What are the NCCN palliative cancer care treatment guidelines for cancer patients with anorexia/cachexia?

Updated: Jun 01, 2019
  • Author: Winston W Tan, MD, FACP; more...
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Guidelines for the management of anorexia/cachexia in patients with advanced cancer have been issued by the NCCN and the European Palliative Care Research Collaborative (EPCRC).

The NCCN guidelines are based on estimates of the patient’s life expectancy. [6] For patients with a life expectancy of years to months, the recommendations are as follows:

  • Evaluate the severity of weight loss
  • Treat reversible causes – Early satiety; symptoms that interfere with food intake (eg, depression, pain, constipation, nausea/vomiting, fatigue, dyspnea)
  • Modify medications that interfere with intake
  • Consider possible endocrine disorders – Hypogonadism, thyroid dysfunction, metabolic abnormalities (eg, increased calcium)
  • Consider appetite stimulant – Megestrol acetate (should be used with caution due to increased risk of blood clots, edema; death occurs in one of every 23 patients, prednisone
  • Consider exercise program
  • Consider consultation with a nutritionist
  • Consider enteral and parenteral feeding as appropriate

For patients with a life expectancy of months to weeks to days, the NCCN recommends first determining the importance of the symptoms to patient and family; if considered important, the anorexia/cachexia can be treated with megestrol acetate. Further recommendations are as follows:

  • Focus should be on patient goals and preferences
  • Provide emotional support
  • Treat depression, if appropriate
  • Provide education and support to patient and family regarding the emotional aspects of withdrawal of nutritional support

Finally, inform the patient and family of the natural history of advanced cancer, including the following:

  • Absence of hunger and thirst is normal
  • Nutritional support may not be metabolized
  • There are risks associated with artificial nutrition and hydration, including fluid overload, infection, and hastened death
  • Symptoms such as dry mouth can be treated with local measures (eg, mouth care, small amounts of liquids)
  • Withholding or withdrawal of enteral or parenteral nutrition is ethically permissible; it will not exacerbate symptoms and may improve some symptoms

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