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Kidd AC, Skrzypski M, Jamal-Hanjani M, Blyth KG. Cancer cachexia in thoracic malignancy: a narrative review. Curr Opin Support Palliat Care 2019; 13:316-322. [PMID: 31592847 DOI: 10.1097/spc.0000000000000465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Thoracic malignancies are amongst the most lethal of all cancers. Cancer cachexia lacks unanimously accepted diagnostic criteria, and therefore is referenced to as a conceptual framework whereby cancer cachexia is 'an ongoing loss of skeletal muscle mass (termed sarcopenia), with or without loss of fat mass that cannot be reversed by conventional nutritional support and leads to progressive functional impairment'. This review summarises the current evidence base in this field, including imaging techniques currently used to define sarcopenia, inflammatory and metabolic changes associated with the syndrome and ongoing research into potential treatment strategies. RECENT FINDINGS Sarcopenia is a key component of the cancer cachexia syndrome. It is common in patients with both early-stage and advanced NSCLC. Patients with sarcopenia have more treatment-related side effects and poorer overall survival compared with nonsarcopenic patients. SUMMARY Early identification of cancer cachexia may facilitate stratification of patients most-at-risk and initiation of emerging anticachexia treatments. If these are proven to be effective, this strategy has the potential to improve tolerance to anti-cancer therapies, improving the quality of life, and perhaps the survival, of patients with thoracic malignancies.
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Affiliation(s)
- Andrew C Kidd
- Institute of Immunity, Infection and Inflammation, University of Glasgow
- Queen Elizabeth University Hospital, Glasgow
| | - Marcin Skrzypski
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Kevin G Blyth
- Institute of Immunity, Infection and Inflammation, University of Glasgow
- Queen Elizabeth University Hospital, Glasgow
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Ravera E, Bozzetti F, Ammatuna M, Radaelli G. Impact of Hospitalization on the Nutritional Status of Cancer Patients. TUMORI JOURNAL 2018; 73:375-80. [PMID: 3660476 DOI: 10.1177/030089168707300410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was undertaken to examine the influence of hospitalization on the nutritional status of cancer patients. We examined 126 patients consecutively admitted to the Istituto Nazionale Tumori of Milan. At admission, all patients underwent standard evaluations, including actual weight, percentage weight loss, arm circumference, triceps skinfold, serum proteins, serum albumin, total iron binding capacity, cholinesterase and peripheral lymphocytes. Finally, from all patients a 24-h dietary recall was obtained, in order to calculate calorie and protein intake. All the patients underwent another evaluation after 1 week of hospitalization; after 2 weeks only 37 of them were evaluated again, since some were operated, some were treated with radio-chemotherapy, some were discharged or had died. Results showed that after one week of hospitalization some variables were significantly altered, such as arm circumference in male patients, serum proteins, cholinesterase, total iron binding capacity, peripheral lymphocytes, calorie and protein intake. A significant weight loss was seen after 2 weeks. The reduced calorie and protein assumption was correlated with depletion of some of the nutritional variables (body weight, arm circumference in males, total iron binding capacity, serum albumin, cholinesterase, lymphocytes). Our data show that hospitalization plays an important role in deterioration of nutritional status in our patient population, and this problem is generally overlooked by the clinicians primarily involved in the care of cancer patients.
