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Journal of Nutrition Research
An official journal of IAPEN India association

Article

Journal of Nutrition Research

Year: 2024, Volume: 12, Issue: 2, Pages: 75-85

Review Article

Nutritional Management in Cancer Cachexia

Received Date:13 December 2024, Accepted Date:28 December 2024, Published Date:30 December 2024

Abstract

Cancer cachexia is a multifactorial syndrome marked by progressive weight loss, muscle wasting, and systemic inflammation, commonly associated with advanced cancer. Its management poses a significant challenge due to the complex interplay of metabolic alterations, reduced appetite, and inflammation. Addressing the nutritional needs of patients with cachexia is a cornerstone of care, aiming to mitigate weight loss, preserve lean body mass, and enhance quality of life (QOL). Effective nutritional strategies include individualized meal plans enriched with energy-dense and protein-rich foods, alongside the use of specialized nutritional supplements. Pharmacotherapy, such as appetite stimulants, anabolic agents, and anti-inflammatory drugs, plays a crucial role in modulating metabolic dysfunction and supporting nutritional goals. Additionally, physical activity tailored to the patient's abilities has been shown to complement nutritional and pharmacological interventions by promoting muscle retention and functional independence. A multidisciplinary approach that integrates dietary support, pharmacotherapy, and exercise is essential for optimizing outcomes in cancer cachexia management and improving patient well-being.

Keywords: Cancer cachexia, Nutritional management in cancer, Malnutrition in cancer

