Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Palliat Med. 2011 Sep;14(9):1004-8. doi: 10.1089/jpm.2011.0098. Epub 2011 Jul 27.
Cancer cachexia is considered intractable, with few therapeutic options. Secondary nutrition impact symptoms (S-NIS) such as nausea may further contribute to weight loss by decreasing nutrient intake. In addition, treatable metabolic abnormalities such as hypogonadism, vitamin B12 deficiency, hypothyroidism, and hypoadrenalism could exacerbate anorexia and muscle wasting in patients with cancer cachexia. We determined the frequency and type of contributors to appetite and weight loss, and the effect of the cachexia clinic on clinical outcomes.
Review of 151 consecutive patients referred to a cachexia clinic. All received dietary counseling and exercise recommendations. Assessments included weight, body mass index (BMI), S-NIS, resting energy expenditure by indirect calorimetry, serum thyroid stimulating hormone (TSH), cortisol, total testosterone, and vitamin B12.
Median weight loss in the 100 days before referral was 9% (4%-13%); median BMI at presentation was 20.8. Median number of S-NIS was 3 (2-4), most commonly treated by metoclopramide, laxatives, and antidepressants. Forty-one percent (24/59) of patients were hypermetabolic and 73% (52/71) of males hypogonadic, whereas hypoadrenalism (0/101, 0%), hypothyroidism (4/113, 4%), and low vitamin B12 (3/107, 3%) were uncommon. Poor appetite and weight loss before referral (r = 0.18, p = 0.036) were associated with increased S-NIS (r = 0.22, p = 0.008). Appetite improved (p < 0.001) and 31/92 (34%) of patients returning for a second visit gained weight.
Patients had a high frequency of multiple S-NIS, hypogonadism, and hypermetabolism. A combination of simple pharmacological and nonpharmacological interventions improved appetite significantly, and increased weight in one third of patients who were able to return for follow-up. Cachexia clinics are feasible and effective for many patients with advanced cancer.
癌症恶病质被认为是难以治愈的，治疗选择有限。继发性营养影响症状（S-NIS），如恶心，可能通过减少营养摄入进一步导致体重下降。此外，可治疗的代谢异常，如性腺功能减退、维生素 B12 缺乏、甲状腺功能减退和肾上腺功能减退，可能会加剧癌症恶病质患者的厌食和肌肉消耗。我们确定了导致食欲和体重下降的因素的频率和类型，以及恶病质诊所对临床结果的影响。
回顾性分析了 151 例连续就诊于恶病质诊所的患者。所有患者均接受饮食咨询和运动建议。评估包括体重、体重指数（BMI）、S-NIS、间接测热法测定静息能量消耗、血清促甲状腺激素（TSH）、皮质醇、总睾酮和维生素 B12。
转诊前 100 天的中位体重下降为 9%（4%-13%）；就诊时的中位 BMI 为 20.8。中位 S-NIS 数为 3（2-4），最常通过甲氧氯普胺、泻药和抗抑郁药治疗。41%（24/59）的患者代谢亢进，73%（52/71）的男性性腺功能减退，而肾上腺功能减退（0/101，0%）、甲状腺功能减退（4/113，4%）和低维生素 B12（3/107，3%）则较为罕见。转诊前食欲差和体重下降（r=0.18，p=0.036）与 S-NIS 增加相关（r=0.22，p=0.008）。食欲改善（p<0.001），92 例中有 31 例（34%）返回第二次就诊的患者体重增加。
患者 S-NIS、性腺功能减退和代谢亢进的发生率较高。简单的药理学和非药理学干预的组合显著改善了食欲，并使三分之一能够返回随访的患者体重增加。恶病质诊所对许多晚期癌症患者是可行且有效的。
