Cachexia, anorexia, and fatigue are an overlapping and often neglected group of symptoms that at some stage affect most patients with cancer. Similar symptoms may be seen in other conditions, including advanced cardiac failure, COPD, renal failure, and AIDS and in patients who have been in intensive care units. The term cachexia is derived from the Greek words kakos and hexis meaning poor condition. Cachexia is a broad heterogeneous syndrome. The key feature is wasting that cannot be easily or completely reversed by an increase in food intake alone. Anorexia or reduced appetite often accompanies cachexia. Some patients with anorexia, however, do not have cachexia. Equally some cachectic patients become wasted but apparently do not have anorexia. Fatigue is a common element but again this can occur in isolation.
Cachexia is complex and multifactorial. A patient's evident chronic negative energy and protein balance is most commonly driven by a combination of reduced food intake and metabolic change. Symptoms can include anorexia, early satiety, taste changes, loss of physical function, and fatigue. Signs may include muscle wasting, loss of subcutaneous fat, and peripheral oedema. Different symptoms may predominate in individual patients and may also change with time. Advanced cachexia is generally easy to recognise, but the early symptoms may be more subtle. An unintentional loss of weight of more than 10% with an appropriate underlying diagnosis has traditionally been used as a definition of cachexia. This definition, however, neglects other relevant symptoms and if used rigidly is likely to delay diagnosis and therefore treatment. Equally, with an ever increasing tendency towards obesity in the general population, lesser degrees of weight loss are likely to identify a proportion of patients who, while at risk of developing cachexia, may still be above ideal body weight.
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