Clinical features of cancer cachexia include host tissue wasting, anorexia, skeletal muscle atrophy, anergy, fatigue, anemia and hypoal-buminemia unresponsive to aggressive nutrition intervention [54, 55]. The cancer cachexia syndrome (CCS) involves a heterogeneous medley of physiological and metabolic derangements resulting in potentially life-threatening malnutrition [56, 57]. Cytokines, especially tumor necrosis factor (TNF), interferon-7 (IFN-7) and interleukins 1 and 6 (IL-1 and IL-6), are implicated in the development of specific symptoms associated with cachexia, such as anorexia and early satiety, as well as derangements in protein, carbohydrate and fat metabolism .
Although often seen in patients with advanced malignancies, CCS may be present in the early stages of tumor growth and may even be the iatrotropic stimulus . The importance of CCS is highlighted by the prognostic significance of weight loss. For any given tumor type, survival is shorter in patients who experience pretreatment weight loss . Early recognition and intervention to prevent worsening of CCS may afford the best opportunity to prevent its debilitating consequences [52,59]. As discussed in Chap. 1, nutrition screening and assessment are vital to this early recognition of malnutrition and CCS.
Weight loss and malnutrition are problematic causes of symptom distress in cancer patients. Anorexia, weight loss and the associated fatigue as well as changes in body image can contribute to depression and decreased social interactions [59, 60]. It is especially relevant in relation to cancer patients to keep in mind that poor intake is rarely the most important cause of cancer-induced weight loss. Patients fed intravenously generally still lose weight, despite intake of adequate or even supraphysiologic calories. CCS is a metabolic syndrome that affects intermediary metabolism and substrate utilization, not just appetite. Therefore, particularly in patients with primary GI tract malignancies, it is rarely appropriate to undertake specialized nutrition support for anorexia or even GI obstruction unless there is a plan in place to treat the obstruction and the underlying cancer.
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