Research methodology: cancer cachexia syndrome
Humans; Prognosis; Ambulatory Care; quality of life; Nutritional Status; Neoplasms/complications; Cachexia/etiology; Body Composition; Weight Gain; Placebo Effect; Biomedical Research/methods; Exercise/physiology
Cachexia is a syndrome and therefore does not have a specific definition. Patients are characterized by the presence of anorexia, early satiety, weight loss, weakness, anaemia and oedema. These features occur to a variable extent in different patients and may change in severity during the course of a patient's illness. The multifactorial origin of cachexia precludes a uniform pathophysiological definition. Taken together these factors have hindered clinical studies both at a fundamental level and in terms of the introduction of effective therapy. The advent of novel therapeutic targets (e.g., ubiquitin-proteasome pathway) and biological response modifiers has opened possibilities for new clinical trials in cachexia. Regulatory authorities feel it is important not only to demonstrate efficacy in terms of patients' nutritional status (e.g., lean body mass) but also functional status (e.g., performance status). This article reviews current methods to assess the latter. Methods focused on measuring physical activity level (e.g., doubly labelled water technique or physical activity meters) promise objective data which can be readily interpreted in terms of clinically meaningful benefit.
2004
Dahele M; Fearon KC
Palliative Medicine
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1191/0269216304pm906ra" target="_blank" rel="noreferrer">10.1191/0269216304pm906ra</a>
Aspects of altered metabolism in children with cancer
Child; Humans; Animals; Nutritional Requirements; Cachexia/etiology; Energy Metabolism; Interleukin-1/physiology; Interleukin-6/physiology; Neoplasms/complications/metabolism/physiopathology; Nutritional Failure; Tumor Necrosis Factor-alpha/physiology
Severe weight loss associated with cancer continues to be a major cause of morbidity in cases of childhood malignancy. The etiology is not completely understood but is probably multifactorial, including reduced ingestion and altered metabolism of nutrients. Changes in the host metabolism of protein, fat and carbohydrate in the cancer-bearing host have been demonstrated both in animal models and in patients. Changes include increased protein turnover and loss of the normal compensatory mechanisms seen in starvation. Additionally, increased lipid breakdown results in depletion of lipid stores and changes in carbohydrate metabolism result in an energy-losing cycle. The increase in protein turnover seen in children with leukemia may be related to the tumor, the chemotherapy administered or to related conditions such as febrile neutropenia. The role of endogenous mediators of cancer cachexia has not yet been clearly elucidated, although tumor necrosis factor, interleukin I and interleukin 6 appear to be involved. Studies of energy expenditure in children with cancer have indicated that certain patients with a raised metabolic rate are at particular risk of severe weight loss. The challenge is to identify these vulnerable patients and to provide adequate nutritional support early in treatment and therefore avoid the deleterious effects of cachexia.
Picton SV
International Journal Of Cancer. Supplement
1998
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1002/(sici)1097-0215(1998)78:11+%3C62::aid-ijc17%3E3.0.co" target="_blank" rel="noreferrer">10.1002/(sici)1097-0215(1998)78:11+%3C62::aid-ijc17%3E3.0.co</a>