Treatment
Nutritional Interventions
➤ Recommendation 1.1. Clinicians may refer patients with advanced
cancer and loss of appetite and/or body weight to a registered
dietitian for assessment and counseling, with the goals of providing
patients and caregivers with practical and safe advice for feeding;
education regarding high-protein, high-calorie, nutrient-dense food;
and advice against fad diets and other unproven or extreme diets.
(Moderate recommendation; IC-L)
➤ Recommendation 1.2. Outside the context of a clinical trial, clinicians
should not routinely offer enteral tube feeding or parenteral nutrition
to manage cachexia in patients with advanced cancer. A short-term
trial of parenteral nutrition may be offered to a very select group of
patients, such as patients who have a reversible bowel obstruction,
short bowel syndrome, or other issues contributing to malabsorption,
but otherwise are reasonably fit. Discontinuation of previously initiated
enteral or parenteral nutrition near the end of life is appropriate.
(Moderate recommendation; IC-L)
Note: Information about additional nutritional interventions considered by the
Expert Panel is provided in Table 1.
Pharmacologic interventions
➤ Recommendation 2.1. Evidence remains insufficient to strongly
endorse any pharmacologic agent to improve cancer cachexia
outcomes; clinicians may choose not to offer medications for the
treatment of cancer cachexia. There are currently no FDA-approved
medications for the indication of cancer cachexia. (Moderate
recommendation; EB-L)
➤ Recommendation 2.2. Clinicians may offer a short-term trial of a
progesterone analog or a corticosteroid to patients experiencing loss
of appetite and/or body weight. The choice of agent and duration of
treatment depends on treatment goals and assessment of risk versus
benefit. (Moderate recommendation; EB-I)
Note: Information about additional pharmacologic interventions considered by the
Expert Panel is provided in Table 1.
Other interventions
➤ Recommendation 3. Outside the context of a clinical trial, no
recommendation can be made for other interventions, such as
exercise, for the management of cancer cachexia.