References

  1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: A new definition. Clinical Nutrition. 2008;27(6):793–799. Available from: https://dx.doi.org/10.1016/j.clnu.2008.06.013
  2. Meza-Valderrama D, Marco E, Dávalos-Yerovi V, Muns MD, Tejero-Sánchez M, Duarte E, et al. Sarcopenia, Malnutrition, and Cachexia: Adapting Definitions and Terminology of Nutritional Disorders in Older People with Cancer. Nutrients. 2021;13(3):1–10. Available from: https://dx.doi.org/10.3390/nu13030761
  3. Bozzetti F, Mariani L. Defining and Classifying Cancer Cachexia: A Proposal by the SCRINIO Working Group. Journal of Parenteral and Enteral Nutrition. 2009;33(4):361–367. Available from: https://dx.doi.org/10.1177/0148607108325076
  4. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. The Lancet. Oncology. 2011;12(5):489–495. Available from: https://doi.org/10.1016/s1470-2045(10)70218-7
  5. Argilés JM, Betancourt A, Guàrdia-Olmos J, Peró-Cebollero M, López-Soriano FJ, Madeddu C, et al. Validation of the CAchexia SCOre (CASCO). Staging Cancer Patients: The Use of miniCASCO as a Simplified Tool. Frontiers in physiology. 2017;8:1–9. Available from: https://doi.org/10.3389/fphys.2017.00092
  6. Mariean CR, Tiucă OM, Mariean A, Cotoi OS. Cancer Cachexia: New Insights and Future Directions. Cancers. 2023;15(23):1–22. Available from: https://doi.org/10.3390/cancers15235590
  7. Biswas AK, Acharyya S. Cancer-associated cachexia: A systemic consequence of cancer progression. Annual Review of Cancer Biology. 2020;4(1):391–411. Available from: https://doi.org/10.1146/annurev-cancerbio-030419-033642
  8. Setiawan T, Sari IN, Wijaya YT, et al. Cancer cachexia: molecular mechanisms and treatment strategies. Journal of Hematology & Oncology. 2023;16:1–26. Available from: https://doi.org/10.1186/s13045-023-01454-0
  9. Wiedmer P, Jung T, Castro JP, Pomatto LCD, Sun PY, Davies KJA, et al. Sarcopenia - Molecular mechanisms and open questions. Ageing Research Reviews. 2021;65:1–17. Available from: https://doi.org/10.1016/j.arr.2020.101200
  10. Shivshankar T, Bhillare A, Krishnamurthy A, Choudhary D, Premlatha S, et al. Expert panel opinion on nutritional management of sarcopenia in cancer patients. Journal of Cancer Research Reviews & Reports. 2024;6(3):1–10. Available from: https://onlinescientificresearch.com/articles/expert-panel-opinion-on-nutritional-management-of-sarcopenia-in-cancer-patients.pdf
  11. Dhillo WS, Small CJ, Stanley SA, Jethwa PH, Seal LJ, Murphy KG, et al. Hypothalamic interactions between neuropeptide Y, agouti-related protein, cocaine- and amphetamine-regulated transcript and alpha-melanocyte-stimulating hormone in vitro in male rats. Journal of neuroendocrinology. 2002;14(9):725–730. Available from: https://doi.org/10.1046/j.1365-2826.2002.00832.x
  12. Siddiqui JA, Pothuraju R, Jain M, Batra SK, Nasser MW. Advances in cancer cachexia: Intersection between affected organs, mediators, and pharmacological interventions. Biochimica et biophysica acta. Reviews on cancer. 2020;1873(2):188359. Available from: https://doi.org/10.1016/j.bbcan.2020.188359
  13. Kotta AS, Kelling AS, Corleto KA, Sun Y, Giles ED. Ghrelin and Cancer: Examining the Roles of the Ghrelin Axis in Tumor Growth and Progression. Biomolecules. 2022;12(4):1–16. Available from: https://doi.org/10.3390/biom12040483
  14. Alves MJ, Figuerêdo RG, Azevedo FF, et al. Adipose tissue fibrosis in human cancer cachexia: The role of TGFβ pathway. BMC Cancer. 2017;17(1):1–12. Available from: https://doi.org/10.1186/s12885-017-3178-8
  15. Han J, Tang M, Lu C, Shen L, She J, Wu G. Subcutaneous, but not visceral, adipose tissue as a marker for prognosis in gastric cancer patients with cachexia. Clinical nutrition. 2021;40(9):5156–5161. Available from: https://doi.org/10.1016/j.clnu.2021.08.003
  16. Ziemons J, Smidt ML, Damink SO, Rensen SS. Gut microbiota and metabolic aspects of cancer cachexia. Best Practice & Research Clinical Endocrinology & Metabolism. 2021;35(3):1–12. Available from: https://doi.org/10.1016/j.beem.2021.101508
  17. Chelakkot C, Ghim J, Ryu SH. Mechanisms regulating intestinal barrier integrity and its pathological implications. Experimental & Molecular Medicine. 2018;50:1–9. Available from: https://doi.org/10.1038/s12276-018-0126-x
  18. Yang W, Huang J, Wu H, Wang Y, Du Z, Ling Y, et al. Molecular mechanisms of cancer cachexia‑induced muscle atrophy (Review) Molecular Medicine Reports. 2020;22(6):4967–4980. Available from: https://dx.doi.org/10.3892/mmr.2020.11608
  19. Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P, et al. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines. ESMO open. 2021;6(3):1–18. Available from: https://doi.org/10.1016/j.esmoop.2021.100092