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Affiliation(s)
- E Ravera
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italia
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Collins J, Noble S, Chester J, Coles B, Byrne A. The assessment and impact of sarcopenia in lung cancer: a systematic literature review. BMJ Open 2014; 4:e003697. [PMID: 24384894 PMCID: PMC3902311 DOI: 10.1136/bmjopen-2013-003697] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES There is growing awareness of the relationship between sarcopenia (loss of muscle mass and function), and outcomes in cancer, making it a potential target for future therapies. In order to inform future research and practice, we undertook a systematic review of factors associated with loss of muscle mass, and the relationship between muscle function and muscle mass in lung cancer, a common condition associated with poor outcomes. DESIGN We conducted a computerised systematic literature search on five databases. Studies were included if they explored muscle mass as an outcome measure in patients with lung cancer, and were published in English. SETTING Secondary care. PARTICIPANTS Patients with lung cancer. PRIMARY OUTCOME Factors associated with loss of muscle mass and muscle function, or sarcopenia, and the clinical impact thereof in patients with lung cancer. RESULTS We reviewed 5726 citations, and 35 articles were selected for analysis. Sarcopenia, as defined by reduced muscle mass alone, was found to be very prevalent in patients with lung cancer, regardless of body mass index, and where present was associated with poorer functional status and overall survival. There were diverse studies exploring molecular and metabolic factors in the development of loss of muscle mass; however, the precise mechanisms that contribute to sarcopenia and cachexia remain uncertain. The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results. There are very limited data on the correlation between degree of sarcopenia and muscle function, which has a non-linear relationship in older non-cancer populations. CONCLUSIONS Loss of muscle mass is a significant contributor to morbidity in patients with lung cancer. Loss of muscle mass and function may predate clinically overt cachexia, underlining the importance of evaluating sarcopenia, rather than weight loss alone. Understanding this relationship and its associated factors will provide opportunities for focused intervention to improve clinical outcomes.
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Affiliation(s)
| | - Simon Noble
- Department of Palliative Medicine, Cardiff University, Cardiff, South Wales, UK
| | - John Chester
- Department of Medical Oncology, Cardiff University, Cardiff, South Wales, UK
| | - Bernadette Coles
- Cancer Research Wales Library, Velindre NHS Trust, Cardiff, South Wales, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, South Wales, UK
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Cenik BK, Sun H, Gerber DE. Impact of renal function on treatment options and outcomes in advanced non-small cell lung cancer. Lung Cancer 2013; 80:326-32. [PMID: 23499397 PMCID: PMC3646907 DOI: 10.1016/j.lungcan.2013.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/18/2013] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Certain chemotherapeutic agents commonly used for advanced non-small cell lung cancer (NSCLC) require minimum threshold renal function for administration. To determine how such requirements affect treatment options, we evaluated renal function patterns in this population. METHODS We performed a single-center retrospective analysis of patients treated for stage IV NSCLC from 2000 to 2007. Associations between patient characteristics, calculated creatinine clearance (CrCl), and clinical outcomes were determined using univariate and multivariate analyses, Cox proportional hazard models, and mixed model analysis. RESULTS 298 patients (3930 creatinine measurements) were included in the analysis. Patients had a median of 5 (interquartile range [IQR] 4-18) Cr measurements. Median baseline CrCl was 96 mL/min (IQR 74-123 mL/min); median nadir CrCl was 78 mL/min (IQR 56-100mL/min). Renal function was associated with age (P<0.001), race (P=0.009), and gender (P=0.001). 23% of patients had a recorded CrCl<60 mL/min (threshold for cisplatin), with median onset 83 days after diagnosis and median time to recover to ≥60 mL/min of 27 (IQR 3-85) days; 11% of patients had a recorded CrCl<45 mL/min (threshold for pemetrexed), with median onset 122 days after diagnosis and median recovery time of 36 (IQR 3-73) days. For both thresholds, approximately 35% of patients had no documented recovery. CONCLUSIONS In this cohort of patients treated for stage IV NSCLC, renal function falls below commonly used thresholds for cisplatin and for pemetrexed in fewer than a quarter of patients. However, these declines may preclude administration of these drugs for prolonged periods.
