Cachexia syndrome: The present state of the problem and importance in clinical practice

Cite item

Full Text


Available updates have changed our idea about cachexia as a terminal condition, which could consider it as a combined metabolic syndrome that gives rise to the worse course of the underlying disease, the lower efficiency of specific therapy, and higher death rates. Chronic inflammatory factors are recognized to be the main mechanisms for the development of cachexia syndrome (CS). In addition, diagnostic criteria for this pathological condition are well defined. These criteria are rather simple for use in clinical practice and they should be assessed by physicians at all stages of a follow-up of patients with severe chronic diseases, since cachexia may develop long before the appearance of the so-called extreme emaciation. The earlier the physician will anticipate the onset of CS, the more successful attempts to correct the latter and accordingly the better prognosis of the underlying disease will be. Available updates on the possibilities of correcting cachexia — anorexia are considered although there are no established standards for the management and treatment of patients with CS now. The elaboration of a step-by-step algorithm for following up the patients and a search for medications with proven clinical efficacy are relevant.

About the authors

M F Ballyuzek

M V Mashkova


  1. Костюкевич О.И. Современные подходы к диагностике и лечению синдром кахексии с позиции врача-терапевта. Онкология.
  2. Donohoe СL, Ryan AM, Reynolds JV. Cancer Cachexia: mechanisms and clinical implications. Gastroenterol Res Prac. 2011;2011:Article ID 601434.
  3. Зайчик А.Ш., Чурилов Л.П. Патологическая физиология. СПб.: ЭЛБИ-СПб; 2007.
  4. Мягкова А.П. Мальабсорбция. Русский медицинский журнал. 1996;4(3):12-15.
  5. Morley JE, Thomas DR, Wilson M-MG. Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr. 2006;83(4):735-743.
  6. Muscaritoli M, Lucia S, Molfino A. Sarcopenia in critically ill patients: the new pandemia. Minerva Anestesiologica. 2013;79(7):717-717.
  7. Поворознюк В.В., Дзерович Н.И. Саркопения и возраст: обзор литературы и результаты собственных исследований. Киев: Институт геронтологии им. Д.Ф. Чеботарева НАМН Украины; 2012.
  8. Kamimoto LA, Easton AN, Maurice E, Husten CG, Macera CA.Surveillance for Five Health Risks Among Older Adults — United States, 1993—1997. CDC MMWR Surveillance Summaries. 1999;48(SS08):89-130.
  9. Fearon KC, Voss AC, Hustead DS. Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006; 83(6):1345-1350.
  10. Mitch WE, Goldberg AL. Mechanisms of muscle wasting. The role of ubiquitin-proteasome pathway. New Engl J Med. 1996; 335:1897-905.
  11. Ryden M, Arvidsson E, Bloomqvist L, Perbeck L, Dicker A, Arner P. Targets for TNF-alpha-induced lipolysis in human adipocytes. Biochem Biophys Res Commun. 2004;318:168-175.
  12. Tirapegui J. Effect of insulin-like growth factor-1 (IGF-1) on muscle and bone growth in experimental models. Int J Food Sci Nutr. 1999;50:231-236.
  13. Lin J, Arnold HB, Della-Fera MA, Azain MJ, Hartzell DL, Baile CA. Myostatin knockout in mice increases myogenesis and decreases adipogenesis. Biochem Biophys Res Commun. 2002;291:701-706.
  14. Арутюнов Г.П. Кахексия как универсальный синдром в клинике внутренних болезней. Ремедиум. 2005;7:34-39.
  15. Powell-Tuck J, Hennessy EM. A comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients. Clin Nutr. 2003;22:307-312.
