title: Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force.
abstract: BACKGROUND
  Weight loss and cachexia are common, reduce tolerance of cancer treatment and the likelihood of response, and independently predict poor outcome.
  
  
  METHODS
  A group of experts met under the auspices of the European School of Oncology to review the literature and-on the basis of the limited evidence at present-make recommendations for malnutrition and cachexia management and future research.
  
  
  CONCLUSIONS
  Our focus should move from end-stage wasting to supporting patients' nutritional and functional state throughout the increasingly complex and prolonged course of anti-cancer treatment. When inadequate nutrient intake predominates (malnutrition), this can be managed by conventional nutritional support. In the presence of systemic inflammation/altered metabolism (cachexia), a multi-modal approach including novel therapeutic agents is required. For all patients, oncologists should consider three supportive care issues: ensuring sufficient energy and protein intake, maintaining physical activity to maintain muscle mass and (if present) reducing systemic inflammation. The results of phase II/III trials based on novel drug targets (e.g. cytokines, ghrelin receptor, androgen receptor, myostatin) are expected in the next 2 years. If effective therapies emerge, early detection of malnutrition and cachexia will be increasingly important in the hope that timely intervention can improve both patient-centered and oncology outcomes.
authors.affiliation: Clinique de Genolier, Genolier, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Aapro
authors.affiliation: Tumor Biology Center, Albert Ludwig's University, Freiburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Arends
authors.affiliation: Department of Medicine and Surgery, University of Milan, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bozzetti
authors.affiliation: School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK k.fearon@ed.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Fearon
authors.affiliation: Hematology/Oncology Division, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Grunberg
authors.affiliation: Department of Oncology, Odense University Hospital, Odense, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Herrstedt
authors.affiliation: School of Healthcare Sciences, Cardiff University, Cardiff, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hopkinson
authors.affiliation: Clinique de Genolier, Genolier, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Jacquelin-Ravel
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Jatoi
authors.affiliation: Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Kaasa
authors.affiliation: Department of Internal Medicine, Kantonsspital, St Gallen, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Strasser
mesh_terms: D001823:Body Composition / Q000502:physiology; D002100:Cachexia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D042241:Early Diagnosis; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D058990:Molecular Targeted Therapy; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D004364:Pharmaceutical Preparations; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D015431:Weight Loss / Q000502:physiology
chemical_list: D004364:Pharmaceutical Preparations
keywords: cancer cachexia; malnutrition; nutritional support; review; systemic inflammation