Holistic multimodal care for cancer cachexia emphasizes integrating medical, nutritional, and emotional support, aiming to improve life quality for patients and caregivers.
🗓️ 08/05/2023
📰 Publication: Asia-Pacific Journal of Oncology Nursing
Sarcopenia is characterised by age-related reductions in skeletal muscle strength, mass, and functional ability. Importantly, sarcopenia is a multifactorial condition associated with metabolic alterations, including poor glucose disposal, insulin resistance, decreased metabolic rate and, thus, type 2 diabetes (T2D). Developing non-pharmaceutical guidelines for the prevention and treatment of both diseases when they coexist is essential to optimise patient health and reduce premature mortality within this patient population.
This review aimed to examine 1) the pathophysiological link between sarcopenia and T2D, and 2) lifestyle interventions with the potential to mitigate both sarcopenia and T2D.
It is known that one in five adults with pre-frailty progresses to frailty over a 3-year period. Low protein and energy intake, increased prevalence of multimorbidity, and a sedentary lifestyle are well-characterised drivers of sarcopenia. Consequently, they act as catalysts of older adults’ transition to frailty. In this vein, stimulating increased muscle protein synthesis through regular physical exercise and protein-enriched diet consumption is pivotal for pre-frail older adults. Current U.S. Food and Nutrition Board guidelines recommend a dietary allowance of 0.8 g/kg of protein per day for older adults. However, this amount may be insufficient for those with pre-frailty due to their low-grade inflammation, multimorbidity, and increased susceptibility to anabolic resistance.
This study aimed to examine the impact of leucine-enriched protein supplementation with or without exercise on 1) physical function, 2) body composition, and 3) systemic inflammation in pre-frail older adults with a daily protein consumption of ≤1 g/kg.
Ageing is often associated with appetite reduction and ensuing weight loss. Although it is known that physical activity (PA) can prevent these ageing-related processes, the exact molecular mechanisms underpinning this ability remain unknown. Recent research has highlighted the role of exerkines, i.e. proteins released during and after PA, in controlling energy metabolism. Growth differentiation factor 15 (GDF-15), a stress-signalling cytokine secreted during PA and involved in ageing, exercise, and appetite control, has emerged as a potential mediator of late-life, ageing-related weight loss.
This study aimed to explore the associations between PA, GDF-15, and body weight changes in older adults enrolled in the Multidomain Alzheimer Preventive Trial over a 3-year period.
📰 Publication: Journal of Cachexia, Sarcopenia and Muscle
This study investigates the connection between sarcopenia and age-related spinal deformities, focusing on lumbar paravertebral muscles (PVM) quality and volume. Results show that sarcopenic patients have higher ectopic fat infiltration in PVM, contributing to spinal deformities, highlighting the importance of understanding and addressing sarcopenia in relation to spinal health.
This systematic literature review highlights the underrecognition of appetite loss in older adults and its association with malnutrition and mortality. The study underscores the urgent need for standardized screening and comprehensive guidelines to improve the assessment and management of appetite loss in this population.
📰 Publication: Journal of Cachexia, Sarcopenia and Muscle 2023
This study reveals the prognostic value of sarcopenia measurements in patients with advanced metastatic gastroesophageal cancer, showing its association with poor overall and progression-free survival. The findings highlight the importance of considering sarcopenia status alongside clinical variables for better prognostication.
This article provides an overview of the current state of research on anorexia of ageing, its metabolic implications, and potential biomarkers, highlighting the need for further investigation into appetite regulation in older adults to improve health outcomes and personalized nutritional care.
Cancer cachexia, a form of malnutrition, can be viewed as a determinant of prognosis. However, there are no effective therapies or treatments for this condition. Hence, the identification of high-risk patients remains crucial for the assessment and management of cancer cachexia. The cancer cachexia risk score was validated to show good performance; it successfully identified at-risk digestive tract cancer patients before abdominal surgery. This risk score can provide vital help to clinicians in their cancer cachexia screening process, allowing them to understand a patient’s prognosis and build better-informed decisions for abdominal surgery.
This review by Tan S et al. aimed to discuss the cancer cachexia risk score in relation to digestive tract cancer patients, to understand whether survival risks can be identified prior to surgery.
Locoregionally advanced nasopharyngeal carcinoma is a type of head and neck cancer. Induction chemotherapy and concurrent chemoradiotherapy is the most common standard of care. However, due to the toxicity and intensity of these treatments, patients’ nutritional statuses are often negatively impacted. Weight loss and malnutrition are often overlooked in head and neck cancer patients, despite the fact that around half of all head and neck cancer patients suffer from malnutrition. This negatively affects their quality of life, affecting physical functioning, nausea and vomiting and can even affect emotional and cognitive functioning. This study supports the need to monitor patients’ nutritional statuses during the later phase of treatments and work on nutritional interventions.
This review by Miao J et al. aimed to explore the need for nutritional interventions in nasopharyngeal carcinoma.
There is an urgent need to find predictive biomarkers for the prognosis of non-small cell lung cancer for survival assessment. Tumour-related factors, such as the pathological stage or histological subtype, are used widely but often vary in patient outcome. Hence, haematological inflammatory parameters, such as neutrophils, lymphocytes and platelets have been used to reflect the inflammation found in cancer. These biomarkers demonstrate prognostic value in cancers such as non-small cell lung cancer. However, it remains unclear which specific combination of biomarkers may help in assessing prognosis, so this study used the newly developed inflammatory burden index (IBI). It was found to be associated with survival, 90-day outcomes, length of hospitalisation and cachexia in non-small cell lung cancer patients. Hence, this may be an advantageous tool for prognosis prediction.
This review by Xie H et al. aimed to compare the prognostic value of inflammation biomarkers in patients with non-small cell lung cancer.
Many types of conditions and diseases are associated with wasting syndromes such as cachexia. However, despite its prevalence, there is limited knowledge regarding the diagnosis and treatment of cachexia due to our lack of understanding of the causative molecular mechanisms. Cachexia must be viewed through an immunological context to understand its full consequences on patient prognosis. For example, it is known that cytokines such as tumour necrosis factor, IL-1β, IL-6 and IFNγ are consistently upregulated in cases of cachexia in both immune and non-immune cells. This appears to lead to the changes in transcriptional regulation, inducing catabolic pathways in muscles and adipose tissue. Yet, despite this understanding, targeting such cytokines has not shown successful in clinical settings. Further research has also been done to identify the involvement of immune cells such as macrophages, neutrophils, myeloid-derived suppressor cells and T cells in cachexia. Yet, their full involvement in the condition is not yet understood. Hence, many questions remain about this interplay between cachexia and immune system. It is vital to discover the common and unique properties of cancer cachexia and infection-associated cachexia to develop effective therapeutic strategies for cachexia.
This review by Baazim H et al. aimed to highlight the relationship between the immune system and cachexia, as well as our current lack of knowledge surrounding this syndrome.
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