  16. Bosley BN, Weiner DK, Rudy TE, Granieri E. Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence. J Am Geriatr Soc. 2004;52:247-251.
  17. O’Driscoll JG, Green DJ, Ireland M. Treatment of end-stage cardiac failure with growth hormone. Lancet. 1997;349:1068.
  18. Cicoira M, Bolger AP, Doehner W, Rauchhaus M, Davos C, Sharma R, Al-Nasser FO, Coats AJ, Anker SD. High tumour necrosis factor-alpha levels are associated with exercise intolerance and neurohormonal activation in chronic heart failure patients. Cytokine. 2001;15:80-86.
  19. Аnker SD. The syndrome of cardiac cachexia in CHF. In: Anker SD, A.J.S. Heart failure. N.Y.: Livingstone; 1996:261-267.
  20. Арутюнов Г.П., Чернявская Т.К., Костюкевич О.И., Волгина О.Н. Сердечная кахексия. Фарматека. 2008;11:68-71.
  21. Albano O. L’assorbimento della trioleina J131 e dellacido deico Brnello scompenso dicivcolo. Minerva Med. 1964;55:2581.
  22. Tuca A, Jimenez-Fonseca P, Gascon P. Clinical evaluation and optimal management of cancer cachexia. Crit Rev Oncol Hematol. 2013;88:625-636.
  23. Лядов В.К., Буланова Е.А., Серяков А.П. Саркопения как ведущий компонент синдрома раковой кахексии. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2012;1:4-8.
  24. European clinical guidelines. Reference as: Radbruch L, Elsner F, Trottenberg P, Strasser F, Fearon K: Clinical practice guidelines on cancer cachexia in advanced cancer patients. Aachen, Department of Palliative Medicinen/European Palliative Care Research Collaborative; 2010.
  25. Behan DP, Grigoriadis DE, Lovenberg T, Chalmers D, Heinrichs S, Liaw C, De Souza EB. Neurobiology of corticotrophin releasing factor (CRF) receptors and CRF-binding protein: implications for the treatment of CNS disorders. Mol Psychiatry. 1996;1:265-277.
  26. Inui A. Cancer anorexia-cachexia syndrome: current issues in research management. CA Cancer J Ckin. 2002;52:72-91.
  27. Ramos EJ, Suzuki S, Marks D, Inui A, Asakawa A, Meguid MM. Cancer anorexia-cachexia syndrome: cytokines and neuropeptides. Curr OpinClin Nutr Metab Care. 2004;7:427-44.
  28. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. New Engl J Med. 1999;340(6):448-454.
  29. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC. Prognostic effect of weight loss prior chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491-497.
  30. Tisdale MJ. Mechanisms of cancer cachexia. Physiol Rev. 2009;89:381-410.
  31. Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D, Wolfe R, Anker SD. Cachexia: a new definition. Clin Nutr. 2008;27:793-799. doi: 10.1016/j.clnu.2008.06.013.
  32. Schutz Y, Kyle UUG, Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18—98 y. Int J Obes. 2002;26:953-960.
  33. McMillian DS. Systemic inflammation, nutritional status and survival in patients with cancer. Cur Opin Clin Nutr Metabol Care. 2009;12(3):223-226.
  34. Луфт В.М. Нутриционная поддержка онкологических больных: возможности и противоречия. Практическая медицина. 2008;3(17):38-41.
  35. Grobbelaar EJ, Owen S, Torrance AD, Wilson JA. Nutritional challenges in head and neck cancer. Clin Otolaryngol Allied Sci. 2004;29:307-313.
  36. Ravasco P, Monteiro-Grillo I, Vidal PM. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005;27(8):659-668.
  37. Tisdale MJ. Cachexia in cancer patients. Nature Rev Canc. 2002;2:862-887.
  38. Bruera E, Roca E, Cedaro L. Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study. Cancer Treatment Reports. 1985;69(7-8):751-754.
