Cachexia in Clinical Practice: Experience from an Endocrine-Led Care Model

Cachexia is a multifactorial syndrome of involuntary weight loss, skeletal muscle wasting, and metabolic dysregulation, commonly seen in advanced cancer and other chronic diseases. Despite its prevalence and prognostic significance, effective treatment strategies remain limited, and there is no standardized model of outpatient care in the US.

To describe the structure, patient characteristics, and outcomes of a multidisciplinary cancer cachexia clinic embedded within an academic endocrinology practice.

We conducted a retrospective analysis of 103 patients referred to a single-center cachexia clinic over five years. Patients underwent comprehensive assessments including weight trajectory, nutritional status, physical performance (5x sit-to-stand test, handgrip strength), and received individualized interventions involving nutrition counseling, resistance training, and pharmacologic management.

The median patient age was 69.7 years, with 64.1% having a cancer diagnosis (61.0% with metastases). Median monthly weight loss decreased from -0.5 kg/month in the 6 months pre-enrollment to 0.0 kg/month after 3 months post enrollment (p < 0.0001), indicating significant stabilization. The 5x sit-to-stand test improved (p = 0.022), though handgrip strength remained unchanged. Patients prescribed an exercise video program trended toward greater weight gain (β = +1.988, p = 0.079), while those prescribed protein powder tended to experience more weight loss (β = -2.102, p = 0.113), although this difference was not statistically significant.

A multimodal cachexia clinic can stabilize weight loss and improve physical function in medically complex patients. These findings support the integration of interdisciplinary approaches to cachexia management and provide a framework for evaluating future interventions in routine clinical settings.