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Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later.
Proc Nutr Soc. 2016 May; 75(2):199-211.PN

Abstract

An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.

Authors+Show Affiliations

School of Food & Nutritional Sciences, University College Cork,Cork,Republic of Ireland.Department of Medical Oncology,Mercy & Cork University Hospitals,Cork,Republic of Ireland.School of Food & Nutritional Sciences, University College Cork,Cork,Republic of Ireland.School of Food & Nutritional Sciences, University College Cork,Cork,Republic of Ireland.School of Food & Nutritional Sciences, University College Cork,Cork,Republic of Ireland.Department of Agricultural, Food and Nutritional Science,Alberta Institute for Human Nutrition, University of Alberta,4-002 Li Ka Shing Centre,Edmonton,AB T6 G 2P5,Canada.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26786393

Citation

Ryan, Aoife M., et al. "Cancer-associated Malnutrition, Cachexia and Sarcopenia: the Skeleton in the Hospital Closet 40 Years Later." The Proceedings of the Nutrition Society, vol. 75, no. 2, 2016, pp. 199-211.
Ryan AM, Power DG, Daly L, et al. Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc. 2016;75(2):199-211.
Ryan, A. M., Power, D. G., Daly, L., Cushen, S. J., Ní Bhuachalla, Ē., & Prado, C. M. (2016). Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. The Proceedings of the Nutrition Society, 75(2), 199-211. https://doi.org/10.1017/S002966511500419X
Ryan AM, et al. Cancer-associated Malnutrition, Cachexia and Sarcopenia: the Skeleton in the Hospital Closet 40 Years Later. Proc Nutr Soc. 2016;75(2):199-211. PubMed PMID: 26786393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. AU - Ryan,Aoife M, AU - Power,Derek G, AU - Daly,Louise, AU - Cushen,Samantha J, AU - Ní Bhuachalla,Ēadaoin, AU - Prado,Carla M, Y1 - 2016/01/20/ PY - 2016/1/21/entrez PY - 2016/1/21/pubmed PY - 2017/1/4/medline KW - BSA body surface area KW - CC cancer cachexia KW - CT computed tomography KW - Cachexia KW - Cancer KW - DXA dual-energy X-ray absorptiometry KW - FFM fat free mass KW - Malnutrition KW - PAL physical activity level KW - QoL quality of life KW - Quality of life KW - REE resting energy expenditure KW - Sarcopenia KW - Survival SP - 199 EP - 211 JF - The Proceedings of the Nutrition Society JO - Proc Nutr Soc VL - 75 IS - 2 N2 - An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms. SN - 1475-2719 UR - https://www.unboundmedicine.com/medline/citation/26786393/Cancer_associated_malnutrition_cachexia_and_sarcopenia:_the_skeleton_in_the_hospital_closet_40_years_later_ L2 - https://www.cambridge.org/core/product/identifier/S002966511500419X/type/journal_article DB - PRIME DP - Unbound Medicine ER -