Psychosocial issues in the diagnosis and management of cancer cachexia and anorexia

Anorexia with its associated decreased food intake and weight loss is a common and profoundly important symptom in cancer, and one which has at times a psychological as well as physical component. When it is physical in origin it may be caused directly or indirectly by the disease process or treatment. Most poorly understood is the anorexia-cachexia syndrome of advanced disease. Psychological causes often reflect anxiety about cancer, its possible progression, depression, anticipatory phenomena, and learned food adversions. Pre-existing psychiatric disorders, especially anorexia nervosa or paranoid states, can substantially complicate cancer treatment. Learned food aversions, which can further restrict limited intake, have been demonstrated in children receiving chemotherapy and may also contribute to aversions of specific foods seen among adult patients after chemotherapy or radiation. Regardless of etiology, psychological management of the anorexia is often helpful. Optimal management often involves use of a combination of modalities: psychotherapeutic, behavioral and/or pharmacologic supplemented by education, counseling and support. Behavioral techniques such as relaxation exercises are useful tools to alter this response as well as to relieve the anxiety precipitated by the patient's concerns about anorexia and weight loss. Environmental interventions and nutritional advice can also be of considerable value in reversing the negative effects of this distressing symptom in cancer.

Nutritional support of cancer patients

The maintenance of nutritional status in cancer patients is a critical part of the overall care. The cachetic, malnourished patient represents a compromised host that may be less responsive to aggressive antitumor therapy. Assessment and monitoring of nutritional status should begin as soon as the diagnosis is made, as maintenance of good nutritional standing is far easier and less expensive than rehabilitating a depleted patient.

Nursing management of diabetic peripheral neuropathies

This article provides a brief description of each of the diabetic peripheral neuropathies. Each distinct peripheral neuropathy is discussed in terms of its incidence, symptomatology, physical signs, medical management, and prognosis. Then Leavell and Clark's Levels of Prevention is used as a framework for nursing intervention for the patient with diabetic peripheral neuropathies. Nursing intervention includes health promotion and specific protection, early diagnosis and prompt treatment, and rehabilitation.

[Whipple's disease: an important differential diagnosis in polyarthritis and fever]

Whipple's disease is frequently recognised only after numerous diagnostic sidetracks. As demonstrated by four patients polyarthritis and fever are characteristic early symptoms for many years. Early consideration of this differential diagnosis and subsequent small intestinal biopsy permit early diagnosis of the disease. Intermittent or long-term antibiotic treatment successfully removes intestinal marasmus and its accompanying symptoms.

Diabetic neuropathic cachexia. Report of a woman with this syndrome and review of the literature

A 64-year-old woman was admitted to the neurology service complaining of lower extremity weakness and pain. She was found to have lost more than 180 kg in a 2 1/2-year period. In addition, she had mild diabetes. A diagnosis of diabetic neuropathic cachexia was made. Not only is this case remarkable for the massive weight loss, but, to our knowledge, this is the first report of this syndrome in a woman.

Thyroid failure and protirelin (thyrotropin-releasing hormone) test abnormalities in depressed outpatients

Forty-four consecutive outpatients referred to a psychiatric hospital for evaluation of depression and anergia were assessed by means of the protirelin (thyrotropin-releasing hormone) test. Nineteen patients (43%) had a blunted thyrotropin (TSH) response to protirelin, while six patients (13.5%) had augmented TSH responses indicating some degree of hypothyroidism. One patient had a low thyroxine level, while three patients had elevated basal TSH levels. Five of the six patients with augmented TSH responses were found to have antithyroid antibodies. These results suggest that a majority of depressed outpatients have abnormalities on the protirelin test and that the TSH response to protirelin is useful in both confirming a diagnosis of major depression and assessing thyroid status.

[Acquired agammaglobulinaemia with predominantly intestinal symptoms (author's transl)]

In a 45-year-old female patient primary acquired agammaglobulinaemia was diagnosed. Intestinal symptoms predominated. The disease was characterized by a B-cell defect. Substitution with gamma-globulin (Beriglobin) practically cured the symptoms. The pathogenesis of the disease remains unexplained.

[The differential diagnosis of anorexia nervosa. Coincidence of somatic disease and psychogenic emaciation (author's transl)]

Three female patients with cachexia are reported in whom a psychogenic emaciation (anorexia nervosa) had been assumed. The postpubertal onset of the disease, deliberate limitation of diet, vomiting and subsequent emaciation and--in 2 patients--amenorrhea, as well as demonstrable experience of conflict supported this. The disease ran a lethal course. Autopsy revealed serious somatic diseases (stenosis of the ileum in two cases and brain tumor in one); their symptoms had been largely overlapped by those of anorexia nervosa.

Diabetic neuropathic cachexia

Six patients with diabetic neuropathy are reported who conform to a hitherto undescribed syndrome. The two outstanding symptoms, namely profound weight loss and severe pain, led to the admitting diagnosis of metastatic carcinoma or carcinomatous neuropathy in each case. The patients were all males, chiefly in the sixth decade of life, had bilateral symmetrical peripheral neuropathy, severe emotional disturbances, anorexia, impotence, mild diabetes, simultaneous onset of neuropathy and diabetes, absence of other specific diabetic complications and a uniformly spontaneous recovery in about one year. Because of the cachectic appearance, the term ‘diabetic neuropathic cachexia’ is suggested.