  20. Caillet P, Liuu E, Simon AR, Bonnefoy M, Guerin O, Berrut G, et al. Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review. Clinical nutrition. 2017;36(6):1473–1482. Available from: https://doi.org/10.1016/j.clnu.2016.12.003
  21. Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World journal of gastrointestinal oncology. 2015;7(4):17–29. Available from: https://doi.org/10.4251/wjgo.v7.i4.17
  22. Lim YL, Teoh SE, Yaow CYL, Lin DJ, Masuda Y, Han MX, et al. A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia. Journal of Clinical Medicine. 2022;11(13):1–21. Available from: https://dx.doi.org/10.3390/jcm11133756
  23. Khatib M, Gaidhane A, Gaidhane S, Quazi Z. Ghrelin as a Promising Therapeutic Option for Cancer Cachexia. Cellular Physiology and Biochemistry. 2018;48(5):2172–2188. Available from: https://dx.doi.org/10.1159/000492559
  24. Hammond S, Erridge S, Mangal N, Pacchetti B, Sodergren MH. The Effect of Cannabis-Based Medicine in the Treatment of Cachexia: A Systematic Review and Meta-Analysis. Cannabis and Cannabinoid Research. 2021;6(6):474–487. Available from: https://dx.doi.org/10.1089/can.2021.0048
  25. Watanabe H, Oshima T. The Latest Treatments for Cancer Cachexia: An Overview. Anticancer Research. 2023;43(2):511–521. Available from: https://dx.doi.org/10.21873/anticanres.16188
  26. Hébuterne X, Lemarié E, Michallet M, Montreuil CBd, Schneider SM, Goldwasser F. Prevalence of Malnutrition and Current Use of Nutrition Support in Patients With Cancer. Journal of Parenteral and Enteral Nutrition. 2014;38(2):196–204. Available from: https://dx.doi.org/10.1177/0148607113502674
  27. Clemente-Suárez VJ, Redondo-Flórez L, Rubio-Zarapuz A, Martínez-Guardado I, Navarro-Jiménez E, Tornero-Aguilera JF. Nutritional and Exercise Interventions in Cancer-Related Cachexia: An Extensive Narrative Review. International Journal of Environmental Research and Public Health. 2022;19(8):1–27. Available from: https://doi.org/10.3390/ijerph19084604
  28. Roeland EJ, Bohlke K, Baracos VE, Bruera E, Fabbro ED, Dixon S, et al. Management of cancer cachexia: ASCO guideline. Journal of Clinical Oncology. 2020;38(21):2437–2443. Available from: https://doi.org/10.1200/JCO.20.00611
  29. Bouleuc C, Anota A, Cornet C, Grodard G, Thiery-Vuillemin A, Dubroeucq O, et al. Impact on Health-Related Quality of Life of Parenteral Nutrition for Patients with Advanced Cancer Cachexia: Results from a Randomized Controlled Trial. The oncologist. 2020;25(5):843–851. Available from: https://doi.org/10.1634/theoncologist.2019-0856
  30. Timmanpyati S, Krishnamurthy A, Parikh P, Bajaj M, Gupta S, Mahajan P, et al. IAPEN India: Nutrition consensus guidelines in oncology clinical practice. Journal of Nutrition Research. 2021;9(1):8–18. Available from: https://doi.org/10.55289/jnutres/v9i1.03
  31. Fujita S, Dreyer HC, Drummond MJ, Glynn EL, Cadenas JG, Yoshizawa F, et al. Nutrient signalling in the regulation of human muscle protein synthesis. The Journal of physiology. 2007;582(Pt 2):813–823. Available from: https://doi.org/10.1113/jphysiol.2007.134593
  32. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical nutrition in cancer. Clinical Nutrition. 2021;40(5):2898–2913. Available from: https://doi.org/10.1016/j.clnu.2021.02.005
  33. Teixeira FJ, Santos HO, Howell SL, Pimentel GD. Whey protein in cancer therapy: A narrative review. Pharmacological Research. 2019;144:245–256. Available from: https://doi.org/10.1016/j.phrs.2019.04.019
  34. Worp WRPHvd, Schols AMWJ, Theys J, Helvoort AV, Langen RCJ. Nutritional Interventions in Cancer Cachexia: Evidence and Perspectives From Experimental Models. Frontiers in nutrition. 2020;7:1–16. Available from: https://doi.org/10.3389/fnut.2020.601329
  35. Kim JS, Khamoui AV, Jo E, Park BS, Lee WJ. β-Hydroxy-β-Methylbutyrate as a Countermeasure for Cancer Cachexia: A Cellular and Molecular Rationale. Anti-cancer agents in medicinal chemistry. 2013;13(8):1188–1196. Available from: https://doi.org/10.2174/18715206113139990321
  36. Manjarrez-Montes-De-Oca R, Torres-Vaca M, González-Gallego J, Alvear-Ordenes I. β-hydroxy-β-methylbutyrate as a dietary supplement (II): cell and molecular mechanism of action. Nutricion hospitalaria. 2014;31(2):597–605. Available from: https://doi.org/10.3305/nh.2015.31.2.8437
  37. Manjarrez-Montes-De-Oca R, Torres-Vaca M, González-Gallego J, Alvear-Ordenes I. El β-hidroxi-β-metilbutirato (HMB) como suplemento nutricional (I): metabolismo y toxicidad [β-hydroxy-β-methylbutyrate as a dietary supplement (I): metabolism and toxicity. Nutricion hospitalaria. 2014;31(2):590–596. Available from: https://doi.org/10.3305/nh.2015.31.2.8432