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Affiliation(s)
- Bercin Kutluk Cenik
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center Dallas, Texas
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center Dallas, Texas
| | - Han Sun
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center Dallas, Texas
- Department of Clinical Sciences, University of Texas Southwestern Medical Center Dallas, Texas
| | - David E. Gerber
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center Dallas, Texas
- Department of Internal Medicine (Division of Hematology-Oncology) University of Texas Southwestern Medical Center Dallas, Texas
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Consensus on the utility of bone markers in the malignant bone disease setting. Crit Rev Oncol Hematol 2011; 80:411-32. [PMID: 21411334 DOI: 10.1016/j.critrevonc.2011.02.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 02/09/2011] [Accepted: 02/17/2011] [Indexed: 01/23/2023] Open
Abstract
Biochemical markers of bone turnover provide insight into ongoing rates of skeletal metabolism and tumor-bone interactions in patients with malignant bone disease. This article reviews the available recent evidence assessing the potential of bone markers for detecting and monitoring malignant bone lesions in patients with advanced cancers, and for assessing overall skeletal health and response to antiresorptive therapies in patients at all stages of cancer progression. Most data thus far are for urinary N-terminal cross-linked telopeptide of type I collagen (NTX) in predicting risks of skeletal morbidity and death and monitoring response to zoledronic acid in patients with bone metastases. Ongoing studies are evaluating such correlations for other markers and therapies. Emerging evidence suggests that bone markers may help identify patients at high risk for bone metastasis or bone lesion progression, thereby allowing improved follow-up. Results from ongoing clinical trials evaluating such potential applications of bone markers are awaited.
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Yavuzsen T, Walsh D, Davis MP, Kirkova J, Jin T, LeGrand S, Lagman R, Bicanovsky L, Estfan B, Cheema B, Haddad A. Components of the anorexia–cachexia syndrome: gastrointestinal symptom correlates of cancer anorexia. Support Care Cancer 2009; 17:1531-41. [DOI: 10.1007/s00520-009-0623-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 03/22/2009] [Indexed: 11/25/2022]
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Konsman JP, Blomqvist A. Forebrain patterns of c-Fos and FosB induction during cancer-associated anorexia-cachexia in rat. Eur J Neurosci 2005; 21:2752-66. [PMID: 15926923 DOI: 10.1111/j.1460-9568.2005.04102.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Forebrain structures are necessary for the initiation of food intake and its coupling to energy expenditure. The cancer-related anorexia-cachexia syndrome is typified by a prolonged increase in metabolic rate resulting in body weight loss which, paradoxically, is accompanied by reduced food intake. The aim of the present work was to study the forebrain expression of Fos proteins as activation markers and thus to identify potential neurobiological mechanisms favouring catabolic processes or modulating food intake in rats suffering from cancer-related anorexia-cachexia. Neurons in forebrain structures showing most pronounced induction of Fos proteins were further identified neurochemically. To provoke anorexia-cachexia, cultured Morris hepatoma 7777 cells were injected subcutaneously in Buffalo rats. This resulted in a slowly growing tumour inducing approximately 7% body weight loss and a 20% reduction in food intake when the tumour represented 1-2% of body mass. Anorexia-cachexia in these animals was found to be accompanied by Fos induction in several hypothalamic nuclei including the paraventricular and ventromedial hypothalamus, in the parastrial nucleus, the amygdala, the bed nucleus of the stria terminalis, ventral striatal structures and the piriform and somatosensory cortices. Neurochemical identification revealed that the vast majority of FosB-positive neurons in the nucleus accumbens, ventral caudate-putamen and other ventral striatal structures contained prodynorphin or proenkephalin mRNA. These findings indicate that forebrain structures that are part of neuronal networks modulating catabolic pathways and food ingestion are activated during tumour-associated anorexia-cachexia and may contribute to the lack of compensatory eating in response to weight loss characterizing this syndrome.
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Affiliation(s)
- Jan Pieter Konsman
- Department of Cell Biology, Faculty of Health Sciences, University of Linköping, S-581 85 Linköping, Sweden.
