On February 26, 2019, MASCC’S Nutrition and Cachexia Study Group presented a webinar, “The Cachexia Clinic — Practical Considerations for Running a Successful Clinic,” featuring Liz Isenring, PhD (Study Group Chair), Egidio Del Fabbro, MD (Study Group Vice-Chair), and Rony Dev, MD. The speakers presented information and practical considerations for establishing and operating a cachexia clinic within a cancer center. Specific objectives included specifying ideal service and team composition, making the case for the importance of a cachexia clinic, presenting brief assessments and basic management strategies, and considering the most useful outcome measures.
Egidio Del Fabbro began with two case presentations of patients who had experienced significant weight loss during their cancer treatment. The cachexia-related symptoms were managed to improve pain control and nutrition impact symptoms to increase dietary intake, leading to weight gain and improved quality of life. Rony Dev followed with important points involved in making the case for addressing cachexia to referring oncologists. Briefly, cachexia is associated with risks of complications and death, increased toxicity, decreased treatment response, failure to complete therapy, increased fatigue, low performance status, and low quality of life. He also stressed that many different clinical services can be involved in cachexia treatment — e.g., oncology, palliative care, physical medicine and rehabilitation, geriatrics, endocrinology, surgery, nutrition — but that often, one service or another may be the best to take a leading role, especially for patients with advanced cancer. It’s also important to make the case for addressing cachexia directly to patients and their families.
Rony Dev also discussed the ideal goals of a cachexia clinic: to assess and manage anorexia (or reduced food intake), comorbidities, metabolic dysfunction, body composition, muscle mass and strength, functional status, psychological factors, and social factors. He stressed the importance of ensuring that all members of an interdisciplinary team share the same message, especially when broad-based disciplines, such as psychosocial, rehabilitation, nutrition, or integrative medicine, are involved. He also stressed the importance of engaging patients early in their illness and reviewed potential interventions and outcome measures. Since there is no good pharmacological treatment for loss of appetite, the problem requires special skills and an interdisciplinary team.
Liz Isenring focused on nutritional management of nutrition impact symptoms and other factors that affect dietary intake, such as taste changes, swallowing problems, pain, depression, and digestive problems. She briefly reviewed the range of evidence-based guidelines for nutritional management of cancer cachexia and reviewed a range of nutrition interventions, including menu items, feeding assistance, nutrient-dense foods, and food taste and appearance, stressing that nutritional management of cachexia involves both art and science. The webinar also included, among other topics, a discussion of nutritional impact symptoms and treatment, muscle wasting, decreased function, and physical assessment and intervention, the role of vitamin D, and key areas for needed research in a cachexia clinic.
In summary, the presenters stressed the following critical considerations for a cachexia clinic:
- The composition of a cachexia clinical team — ideally interdisciplinary, but may vary with institution;
- The importance of making the case to patients, their families, oncologists, and other healthcare leaders;
- Needed supportive care measures to address nutrition impact symptoms, diet, physical performance, etc.;
- Recognition that exact measures implemented may depend on available resources;
- Finding ways to engage patients early in their treatment;
- Improving education and adherence to treatment regimens;
- Finding ways to measure meaningful outcomes.
The webinar concluded with a brief question and answer period.
