Objective: The success of treatments for loss of appetite and weight is limited, probably because of the complexity of anorexia/cachexia syndromes (ACS). Animal models of cancer cachexia suggest distinct pathogenetic mechanism of "primary" ACS. Palliative multi-dimensional assessment suggests significant causes for "secondary" ACS. To establish clinical useful definitions of distinct ACS.
Methods: 1. Review and synthesis of literature comprising basic science to terminal care. An explorative review design with peer review had to be applied. 2. In patients seen to explore eating-related distress, the usefulness of primary versus secondary ACS for counseling patients and relatives was tested.
Results: 1. The animal models support (overlapping) ACS triggered by proinflammatory cytokines (TNF et al.), by altered gut-brain axis, or by altered somatotropic axis. Palliative multi-dimensional assessment support the impact of a number of important causes for loss of appetite or weight, such as severe symptoms (i.e., pain, shortness of breath, depression), syndromes (i.e.constipation, mucositis, bowel obstruction), or prolonged bed rest. [StrasserF, BrueraE. ProgrPallCare 2002;10: 161. StrasserF. 3rd Ed. Oxford Textbook Pall Med. Chapter 8.3.1.]. 2. In 15 patients with ACS and their relatives (defined as being present for>50% of meals) counseled by a multidisciplinary team for eating-related distress, the clear explanation of the primary and secondary ACS facilitated understanding and reduced distress, as judged by the team members.
Conclusions: Palliative, multidimensional concepts of ACS carry the potential to optimize quality of life of patients until death with 1) targeted therapies, 2) improved decision making, and 3) more focused research projects.