title: Practical multimodal care for cancer cachexia.
abstract: Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory.
  
  
  
  Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments.
  
  
  
  We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.
authors.affiliation: aKing's College London, Cicely Saunders Institute, London, UK bSchool of Healthcare Sciences, Cardiff University, Cardiff, UK cOncology Department, St. Bartholomew's Hospital, London, UK dTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK eDepartment of Surgery, Royal Infirmary, Edinburgh, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Maddocks
authors.forename: Jane
authors.initials: J
authors.lastname: Hopkinson
authors.forename: John
authors.initials: J
authors.lastname: Conibear
authors.forename: Annie
authors.initials: A
authors.lastname: Reeves
authors.forename: Clare
authors.initials: C
authors.lastname: Shaw
authors.forename: Ken C H
authors.initials: KC
authors.lastname: Fearon
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002100:Cachexia / Q000178:diet therapy / Q000209:etiology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D018529:Nutritional Support / Q000379:methods; D010166:Palliative Care / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods; D011788:Quality of Life
chemical_list: D000893:Anti-Inflammatory Agents