A difficult clinical problem: diagnosis, impact and clinical management of cachexia in palliative care

Cachexia is a distressing and debilitating condition, affecting significant numbers of patients with advanced disease and causing significant distress; it is the primary cause of death in about 20% of all patients with cancer. Though cachexia is most commonly associated with particular tumours, such as head and neck, gastrointestinal tract, pancreas, central nervous system and lung, it may affect any patient with any tumour at any site; no patient and no tumour are excluded. Its origin is both complex and multifactorial, appearing to reflect both reduced nutrient availability and increased nutritional demand, resulting from metabolic and pathphysiological changes, functional inability to ingest or utilize nutrients related perhaps to mechanical interference (e.g. obstruction, malabsorption, surgical intervention), treatment-related toxicity or social and psychological factors. This article offers an overview of the cachectic process, considering its pathophysiology and the factors contributing to its development before considering its diagnosis and impact on individuals. Although guidelines for its clinical management are provided, the article does not provide specialist advice; support will be needed from a dietitian or clinical nurse specialist.