cachexia and sarcopenia

Understanding cachexia and sarcopenia for pancreatic cancer patients

By some estimates, almost one-third of cancer deaths feature cachexia, a wasting syndrome. Cancer cachexia is a complex metabolic disorder characterised by a loss of skeletal muscle mass, called sarcopenia, and weight loss that cannot be reversed.

Despite the significant impact cachexia and sarcopenia have on patient outcomes, they are still not completely understood.

Medical oncologist Dr Katherine Geddes says that researchers have gained a deeper understanding of cancer cachexia in recent years. Recent definitions of cachexia have defined three stages: pre-cachexia, cachexia, and refractory cachexia. What used to be thought of as cachexia is now recognised as a later stage of the syndrome, that is irreversible and can significantly impact a person’s quality of life.

Dr Geddes notes that sarcopenia is an issue for pancreatic cancer patients, as they tend to lose a lot of weight as a result of their cancer. This weight loss can affect how patients tolerate treatment or their suitability for treatment.

“All chemotherapy is based on a height-weight calculation,” says Dr Geddes. “People who have abnormal body composition are thought to be at higher risk of poor tolerance to treatment and we know that having low muscle mass at cancer diagnosis is associated with a worse cancer-related survival outcome.”

Dr Geddes received the AGITG’s Best New Concept Award in 2017 for her research project ‘The prevalence and significance of sarcopaenia in patients with operable adenocarcinoma of the stomach or gastro‐oesophageal junction undergoing treatment with curative intent and the impact of altered body composition on chemotherapy delivery’. This project focused on at why there appears to be an increase in sarcopenia after patients receive chemotherapy.  The concept has been further developed since presentation at the 2017 New Concepts Symposium and is now entitled ‘the LOWGEAR study – LOW muscle mass in Gastric or gastro-oEsophageal junction cancer undergoing curative treatment, And the impact of alteRed body composition on patient outcomes’.  A submission for grant funding is currently under review by Cancer Australia.

As these problems are so complex, it is difficult to treat them or for patients to change their outcomes.

“We think the solution is multi-factorial,” says Dr Geddes. “It seems like a combination of maximal dietetic support, an exercise program and possibly medication could have the best outcomes. Once we understand sarcopenia a bit better we will be able to better design an intervention that will improve cancer outcomes.”