Module 11 - IPCRC.NET
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Transcript Module 11 - IPCRC.NET
The
EPEC-O
TM
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPECTM Project with major funding
provided by NCI, with supplemental funding provided by the Lance Armstrong
Foundation.
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EPEC – Oncology
Education in Palliative and End-of-life Care – Oncology
Module 3b
Symptoms –
Anorexia / cachexia
Anorexia / cachexia . . .
Cachexia – wasting syndrome
Lean tissue
Performance status
Altered resting energy expenditure
Appetite
. . . Anorexia / cachexia
Cachexia
Starvation
Lean tissue
Fat mass
Impact of feeding
-
++
-
Anorexia / cachexia
Epidemiology
Incidence varies with site
Incidence increases with stage
Anorexia / cachexia
Impact
≥ 5% weight loss and poor prognosis
Trend toward lower chemotherapy
response rates
Anorexia and poor prognosis
QOL, function
Affects caregivers
MacDonald N, et al. J Am Coll Surg, 2003.
Dewys WD, et al. Am J Med, 1980.
Loprinzi CL, et al. JCO, 1994.
Key points
1. Pathophysiology
2. Assessment
3. Management
Pathophysiology
Chronic inflammation
Metabolic changes
Lipolytic / proteolytic substances
Hormonal changes
Role of neurotransmitters
Cytokine impact on hypothalamus
Todorov P, et al. Nature, 1996.
Todorov P, et al. Cancer Research, 1998.
Zigman JM, et al. Endocrinology, 2003.
Balkwill F, et al. Lancet, 2001.
Assessment
Appetite / weight loss history
Identify reversible causes
Physical signs of wasting
Biochemical markers
Radiographic studies as indicated
… Assessment
Reversible causes of weight loss
Psychological
factors
Malabsorption
Pain
Endocrine
Comorbid
conditions
Social / economic
Mucositis
Nausea / vomiting
Constipation
Early satiety
Management . . .
Treat comorbid conditions
Educate, support
Favorite foods / nutritional
supplements / counseling
Treat reversible causes (eg, early
satiety, mucositis)
Anorexia / cachexia
what does not work
Feeding (enteral or parenteral)
ACP. Ann Int Med, 1989.
Ovesen. J Clin Oncol, 1993.
Management of anorexia
Dexamethasone
Megestrol acetate
Tetrahydrocannabinol (THC)
Androgens
Loprinzi CL, et al. JCO, 1999.
Von Roenn JH, et al. 2003.
Moertel CG, et al. Cancer, 1974.
Management of cachexia
Investigational
Anabolic steroids
Omega-3-fatty acids
Amino acids
NSAIDs
Multi-vitamins
Exercise
Von Roenn JH, et al. ASCO, 2003.
Jatoi A, et al. ASCO, 2003.
Fearon KCH, et al. Gut, 2003.
McMillan DC, et al. Br J Ca, 1999.
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Summary
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Use comprehensive
assessment and
pathophysiology-based therapy
to treat the cause and improve
the cancer experience