B-QuiCK: Cachexia

Cachexia

Assessment and diagnosis

• Measure weight, BMI, assess musculature and strength
• Check for oral issues
• Request CRP, lipids, HbA_1c, 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.

Management

• 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