Cancer cachexia syndrome in head and neck cancer patients: part I. Diagnosis, impact on quality of life and survival, and treatment.
BACKGROUND
Cancer cachexia is a debilitating, wasting condition that affects many cancer patients, including those with head and neck cancer. The overall incidence of cancer cachexia is quite high for some types of cancer, and cachexia will be the main cause of death for more than 20% of all cancer patients. This syndrome uniquely challenges patients with head and neck cancer. This article outlines the diagnosis of cancer cachexia, reviews its impact on patient quality of life (QOL) and survival, and updates the reader on potential therapies that may suppress it.


METHODS
A comprehensive literature search was performed using PubMed of the National Library of Medicine, which includes more than 15 million citations back to the 1950s. The Cochrane Library and Google search engine were used as well.


RESULTS
This syndrome differs significantly from starvation, and thus accurate and timely diagnosis is essential. Nutritional therapy alone is insufficient. Current management strategies include corticosteroids and megesterol acetate, in conjunction with nutritional therapy. Future strategies may include nutraceuticals, omega-3 fatty acids, inflammatory antagonists, and other targeted treatments.


CONCLUSIONS
Because cancer cachexia differs significantly from starvation, nutritional supplementation must be used in conjunction with other anti-cachexia agents to reverse the chronic systemic inflammatory state and the effects of circulating tumor-derived factors seen in cachexia. Careful identification of patients at risk and those suffering from this syndrome will lead to better outcomes and treatments. Ultimately, more research is needed to better treat this devastating condition.
Couch
Marion
M
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, G0412 Neurosciences Hospital, Chapel Hill, NC 27599-7070, USA. marion-couch@med.unc.edu
Lai
Victor
V
Cannon
Trinitia
T
Guttridge
Denis
D
Zanation
Adam
A
George
Jonathan
J
Hayes
D Neil
DN
Zeisel
Steven
S
Shores
Carol
C
D002100:Cachexia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000401:mortality; D006801:Humans; D018529:Nutritional Support; D011788:Quality of Life; D015996:Survival Rate