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INFORMATION Note:
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Treatment
Therapy for cachexia is in four areas:
- Support for the distress of cachexia:
This includes exploring body and sexual image, catering advice, coping
strategies for fatigue, and support for psychological adjustment
disorders.
- Nutrition: Although extra nutrition
replaces deficiencies and may partly restore body image through fat
deposition, it does not usually reverse cachexia. In particular,
loss of skeletal muscle is not reversed. Even total parenteral
nutrition results in more weight by putting on fat, but no increased
in muscle strength which can make the situation worse.
- Appetite stimulants: Corticosteroids
(e.g. dexamethasone, prednisolone) are commonly used but have a
limited action of 4 weeks, and can have troublesome long-term adverse
effects (proximal muscle weakness, increase in blood glucose, reduced
healing, suppressed immunity to infection). However,
corticosteroids have the advantage of inducing a sense of well-being
and do improve the quality of life for many patients. Megestrol
acetate is effective in doses of 800 mg/day but is expensive and can
cause troublesome fluid retention. Cyproheptidine and hydrazine
sulphate have been shown to be no better than placebo - hydrazine may
actually reduce survival. See also the CLIP tutorials:
Enriching and fortifying the diet
and Maintaining the environment
for eating and drinking.
- Blocking/inhibiting cytokines and SIR:
NSAIDs such as ibuprofen have been shown to have a modest ability to
inhibit cachexia. A possible alternative is the use of
eicosapentaenoic acid (EPA), a fatty acid derived from fish oil.
Given in doses of 2-6 g/day together with 600 calories it is capable
of reversing weight loss in cachetic pancreatic cancer patients, and
can increase their survival. Concentrated omega-3 oils are
available in chemists and contain up to 30% EPA.
In future, it is possible that the cachexia
process may prove to be as important a target as tumour growth.
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