B-QuiCK: Cachexia

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Assessment and diagnosis

  • Measure weight, BMI, assess musculature and strength
  • Check for oral issues
  • Request CRP, lipids, HbA1c, FBC and LFTs

Diagnose cachexia if ≥ 5% loss of body weight or BMI ≤ 20 kg/m2 and three or more of: decreased strength, fatigue, anorexia, low muscle mass, raised CRP and reduced albumin or Hb.


  • Importance of patient + family/whānau understanding that cachexia is not just a lack of food/eating
  • Treat any mucositis, candidiasis, constipation, nausea and vomiting
  • Recommend frequent, small, calorie dense meals + discuss strategies for enhancing nutrition/mealtimes
  • Consider mental health and wellbeing
  • Recommend as much physical activity as tolerated

Pharmacological treatments

  • Oral liquid feed, e.g. Ensure powder, as meal supplement
  • If shorter life expectancy, dexamethasone 2 – 4 mg or prednisone 30 mg, in the morning, adjusted to the lowest effective dose; beneficial effect on appetite likely to decrease after 3 – 4 weeks, discontinue if no benefit after five days
  • If longer life expectancy, megestrol 160 – 800 mg, daily; beneficial effect on appetite longer lasting than with corticosteroids
  • If nausea, metoclopramide 10 mg, three times daily, ideally before meals
  • Pancreatic enzyme replacement if malabsorption due to pancreatic insufficiency
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