Management

 

Pharmacological management: According to the Scottish palliative guidline for cachexia, the following treatment is recommeded:

 

Appetite stimulants

This includes corticosteroids and progestogens;

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 It is believed that appetite stimulants stimulate the hypothalamus to elevate levels of neuroeptide Y (NPY) which increases appetite and reduces energy expenditure. High levels of NPY decreases leptin and insulin which plays a role in suppression of food intake.

 

 

Corticosteroids include oral dexamethasone (4mg/day) or prednisolone (30mg

given in the morning.)

 

 

• Useful in encouraging appetite but little effect in helping to increase body mass.

•   Rapid onset but these medications are not intended for long term use due to the efficacy diminishing after 6-8 weeks of use and appearance of side effects

 such as muscle wasting, gastritis, fluid retention, insomnia, oral thrush (candiasis), adrenal suppression and steroid induced diabetes.

•  Gastroprotection should be considered such as proton pump inhibitor or histamine 2 receptor antagonist (omeprazole 20mg once daily) due to risks of gastritis.

•  However, in patients with advanced cancer they may not live long enough for the side effects to manifest. The lowest effective dose should be used and after administering for 1 week, the dose should be stepped down gradually to the lowest effective dose possible.

•  If however, there is no response to the use of corticosteroids then it should be stopped.