Law Michelle L
Department of Human Sciences and Design, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, United States.
Front Pain Res (Lausanne). 2022 Aug 22;3:971295. doi: 10.3389/fpain.2022.971295. eCollection 2022.
Cachexia is a syndrome of unintentional body weight loss and muscle wasting occurring in 30% of all cancer patients. Patients with cancers most commonly leading to brain metastases have a risk for cachexia development between 20 and 80%. Cachexia causes severe weakness and fatigue and negatively impacts quality and length of life. The negative energy balance in cachectic patients is most often caused by a combination of increased energy expenditure and decreased energy intake. Basal metabolic rate may be elevated due to tumor secreted factors and a systemic inflammatory response leading to inefficiency in energy production pathways and increased energy demand by the tumor and host tissues. A growing body of research explores physiological and molecular mechanisms of metabolic dysregulation in cachexia. However, decreased energy intake and physical functioning also remain important contributors to cachexia pathogenesis. Pain associated with metastatic malignancy is significantly associated with inflammation, thus making inflammation a common link between cancer pain and cachexia. Pain may also influence appetite and food intake and exacerbate fatigue and functional decline, potentially contributing to cachexia severity. Cancer pain and cachexia often occur simultaneously; however, causal relationships remain to be established. Appropriate assessment and treatment of pain in advanced cancer patients may positively impact nutrition status and physical functioning, slowing the progression of cachexia and improving quality and length of life for patients.
恶病质是一种非自愿体重减轻和肌肉消耗的综合征，在所有癌症患者中有30%会出现。最常导致脑转移的癌症患者发生恶病质的风险在20%至80%之间。恶病质会导致严重的虚弱和疲劳，并对生活质量和寿命产生负面影响。恶病质患者的负能量平衡最常由能量消耗增加和能量摄入减少共同导致。由于肿瘤分泌因子和全身炎症反应，基础代谢率可能会升高，导致能量产生途径效率低下，以及肿瘤和宿主组织对能量的需求增加。越来越多的研究探讨了恶病质中代谢失调的生理和分子机制。然而，能量摄入减少和身体功能下降仍是恶病质发病机制的重要因素。与转移性恶性肿瘤相关的疼痛与炎症显著相关，因此炎症是癌症疼痛和恶病质之间的共同联系。疼痛还可能影响食欲和食物摄入，加剧疲劳和功能衰退，可能导致恶病质加重。癌症疼痛和恶病质常同时出现；然而，因果关系仍有待确定。对晚期癌症患者进行适当的疼痛评估和治疗可能会对营养状况和身体功能产生积极影响，减缓恶病质的进展，提高患者的生活质量和寿命。
