Nonpharmacological Management of Cancer-Related Cachexia: A Systematic Review.

OBJECTIVES

Cancer-related cachexia affects approximately 50% to 80% of cancer patients and contributes significantly to cancer-related mortality, accounting for 20% of deaths. This multifactorial syndrome is characterized by systemic inflammation, anorexia, and elevated energy expenditure, leading to severe weight loss and muscle wasting. Understanding the underlying mechanisms is critical for developing effective interventions. While progress has been made over the past decade, most therapeutic approaches have centered on pharmacological agents or nutritional supplements. This systematic review seeks to address a critical gap by examining interventional studies that focus on nonpharmacological, nonsupplement, and nonparenteral strategies for managing cancer-related cachexia.

METHODS

A systematic review followed the guidelines provided by PRISMA 2020. The review was conducted to identify clinical trials on the nonpharmacological, nonsupplement, and nonparenteral management of cancer-related cachexia. The literature search encompassed PubMed, CINAHL, and Scopus, targeting studies published between 2014 and 2024. Inclusion criteria required studies to be written in English, involve human participants aged 18 years or older, and focus on individuals diagnosed with active solid tumors. Studies involving participants with hematological malignancies were excluded due to the unique dietary requirements associated with these conditions.

RESULTS

The search identified 2,949 articles, of which 10 met the eligibility criteria. The nonpharmacological interventions examined included acupuncture, nutritional advice, education and support, informational booklets, behavior change support, and exercise. Significant heterogeneity was observed in both the types of interventions and the sample sizes across the studies. Most participants were outpatients. Commonly, assessed outcomes included body weight, body mass index, quality of life (QoL), and muscular strength. This variation highlights the need for more standardized approaches to better evaluate the impact of such interventions.

CONCLUSIONS

Exercise interventions improved lean mass, QoL, and fatigue. Complementary interventions like acupuncture have demonstrated promising benefits in managing cancer-related cachexia. These include improved appetite, enhanced Karnofsky Performance Status (indicating better functional ability), and reduced weight loss. While some studies suggest nutritional interventions may positively impact weight or dietary habits, the evidence remains inconclusive. This highlights the importance of initiating interventions early in the course of care, just after the diagnosis and the start of treatment to maximize potential benefits. Additionally, actively involving patients in their care is crucial, as this can enhance adherence, personalize strategies, and address individual needs more effectively.

IMPLICATIONS FOR NURSING PRACTICE

The assessment and nonpharmacological management of cancer-related cachexia play a vital role in enhancing the QoL for cancer patients. Individualized nutritional interventions, educational programs, exercise routines, and tailored lifestyle advice have shown the potential to positively impact food intake, body composition, fatigue levels, and overall patient satisfaction during anticancer treatments. These approaches not only address the physical challenges of cachexia but also support the psychological and emotional well-being of patients, contributing to a more comprehensive and patient-centered care strategy.