  38. May PE, Barber A, D'olimpio JT, Hourihane A, Abumrad NN. Reversal of cancer-related wasting using oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine. American journal of surgery. 2002;183(4):471–479. Available from: https://doi.org/10.1016/s0002-9610(02)00823-1
  39. Soares JDP, Howell SL, Teixeira FJ, Pimentel GD. Dietary Amino Acids and Immunonutrition Supplementation in Cancer-Induced Skeletal Muscle Mass Depletion: A Mini-Review. Current pharmaceutical design. 2020;26(9):970–978. Available from: https://doi.org/10.2174/1381612826666200218100420
  40. Tanaka K, Nakamura S, Narimatsu H. Nutritional approach to cancer cachexia: A proposal for dietitians. Nutrients. 2022;14(2):1–16. Available from: https://doi.org/10.3390/nu14020345
  41. Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. Journal of the American College of Nutrition. 2002;21(6):495–505. Available from: https://doi.org/10.1080/07315724.2002.10719248
  42. Fearon KC, Meyenfeldt MFV, Moses AG, Geenen RV, Roy A, Gouma DJ, et al. Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut. 2003;52(10):1479–1486. Available from: https://doi.org/10.1136/gut.52.10.1479
  43. Bruera E, Strasser F, Palmer JL, Willey J, Calder K, Amyotte G, et al. Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2003;21(1):129–134. Available from: https://doi.org/10.1200/jco.2003.01.101
  44. Camperi A, Pin F, Costamagna D, Penna F, Menduina ML, Aversa Z, et al. Vitamin D and VDR in cancer cachexia and muscle regeneration. Oncotarget. 2017;8(13):21778–21793. Available from: https://dx.doi.org/10.18632/oncotarget.15583
  45. Wei L, Wang R, Lin K, Jin X, Li L, Wazir J, et al. Creatine modulates cellular energy metabolism and protects against cancer cachexia-associated muscle wasting. Frontiers in Pharmacology. 2022;13:1–16. Available from: https://dx.doi.org/10.3389/fphar.2022.1086662
  46. Cella PS, Marinello PC, Borges FH, Ribeiro DF, Chimin P, Testa MTJ, et al. Creatine supplementation in Walker-256 tumor-bearing rats prevents skeletal muscle atrophy by attenuating systemic inflammation and protein degradation signaling. European journal of nutrition. 2020;59(2):661–669. Available from: https://doi.org/10.1007/s00394-019-01933-6
  47. Bindels LB, Beck R, Schakman O, Martin JC, Backer FD, Sohet FM, et al. Restoring Specific Lactobacilli Levels Decreases Inflammation and Muscle Atrophy Markers in an Acute Leukemia Mouse Model. PLoS ONE. 2012;7(6):1–10. Available from: https://dx.doi.org/10.1371/journal.pone.0037971
  48. Panebianco C, Villani A, Potenza A, Favaro E, Finocchiaro C, Perri F, et al. Targeting Gut Microbiota in Cancer Cachexia: Towards New Treatment Options. International Journal of Molecular Sciences. 2023;24(3):1–14. Available from: https://dx.doi.org/10.3390/ijms24031849
  49. Xiao L, Land Bv, Worp WRPHvd, Stahl B, Folkerts G, Garssen J. Early-Life Nutritional Factors and Mucosal Immunity in the Development of Autoimmune Diabetes. Frontiers in Immunology. 2017;8:1–15. Available from: https://dx.doi.org/10.3389/fimmu.2017.01219
  50. Besten Gd, Eunen Kv, Groen AK, Venema K, Reijngoud DJ, Bakker BM. The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism. Journal of Lipid Research. 2013;54(9):2325–2340. Available from: https://dx.doi.org/10.1194/jlr.r036012
  51. Sakakida T, Ishikawa T, Doi T, Morita R, Endo Y, Matsumura S, et al. Water‐soluble dietary fiber alleviates cancer‐induced muscle wasting through changes in gut microenvironment in mice. Cancer Science. 2022;113(5):1789–1800. Available from: https://dx.doi.org/10.1111/cas.15306
  52. Yu X, Ren P, Yang R, Yue H, Tang Q, Xue C. Astaxanthin Ameliorates Skeletal Muscle Atrophy in Mice With Cancer Cachexia. Nutrition and Cancer. 2024;76(6):529–542. Available from: https://dx.doi.org/10.1080/01635581.2024.2335584
  53. Wang G, Biswas AK, Ma W, Kandpal M, Coker C, Grandgenett PM, et al. Metastatic cancers promote cachexia through ZIP14 upregulation in skeletal muscle. Nature Medicine. 2018;24(6):770–781. Available from: https://dx.doi.org/10.1038/s41591-018-0054-2
  54. Tamayo-Torres E, Garrido A, Cabo RD, Carretero J, Gómez-Cabrera MC. Molecular mechanisms of cancer cachexia. Role of exercise training. Molecular Aspects of Medicine. 2024;99:1–14. Available from: https://doi.org/10.1016/j.mam.2024.101293
  55. Nishikawa H, Goto M, Fukunishi S, Asai A, Nishiguchi S, Higuchi K. Cancer Cachexia: Its Mechanism and Clinical Significance. International Journal of Molecular Sciences. 2021;22(16):1–14. Available from: https://doi.org/10.3390/ijms22168491

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© This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Published By India Association for Parenteral and Enteral Nutrition (IAPEN)

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