What are the EPCRC palliative care treatment guidelines for anorexia/cachexia?

Updated: Jun 01, 2019
  • Author: Winston W Tan, MD, FACP; more...
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Answer

Answer

The EPCRC guidelines focus on refractory cachexia in patients with advanced cancer, which it defines as “a stage where reversal of weight loss is no longer possible due to very advanced or rapidly progressive cancer unresponsive to anti-cancer therapy.” The recommendations in the guidelines are aimed at alleviating the consequences and complications of cachexia and eating-related distress of patients and families and include the following [12] :

  • Educate patient and family to minimize eating-related distress; counsel them about weight loss–related distress and end-of-life issues
  • Enteral nutrition therapy may be partially effective for selected patient groups
  • The burden of parenteral nutrition will outweigh any benefits in the majority of patients
  • The use of thalidomide is not recommended
  • The use of cannabinoids is not recommended
  • Progestins should be considered for patients with anorexia as a major distressing symptom
  • Steroids may be given for short periods (at most 2 weeks); longer duration may increase the burden on the patient from side effects and may cause a deterioration in muscle strength

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