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Paillaud E, Bories PN, Aita SL, Scherman E, Jeanfaivre V, Lejonc JL, Campillo B. Prognostic value of dietary intake and inflammation on survival in patients with advanced cancer: relationship with performance status, pain, and digestive disorders. Nutr Cancer 2003; 45:30-5. [PMID: 12791502 DOI: 10.1207/s15327914nc4501_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Elena Paillaud
- Service de medecine interne Hopital Albert Chenevier, Assistance Publique Hopitaux de Paris, 40 Rue Mesly 94010 Creteil Cedex, France.
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Brown JK. A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia. Oncol Nurs Forum 2002; 29:517-32. [PMID: 11979284 DOI: 10.1188/02.onf.517-532] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate and synthesize the evidence regarding cancer-related anorexia and cachexia symptom management and make recommendations for future directions. DATA SOURCES Cochrane Library, MEDLINE, CANCERLIT, CINAHL, Dissertation Abstracts, EBM Reviews--Best Evidence, EMBASE, and the Computer Retrieval of Information on Scientific Projects. Current overviews, clinical trials, systematic research reviews, and meta-analyses. DATA SYNTHESIS All studies focused on increasing food intake. Nonpharmacologic clinical trials increased caloric and protein intake but resulted in no improvement in nutritional status, weight, tumor response, survival, or quality of life. Weight, appetite, and well-being were improved with megestrol acetate, but nutritional status was not improved. Some exercise studies demonstrated improvements in nutrition-related outcomes, but these were not primary research outcomes. CONCLUSIONS Symptom management of anorexia and cachexia should focus on decreasing energy expenditure or minimizing factors creating a negative energy balance, as well as improving food intake. Increased measurement sensitivity also is needed. IMPLICATIONS FOR NURSING Improved nutritional assessment skills are needed with an emphasis on anticipated problems and current status.
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Affiliation(s)
- Jean K Brown
- University of Buffalo, State University of New York, NY, USA.
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Abstract
OBJECTIVES To examine the psychosocial issues related to lung cancer with a specific focus on women and quality of life. To review the role of behavioral medicine as an approach to treatment, including individual, family, and group interventions. DATA SOURCES Review articles, book chapters, and research studies pertaining to the psychosocial issues encountered by patients with lung cancer and behavioral medicine interventions. CONCLUSIONS Behavioral interventions, used in addition to medical treatment, have been shown to reduce the nausea and vomiting associated with chemotherapy, decrease suffering from pain, and diminish anxiety associated with dyspnea. These mind/body approaches help to reduce emotional distress, promote improved quality of life, enhanced coping, a sense of control, and hopefulness. IMPLICATIONS FOR NURSING PRACTICE Nurses can play an active role in helping patient's and family members learn new coping skills that will help promote a sense of competence, control, and support. Relaxation, mediation, distraction, social support, and cognitive therapies are a few of the interventions to help enrich the lives of patients and their families.
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Affiliation(s)
- L S Ryan
- Cape Psych Center, Cape Cod Hospital, Hyannis, MA, USA
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Sarna L, Lindsey AM, Dean H, Brecht ML, McCorkle R. Weight change and lung cancer: relationships with symptom distress, functional status, and smoking. Res Nurs Health 1994; 17:371-9. [PMID: 8090948 DOI: 10.1002/nur.4770170508] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The pattern of weight change (at five 6-week intervals beginning 2 months after diagnosis of advanced disease) is described in adults with progressive lung cancer (N = 60). Weight loss of 10% or more at study entry occurred in 35% of subjects; 37% lost weight at three or more intervals; and 25% lost weight at only one interval. Pre-illness weight loss was moderately correlated with subsequent decreased functional status (Enforced Social Dependency Scale) at Times 1, 2, and 3 (r = -.49, r = -.43, r = -.48, p < .001). Weight loss correlated with subsequent increased symptom distress (Symptom Distress Scale, SDS) at three times (Times 2, 4, and 5: r = -.34, r = -.30, r = -.43, p < .05). Chemotherapy (50% of subjects) and smoking (25% at study entry) predicted weight loss from Time 1 to 5, explaining 28% of the variance.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/epidemiology
