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Review
. 2019 May;24(5):691-701.
doi: 10.1634/theoncologist.2018-0266. Epub 2018 Dec 27.

Pancreas Cancer-Associated Weight Loss

Andrew E Hendifar  1 , Maria Q B Petzel  2 , Teresa A Zimmers  3 , Crystal S Denlinger  4 , Lynn M Matrisian  5 , Vincent J Picozzi  6 , Lola Rahib  5 ; Precision Promise Consortium
Collaborators, Affiliations
Review

Pancreas Cancer-Associated Weight Loss

Andrew E Hendifar et al. Oncologist. 2019 May.

Abstract
in English, Chinese

Unintentional weight loss in patients with pancreatic cancer is highly prevalent and contributes to low therapeutic tolerance, reduced quality of life, and overall mortality. Weight loss in pancreatic cancer can be due to anorexia, malabsorption, and/or cachexia. Proper supportive care can stabilize or reverse weight loss in patients and improve outcomes. We review the literature on supportive care relevant to pancreatic cancer patients, and offer evidence-based recommendations that include expert nutritional assessment, counseling, supportive measures to ensure adequate caloric intake, pancreatic enzyme supplementation, nutritional supplement replacement, orexigenic agents, and exercise. Pancreatic Cancer Action Network-supported initiatives will spearhead the dissemination and adoption of these best supportive care practices. IMPLICATIONS FOR PRACTICE: Weight loss in pancreatic cancer patients is endemic, as 85% of pancreatic cancer patients meet the classic definition of cancer cachexia. Despite its significant prevalence and associated morbidity, there is no established approach to this disease entity. It is believed that this is due to an important knowledge gap in understanding the underlying biology and lack of optimal treatment approaches. This article reviews the literature regarding pancreas cancer-associated weight loss and establishes a new framework from which to view this complex clinical problem. An improved approach and understanding will help educate clinicians, improve clinical care, and provide more clarity for future clinical investigation.

摘要

无意识的体重减轻在胰腺癌患者中十分常见，可以导致治疗耐受性低、降低生活质量以及总死亡率。胰腺癌患者的体重减轻可能归因于厌食症、吸收障碍和/或恶病质。适当的支持性治疗可以让患者的体重减轻状况稳定下来或发生逆转，同时还能改进预后。我们查阅了与胰腺癌患者相关的支持性治疗文献并提出了基于证据的建议，包含专家营养评估、咨询服务、确保充足的热量摄入的支持性措施、胰酶补充、营养补充剂替换、开胃药物和锻炼。胰腺癌行动网络支持的各项举措将带头宣传并采用此类最佳支持性治疗实践。

实践意义:由于 85% 的胰腺癌患者符合癌症恶病质的经典定义，所以，胰腺癌患者的体重减轻很常见。尽管它具有显著的流行率和相关病损率，但是，我们没有确定的方法来治疗此类疾病。人们认为，这是由于在理解潜在的生物学方面存在重要的知识差距和缺乏最佳的治疗方法。本文查阅了有关胰腺癌相关体重减轻的文献，并建立了一个可供人们查看此类复杂的临床问题的全新框架。改进的方法和认识将有助于教育临床医生、改善临床治疗并为未来的临床研究提供更清晰的信息。

Keywords: Anorexia; Cachexia; Malabsorption; Pancreatic cancer; Supportive care; Weight loss.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Definitions and classifications. Abbreviation: PC, pancreatic cancer.
Figure 2.
Figure 2.
Clinically significant weight loss (see Table 1 for interpretation). Abbreviations: CRP, c‐reactive protein; GI, gastrointestinal; PEI, pancreatic exocrine insufficiency.
Figure 3.
Figure 3.
Consensus recommendations for pancreatic cancer‐associated weight loss.
See this image and copyright information in PMC

References

    1. Bye A, Jordhoy MS, Skjegstad G et al. Symptoms in advanced pancreatic cancer are of importance for energy intake. Support Care Cancer 2013;21:219–227. - PubMed
    1. Ferrucci LM, Bell D, Thornton J et al. Nutritional status of patients with locally advanced pancreatic cancer: A pilot study. Support Care Cancer 2011;19:1729–1734. - PMC - PubMed
    1. Hendifar A, Chang J, Huang B et al. Cachexia, and not obesity, prior to pancreatic cancer diagnosis worsens survival and is negated by chemotherapy. J Gastrointest Oncol 2018;9:17–23. - PMC - PubMed
    1. Bachmann J, Heiligensetzer M, Krakowski‐Roosen H et al. Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg 2008;12:1193–1201. - PubMed
    1. Hendifar AE, Co Tan CR, Yaffee P et al. Evaluating outcomes of pancreatic cancer patients with cachexia. J Clin Oncol 2014;32(suppl 15):e15208a.

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