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Practice Guideline
. 2021 Jun;6(3):100092.
doi: 10.1016/j.esmoop.2021.100092.

Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆

J Arends  1 , F Strasser  2 , S Gonella  3 , T S Solheim  4 , C Madeddu  5 , P Ravasco  6 , L Buonaccorso  7 , M A E de van der Schueren  8 , C Baldwin  9 , M Chasen  10 , C I Ripamonti  11 ; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org
Affiliations
Practice Guideline

Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆

J Arends et al. ESMO Open. 2021 Jun.

Abstract

  1. •

    This ESMO Clinical Practice Guideline provides key recommendations for managing cancer-related cachexia.

  2. •

    It covers screening, assessment and multimodal management of cancer cachexia.

  3. •

    All recommendations were compiled by a multidisciplinary group of experts.

  4. •

    Recommendations are based on available scientific data and the author's expert opinion.

Keywords: Clinical Practice Guidelines; assessment; cachexia; cancer; nutrition; treatment.

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Conflict of interest statement

Disclosure FS reports receipt of unrestricted industry grants to institute for clinical research from Celgene, Fresenius and Helsinn, participation in company-led clinical cachexia trials for Novartis and participation in an advisory role for Helsinn, Mundipharma, Novartis, Fresenius and Kaiku Health (reimbursements to institute); TSS reports receipt of honoraria from Fresenius Kabi; MC reports receipt of payment from Tetra Biopharmaceuticals for helping to write research protocols; JA reports receipt of consultancy fees from Baxter and Danone and honoraria from Berg-Apotheke, Falk, Fresenius Kabi, Nutricia and Roche; CIR reports receipt of funding for independent educational events from Inpharm, Kyowa Kirin, Amgen Europe and Molteni SpA; MAEdvdS reports receipt of honoraria for independent lectures at educational and scientific events organised by Nutricia, Fresenius Kabi and Baxter; all other authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
Invasiveness of interventions relative to expected survival. ONS, oral nutritional supplement.
Figure 2
Figure 2
The complexity of causes contributing to weight loss in patients with cancer. GI, gastrointestinal.
Figure 3
Figure 3
Evolution of cancer cachexia. Adapted from Fearon et al.
Figure 4
Figure 4
Screening and assessment of nutritional and metabolic risk for cachexia. GI, gastrointestinal; MNA-sf, Mini Nutritional Assessment short form; MST, Malnutrition Screening Tool; MUST, Malnutrition Universal Screening Tool; NRS-2002, Nutrition Risk Screening 2002; PG-SGA, Patient-Generated Subjective Global Assessment; SNAQ, Short Nutritional Assessment Questionnaire.
Figure 5
Figure 5
Choosing nutritional intervention options. Purple: symptom; turquoise: nutritional interventions; white: other aspects of management. EN, enteral nutrition; GI gastrointestinal; NTF, nasogastric tube feeding; ONS, oral nutritional supplement; PEG, percutaneous endoscopic gastrostomy; PN, parenteral nutrition.
Figure 6
Figure 6
Responsibilities and interactions of members of the multimodal care team. GI, gastrointestinal. Solid line arrows depict responsibilities. Dashed line arrows depict interactions. Further cooperation (e.g. with gastroenterologists, surgeons, head and neck specialists) will frequently be necessary.
See this image and copyright information in PMC

References

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    1. Schcolnik-Cabrera A., Chávez-Blanco A., Domínguez-Gómez G. Understanding tumor anabolism and patient catabolism in cancer-associated cachexia. Am J Cancer Res. 2017;7(5):1107–1135. - PMC - PubMed
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