Weight loss from cancer is a major issue in our day to day practice. Half of all cancer patients face significant weight loss. The type of cancer related weight loss that I am alluding to is known as cancer cachexia where the weight loss is involuntary, debilitating and associated with severe muscle wasting. This has a major impact on quality of life and nearly 20% of cancer deaths is attributed to weight loss and not directly to Cancer..
The Meaning of words:
Anorexia: Reduced appetite or the reduced desire to eat. Anorexia is present in 15 percent to 25 percent of all cancer patients at the time of diagnosis.
Cachexia: The net result which is seen as severe weight loss, muscle loss, and general weakness.
Most patients with cancer have both Anorexia and Cachexia. There are some who have a great appetite but continue to lose weight. Some of my patients tell me.."But doc..I don't understand, I am eating well but continue to lose weight...". The reason for this is simple, such patients are just burning up more calories than they are able to replace by eating.
Why is it important to recognize and take action when you see weight loss in cancer patients?
Patients who stop losing weight feel better, have a better quality of life, improve their immunity, reduce their chance of infections, keep their energy level and strength up so that they can better tolerate treatment and have an increased ability to recover and heal quickly.
Reasons for weight loss in Cancer:
1. The diversion of nutrients to the cancers cells and away from normal tissues and organs. It is very similar to a parasite within the body that feeds off any food that is taken in.
2. Cancers secrete chemicals that significantly reduces protein production and increases their breakdown. Muscle wasting and weight loss is the inevitable outcome.
3. Side effects of Treatment: mouth sores, dry mouth, trouble swallowing, nausea, vomiting, diarrhea, constipation, pain, depression and anxiety. Cancer medications may cause patients to taste and smell foods different.
4. Direct result of cancer: Cancers of the mouth, esophagus and stomach may produce physical pain and obstruction that causes the patients not able to eat and swallow foods resulting in malnutrition.
How do you recognize cancer related weight loss?
Many times, this is very obvious and is verbalized by the patient. However, early signs of such a situation can be recognized when patients lose more than 5 % of their body weight in the prior 6 months involuntarily.
Treatment of Cancer Related Weight Loss:
A. Treat Side effects of treatment aggressively. Such conditions as mouth sores, dry mouth etc with medications.
B. Treat the direct effects of cancer with anti cancer treatment such as chemotherapy and radiation therapy as well as surgery. Placement of a feeding tube into the stomach is utilized for those patients who have issues with swallowing and physical problems in eating.
C. Treating Anorexia and Cachexia with:
1. Megestrol in the form of Megace solution is known to increase muscle mass in patients with cancer.
2. Dronabinol and Marinol are FDA-approved forms of marijuana that can help stimulate the appetite.
3. Steroids such as Dexamethasone.
4. Fish oil. Numerous studies have reported the benefits of fish oil supplementation. Recent studies have demonstrated their beneficial effects in correcting weight loss and anorexia from cancer and its treatment.
In summary, weight loss in cancer patients is a situation that is not adequately recognized and treated by patients and their care givers. My contention is that, aggressively addressing this issue can have a major impact on the life of our patients. We can not only improve their overall quality of life but also possibly achieve better cure rates since these patients may be able to better tolerate more aggressive therapy.