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Cancer-associated cachexia

Key sources
The following summarized guidelines for the evaluation and management of cancer-associated cachexia are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2023; 2020), the European Society of Medical Oncology (ESMO 2021), and the American Society for Parenteral and Enteral Nutrition (ASPEN 2017).
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Guidelines

1.Screening and diagnosis

Screening for malnutrition risk: obtain standardized screening for nutritional risk using a validated tool at regular intervals in all patients undergoing anticancer treatment and in patients with a life expectancy of at least a few (3-6) months.
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  • Definition

2.Medical management

General principles: as per ESMO 2021 guidelines, offer interventions with the goal of either improving or alleviating the consequences of cachexia in all patients with cachexia.
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  • Corticosteroids

  • Progesterone analogs

  • Olanzapine

  • Other agents

  • End-of-life care

3.Nonpharmacologic interventions

Nutritional support, general principles: obtain regular nutritional screening and provide nutritional support, including (if necessary) enteral or parenteral nutrition, in all patients receiving anticancer treatment and in patients with an expected survival of more than a few months.
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  • Nutritional support (nutritional requirements)

  • Nutritional support (tube feeding)

  • Nutritional support (parenteral nutrition)

  • Dietary supplements

  • Exercise

  • Psychosocial support

4.Patient education

General counseling
As per ESMO 2021 guidelines:
Provide supportive nutritional advice and education about cachexia and psychological and palliative support to all patients experiencing eating-related distress.
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Provide dietary counseling as the first choice of nutritional support to improve oral intake and possibly weight gain in cachectic or at-risk patients able to eat. Emphasize protein intake, an increased number of meals per day, treatment of nutrition impact symptoms, and offer nutritional supplements when necessary during dietary counseling. Ensure that adequately trained professionals guide this advice.
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