Nutrition support and cachexia management
Screening for malnutrition, dietitian-led counselling, supplements and tube or intravenous feeding where indicated, plus treatment of cancer cachexia, the muscle-wasting syndrome that affects up to 80% of advanced patients.
Malnutrition affects 20-70% of patients depending on tumour and stage and is an independent predictor of mortality, toxicity and complications. ESPEN (2017, 2021) and ASCO (2020) guidelines recommend routine screening (NRS-2002, PG-SGA), dietitian counselling, oral supplements, enteral feeding for head and neck and oesophageal cancer during chemoradiation, and limited use of parenteral nutrition. Cachexia (weight loss >5% with sarcopenia and inflammation, Fearon 2011 consensus) has its first approved drug in Japan (anamorelin, ghrelin agonist, 2021; EMA refused 2017); ponsegromab (anti-GDF-15) increased weight in a phase 2 trial (NEJM 2024) and is in phase 3. Exercise and protein intake are the non-pharmacologic core; immunonutrition before surgery reduces infections.
How it works
Screen at diagnosis and during treatment; intervene in stepwise fashion from counselling to artificial nutrition; treat cachexia as a multimodal problem (nutrition, exercise, anti-inflammatory/appetite drugs) rather than by feeding alone.
- Cheap screening and counselling reduce complications
- Prehabilitation nutrition improves surgical outcomes
- First mechanism-based cachexia drugs (GDF-15) are arriving
- Cachexia has no approved drug in the US or EU
- Parenteral nutrition rarely helps and carries risk
- Dietitian access uneven
Latest papers
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