Abstract
Malnutrition is common in cancer patients and can occur throughout a patient’s disease course. The contributors to the clinical syndrome of cancer cachexia are often multifactorial, and produced by the cancer and associated pro-inflammatory response. Since cancer cachexia is a multifactorial syndrome, a multimodal therapeutic approach is ideal. A key component of therapy is identifying and managing symptom barriers to adequate oral intake, known as nutritional impact symptoms (NIS). NIS are associated with reduced intake and weight loss in patients with advanced cancer, and aggregate NIS are a predictor of survival in patients with Head and Neck Cancer and in patients undergoing surgery for esophageal cancer. Currently, there are no guidelines regarding the specific management of NIS in oncology patients. Experience from specialist centers suggest relatively simple assessments and inexpensive interventions are available for the diagnosis and treatment of NIS. We present three patient cases from a cachexia clinic, where NIS management decreased symptom burden and improved clinical outcomes such as weight and physical performance.
Highlights
Weight loss is considered the key criterion for cachexia and malnutrition [1]
A patient in a clinical trial with inadequately managed nausea or oral pain may not experience the beneficial effects of an investigational drug for cancer cachexia
European Society of Medical Oncology (ESMO) guidelines [7] recommend that at risk patients be assessed for nutrition impact symptoms (NIS), GI dysfunction, chronic pain and psychosocial distress
Summary
Weight loss is considered the key criterion for cachexia and malnutrition [1] Since both of these conditions are defined by the presence of weight loss [2], the notion of managing nutrition impact symptoms (NIS) is an essential component of multimodal, multidisciplinary treatment. American Society of Clinical Oncology (ASCO) management guidelines note that “uncontrolled NIS” are frequently encountered in patients with cachexia and are associated with adverse outcomes such as weight loss and decreased survival [6]. European Society of Medical Oncology (ESMO) guidelines [7] recommend that at risk patients be assessed for NIS, GI dysfunction, chronic pain and psychosocial distress. Clinical Oncology Society of Australia (COSA) guidelines [11] emphasize a multidisciplinary approach and note that alongside medical nutrition therapy, interventions should include management of treatment side effects and symptoms. It is important to note that in addition to NIS, other nonsymptom barriers such as poor communication, conflicting advice and financial constraints may impede the management of cachexia [12]
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