- Adenocarcinoma/physiopathology
- Adult
- Aged
- Aged, 80 and over
- Analysis of Variance
- Carcinoma, Large Cell/drug therapy
- Carcinoma, Large Cell/epidemiology
- Carcinoma, Large Cell/physiopathology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/epidemiology
- Carcinoma, Non-Small-Cell Lung/physiopathology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/physiopathology
- Comorbidity
- Female
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/epidemiology
- Lung Neoplasms/physiopathology
- Male
- Middle Aged
- Prognosis
- Smoking/epidemiology
- Smoking/physiopathology
- Time Factors
- Weight Gain
- Weight Loss
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Affiliation(s)
- L Sarna
- School of Nursing, University of California, Los Angeles 90024-6918
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Ovesen L, Hannibal J, Mortensen EL. The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast, and ovary. Nutr Cancer 1993; 19:159-67. [PMID: 8502586 DOI: 10.1080/01635589309514246] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
One hundred four consecutive patients with newly diagnosed small cell lung cancer, metastatic breast cancer, and ovarian cancer in good physical functional condition (performance rating 0-1 on Eastern Cooperative Oncology Group scale) were divided into a weight-losing group (> or = 5% unintentional weight loss within 3 mo; n = 48) and a weight-stable group (n = 56). Dietary intakes in relation to fat-free mass were not different in the two groups. According to the Quality of Life index and the General Health Questionnaire, weight-losing patients had significantly lower quality of life than weight-stable patients. In patients with weight loss, daily intakes of energy and protein correlated significantly with scores on the General Health Questionnaire. This study has shown that many ambulatory cancer patients do not eat enough to maintain weight and that even a moderate weight loss is associated with psychological distress and lower quality of life.
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Affiliation(s)
- L Ovesen
- Division of Nutrition and Food Chemistry, National Food Agency, Søborg, Denmark
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Armes PJ, Plant HJ, Allbright A, Silverstone T, Slevin ML. A study to investigate the incidence of early satiety in patients with advanced cancer. Br J Cancer 1992; 65:481-4. [PMID: 1558808 PMCID: PMC1977596 DOI: 10.1038/bjc.1992.98] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- P J Armes
- Imperial Cancer Research Fund, Department of Medical Oncology, St Bartholomew's Hospital, London
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Lindsey AM, Piper BF. Anorexia, serum zinc, and immunologic response in small cell lung cancer patients receiving chemotherapy and prophylactic cranial radiotherapy. Nutr Cancer 1986; 8:231-8. [PMID: 3022247 DOI: 10.1080/01635588609513899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Anorexia is a major clinical problem for patients with certain types of cancer. The specific mechanisms that result in this spontaneous decline in food intake remain unknown. In noncancer populations, zinc has been shown to play a role in maintaining normal appetite, taste acuity, and immunocompetence. One purpose of this prospective, longitudinal study of cachexia in ten males with small cell lung carcinoma was to determine if anorexia (caloric intake), perceived taste changes, zinc intake, and impaired cellular immunity were associated with serum zinc concentrations. The average daily caloric intake declined 490 kcal from time of diagnosis to seven months after diagnosis (mean caloric intake = 72% of RDA). Daily zinc intake ranged from 6.5 to 25.4 mg over the seven months. During this period, the mean serum zinc concentrations, although low (71 micrograms/dl), remained within the normal range. The average weight declined from 81.7 to 74.1 kg. There was no identifiable pattern of perceived taste changes; most of the perceived changes were recorded during the period coinciding with prophylactic cranial radiation. At the initial testing, four of nine subjects were anergic to a battery of skin test antigens (mumps, candida, tuberculin purified protein derivative). The only subject who remained responsive to two antigens throughout the study remained alive at 12 months. Caloric intake was inadequate to maintain weight. While zinc intake was low, low normal serum zinc concentrations were maintained; thus in this sample, serum zinc does not appear to be the anorexigenic factor.
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