Cancer-related anorexia/weight-loss syndrome, commonly experienced by patients with advanced incurable cancer, is characterized by general weight loss and muscle wasting, loss of appetite, overall decline in quality of life, and shortened survival. Most patients with advanced cancer develop this syndrome at some point during the course of their disease.
The approach to managing patients with cancer anorexia/weight-loss syndrome has improved dramatically over the past 50 years. A 1955 article described efforts to force-feed a cohort of 64 “terminal cancer patients” with various advanced malignancies, including cancer of the cervix, colon, stomach, pancreas, and breast. Study participants were subjected to nasogastric tube feedings. The investigators described how “many who were bedfast in the hospital were temporarily restored to family living without special care.” Even so, the investigators were not able to determine whether the patients' length of life was extended or shortened, further noting that “tumors that were palpable or visible seemed to increase in size…” Today, force-feeding patients with advanced, incurable cancer is viewed as ineffective and is almost obsolete. Despite progress in the management of cancer-related anorexia/weight-loss syndrome, however, many aspects of this syndrome continue to be vexing from a clinical and research perspective.
This chapter outlines areas of progress and ongoing challenge. We address: (1) the clinical significance of cancer anorexia/weight-loss syndrome; (2) the current thinking on its pathophysiology; (3) current treatment approaches; and (4) recent inconsistencies between translational and clinical research, all of which underscore the need for avid, continued clinical investigation.