  39. Chlebowski RT, Herrold J, Ali I. Influence on nandrolone decanoate on weight loss in advanced non-small cell lung cancer. Cancer. 1986;58(1):183-186.
  40. Lundholm K, Körner U, Gunnebo L, Sixt-Ammilon P, Fouladiun M, Daneryd P, Bosaeus I. Insulin treatment in cancer cachexia: effects on survival, metabolism, and physical functioning. Clin Cancer Res. 2007;13(9):2699-2706. doi: 10.1158/1078-0432.ccr-06-2720.
  41. Agteresch HJ, van den Berg JW, Wilson JH, Dagnelie PC. Beneficial effects of adenosine triphosphate on nutritional status in advanced lung cancer patients: a randomized clinical trial. J Clin Oncol. 2002;20(2):371-378.
  42. Berenstein EG, Ortiz Z. Megestrol acetate for the treatment of anorexia-cachexia syndrome. Cochrane Database of Systematic Reviews, no. 2, Article ID CD004310, 2005.
  43. Mantovani G, Macciò A, Esu S, Lai P, Santona MC, Massa E, Dessì D, Melis GB, Del Giacco GS. Medroxyprogesterone acetate reduces the In vitro production of cytokines and serotonin involved in anorexia/cachexia and emesis by peripheral blood mononuclear cells of cancer patients. EurJ Cancer. 1997;33(4):602-607.
  44. Jatoi A, Windschitl HE, Loprinzi CL, Sloan JA, Dakhil SR, Mailliard JA, Pundaleeka S, Kardinal CG, Fitch TR, Krook JE, Novotny PJ, Christensen B. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol. 2002;20(2):567-573.
  45. Strasser F, Luftner D, Possinger K, Ernst G, Ruhstaller T, Meissner W, Ko YD, Schnelle M, Reif M, Cerny T. Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. JClin Oncol. 2006;24(21):3394-3400.
  46. Argils JM, Meijsing H, Pallars-Trujillo J, Guirao X, López-Soriano FJ. Cancer cachexia: a therapeutic approach. Med Res Rev. 2001;21(1):83-101.
  47. Kardinal CG, Loprinzi CL, Schaid DJ Hass AC, Dose AM, Athmann LM, Mailliard JA, McCormack GW, Gerstner JB, Schray MF. A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer. 1990;65(12):2657-2662.
  48. Gordon JN, Trebble TM, Ellis RD, Duncan HD, Johns T, Goggin PM. Thalidomide in the treatment of cancer cachexia: a randomized placebo controlled trial. Gut. 2005;54(4):540-545.
  49. Goldberg RM, Loprinzi CL, Mailliard JA, O’Fallon JR, Krook JE, Ghosh C, Hestorff RD, Chong SF, Reuter NF, Shanahan TG. Pentoxifylline for treatment of cancer anorexia and cachexia? A randomized, double-blind, placebo-controlled trial. J Clin Oncol. 1995;13(11):2856-2859.
  50. Dewey A, Baughan C, Dean Τ, Johnson I. Eicosapentaenoic acid (EPA, an omega-3 fatty acid from fish oils) for the treatment of cancer cachexia. Cochrane Database of Systematic Reviews, no. 1, Article ID CD004597, 2007.
  51. Lissoni P, Paolorossi F, Ardizzoia A, Barni S, Chilelli M, Mancuso M, Tancini G, Conti A, Maestroni GJ. A randomized study of chemotherapy with cisplatin plus etoposide versus chemoendocrine therapy with cisplatin, etoposide and the pineal hormone melatonin as a first-line treatment of advanced non-small cell lung cancer patients in a poor clinical state. J Pineal Res. 1997;23(1):15-19.
  52. Lissoni P. Is there a role for melatonin in supportive care? SupportiveCare in Cancer. 2002;10(2):110-116.
  53. Kotler DP. Cachexia. Ann Intern Med. 2000;133(8):622-634.
  54. Jatoi A, Ritter HL, Dueck A, Nguyen PL, Nikcevich DA, Luyun RF, Mattar BI, Loprinzi CL. A placebo-controlled, double-blind trial of infliximab for cancer-associated weight loss in elderly and/or poor performance non-small ling cancer patients (N01C9). Lung Cancer. 2010 68(2):234-239. doi: 10.1016/j.lungcan.2009.06.020.
