Teaching other ways to show caring
What are some of the medical education pearls for health care professionals when dealing with Anorexia/Cachexia Syndrome?
- Highlight the emotional, sensitive nature of the topic
- Don’t assume knowledge
- Address value judgements (gently)
- Re-align expectations
- not a black & white issue
- find out goals of pt. and family
- Do not resuscitate
- NEVER: “There’s nothing more we can do.”
- Death by cachexia (“You don’t want him to starve to death”)
