A multimodal approach to cancer-related cachexia: from theory to practice

ABSTRACT

Introduction: Cachexia represents a relevant issue in oncological care, which is still lacking effective therapies. Although the incidence of cancer cachexia varies across cancer types, it is responsible for approximately a quarter of cancer-related deaths. The pathophysiology of this syndrome is multifactorial, including weight loss, muscle atrophy and impairment of the pro-/anti-inflammatory balance.

Areas covered: Diagnostic criteria and optimal endpoints for cachexia-dedicated trials are still debated, slowing the identification of interventions counteracting cachexia sequaele. The multifaceted features of this syndrome support the rationale for personalized therapy. A multimodal approach is likely to offer the best option to address key cachexia-related issues. Pharmacologic agents, physical exercise, nutritional and psycho-social interventions may have a synergistic effect, and improve quality of life.

Expert opinion: A personalized multimodal intervention could be the best strategy to effectively manage cancer cachexia. To offer such a comprehensive approach, a specialized staff, including health professionals with different expertise, is necessary. Each specialist plays a specific role inside the multimodal intervention, with the aim of delivering the best cancer care and access to the most effective therapeutic options for each patient.

KEYWORDS:

• Cancer
• cachexia
• multimodal intervention
• exercise
• nutrition
• psychological support

Article highlights

• Cachexia represents a relevant issue in cancer care, occurring with a high incidence in several cancer types;

• The pathophysiology of cancer cachexia is multifactorial, including several features including; weight loss, muscle atrophy and inflammatory status;

• Although multiple approaches have been explored, no validated therapies exist to date;

• Theoretically, a multimodal approach could offer the best therapeutic option;

• Supportive care, such as exercise, nutrition and psychological support, integrated with pharmacological agents could effectively manage cancer cachexia;

• A comprehensive approach by an interdisciplinary team of health professionals with different expertise may improve the quality of cancer care.

Acknowledgments

S Pilotto is also supported by the Italian Association for Cancer Research AIRC-IG 20583 and by the International Association for Lung Cancer (IASLC).

Declaration of interest

M Milella reports personal fees from Pfizer, EUSA Pharma and Astra Zeneca, outside the submitted manuscript. S Pilotto received honoraria or speakers’ fee from Astra-Zeneca, Eli-Lilly, BMS, Boehringer Ingelheim, MSD and Roche, outside the submitted manuscript.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.