  55. Lundholm K, Daneryd P, Körner U, Hyltander A, Bosaeus I. Evidence that long-term COX-treatment improves energy homeostasis and body composition in cancer patients with progressive cachexia. Int J Oncol. 2004;24(3):505-512.
  56. Fritsche K. Fatty acids as modulators of the immune response. Ann RevNutr. 2006;26(1):45-73.
  57. Berenstein EG, Ortiz Z. Megestrol acetate for the treatment of anorexia-cachexia syndrome. Cochrane Database of Systematic Reviews, no.2, 2005.
  58. Shing-Shing Yeh, Sherri Lovitt, Michael W. Schuster. Pharmacological Treatment of Geriatric Cachexia: Evidence and Safety in Perspective. J Am Med Dir Assoc. 2007;363-377.
  59. Jatoi A, Rowland K, Loprinzi CL, Sloan JA, Dakhil SR, MacDonald N, Gagnon B, Novotny PJ, Mailliard JA, Bushey TI, Nair S, Christensen B; North Central Cancer Treatment Group. An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: a North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort. J Clin Oncol. 2004;22(12):2469-2476.
  60. Payne JR, Kotwinski PJ, Montgomery HE. Cardiac effects of anabolic steroids. Heart. 2004;90:473-475.
  61. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004;34:513-554.
  62. Hyltander A, Daneryd P, Sandström R, Körner U, Lundholm K. β-Adrenoceptor activity and resting energy metabolism in weight losing cancer patients. Eur J Cancer. 2000;36(3):330-334.
  63. Springer J, Filippatos G, Akashi YJ, Anker SD. Prognosis and therapy approaches of cardiac cachexia. Curr Opin Cardiol. 2006;21:229-233.
  64. Maggio M, Ceda GP, Lauretani F, Pahor M, Bandinelli S, Najjar SS, Ling SM, Basaria S, Ruggiero C, Valenti G, Ferrucci L. Realation of angiotensin-converting enzyme inhibitor treatment to insulin-like growth factor-1 serum levels in subjects >65 years of age (the InCHIANTI study). Am J Cardiol. 2006;97:1525-1529.
  65. Lamont LS, Brown T, Riebe D, Caldwell M. The major components of human energy balance during chronic beta-adrenergic blockade. J CardiopulmRehabil. 2000;20:247-250.
  66. Reichel K, Rehfeldt C, Weikard R, Schadereit R, Schadereit R, Krawielitzki K. Effect of a beta-agonist and a beta-agonist/beta-antagonist combination on muscle growth, body composition and protein metabolism in rats. Arch Tierernahr. 1993;45:211-225.
  67. Anker S, Haehling S, Springer J, Thum T. Treatment of cachexia with statins. EP 1973542 A2 (текст из патента WO2007083119A2), 2008.
  68. Anker SD, Negassa A, Coats AJ. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet. 2003;361(9363):1077-1083.
  69. Cardinale D, Colombo A, Sandri MT. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation. 2006;114(23):2474-2481.
  70. Баллюзек М.Ф., Ионова А.К. Кардиоонкология в программах лечения и реабилитации онкологических больных. Российский кардиологическийжурнал. 2014;5(109):75-80.
  71. Анисимов В.Н. Мелатонин и его место в современной медицине. РМЖ 2006;14(4):269-273.
  72. Анисимов В.Н. Молекулярные и физиологические механизмы старения. СПб.: Наука; 2003:468.
  73. Кветная Т.В., Князькин И.В. Мелатонин: роль и значение в возрастной патологии. СПб.: ВмедА; 2003:93.
  74. Баллюзек М.Ф., Гриненко Т.Н., Кветной И.М. Гормоны сердца в формировании сердечно-сосудистой патологии. Клиническая медицина. 2005;11:4-12.

Copyright (c) 2015 Ballyuzek M.F., Mashkova M.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail:


© 2018-2021 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies