Symptoms of cachexia
Healthcare providers may use the term “cachectic” when talking about cachexia symptoms. Symptoms include:
- Unexplained weight loss: This is weight loss that happens when you aren’t trying to lose weight and even though you’re eating high-calorie meals. A healthcare provider may suspect you have cachexia if you’ve lost 5% or more of your weight within the past six to 12 months.
- Muscle loss: Healthcare providers may call this muscle wasting or muscle atrophy. In cachexia, your muscle mass decreases so your muscles appear smaller and aren’t as strong.
- Fatigue and weakness: Cachexia can make you feel exhausted and too tired to manage daily tasks. You may also feel like you don’t have the strength to move around as you would normally.
- Anorexia (loss of appetite): In anorexia, you don’t feel hungry and lose interest in eating at all. Anorexia in cachexia is different from the eating disorder anorexia nervosa.
Cachexia causes
In general, cachexia happens when there’s a disconnect between energy demand (your metabolism) and energy supply (food). The disconnect often happens because you’re very sick with a chronic medical condition like cancer or heart disease.
When you’re very sick, your metabolism speeds up as your immune system reacts to the disease, creating an ongoing demand for more energy from the food you eat. But the same condition that sparks your metabolism may affect your appetite.
Without an adequate energy supply from food, your body taps your muscles and fat to get more energy, so you lose muscle mass and weight.
The specific causes of cachexia include:
- Too many cytokines: Cytokines are proteins in your immune system. They manage how and when your immune cells react to intruders like viruses. In cachexia, extra cytokines cause inflammation that makes you lose fat and muscle.
- System-wide inflammation: Cancer and other chronic diseases cause inflammation that can lead to loss of fat and muscle.
- Insulin resistance: Insulin resistance is when your muscles and fat don’t react to insulin as they should. Insulin resistance in cachexia may increase muscle loss.
- Increased protein turnover: Protein turnover refers to the way new proteins replace older proteins in your cells. This happens through protein degradation (breaking down proteins). In cachexia, proteins in your cells break down too quickly to be replaced with new proteins. This leads to muscle loss.
What conditions cause cachexia?
Cachexia most often happens if you have cancer. Research shows 40% of people with cancer have the condition when they’re first diagnosed with cancer, and 70% of people with advanced or late-stage cancer have cachexia.
But people with other advanced chronic diseases may develop cachexia, such as:
- Congestive heart failure: Cardiac cachexia affects about 16% to 42% of people with congestive heart failure.
- Chronic obstructive pulmonary disease (COPD): About 27% to 35% of people with COPD also develop cachexia.
- Chronic kidney disease (CKD): Cachexia affects between 30% and 60% of people with CKD.
- Certain infectious diseases: Cachexia is a common complication of advanced acquired immune deficiency syndrome (AIDS). It affects between 10% and 35% of people with advanced AIDS. People with tuberculosis or malaria may also develop cachexia.
- Chronic inflammatory diseases: Between 18% and 67% of people with rheumatoid arthritis develop cachexia.
Complications of cachexia
Cachexia can be life-threatening. For example, this condition accounts for 20% of all cancer-related deaths. The muscle loss it causes can affect your heart and your ability to breathe.
In general, a cachexia diagnosis often means the end of life is near. That’s understandably hard news for someone with the condition and for the people who love them. A cachexia diagnosis often causes mental health concerns like anxiety and depression.
Weight loss from cachexia changes your appearance, which may make you feel self-conscious. It makes you weak and affects your ability to take care of yourself.
Research shows cachexia may create tension between those with the condition and the people who care for them. If someone you love has cachexia, you may feel as if you’re watching them waste away as they lose weight, muscle and their independence.
In some cases, caregivers see encouraging people to eat as a way to slow the end-of-life process. They become frustrated and upset when their loved one refuses to eat. Tension about eating can make social interactions upsetting. For example, people who are near the end of life may pretend to be asleep during visits with family and friends so that their visitors don’t try to make them eat.
FAQs
While cancer cachexia typically affects people with advanced cancer, you can develop pre-cachexia symptoms at any cancer stage. In that case, you may live for years with cancer and complications like cachexia. But research suggests that having refractory cancer cachexia reduces cancer survival rates by 30%.
Is there any way to stop cachexia? ›
People with cachexia lose muscle and often fat as well. Cachexia is very different to general weight loss. Doctors can't reverse it fully despite you being able to eat. Feeding through a tube is not effective either.
Can a person survive cachexia? ›
The survival rate of cachexia can vary depending on the cause. Progressive cachexia is often a sign of poor prognosis and a relatively shorter survival time. The amount and rate of weight loss and survival time are directly related to the survival time of the underlying condition in people with HIV, cancer, and more.
What is life expectancy with cardiac cachexia? ›
The prognosis for cardiac cachexia isn't good. About 50% of people who have the condition die in 18 months. Some people only survive three, six or 12 months, according to one study.
What does someone with cachexia look like? ›
Clinically, cachexia manifests as asthenia; anorexia; early satiety; nausea; taste change; significant loss of body fat, muscle, and other components; anemia; and hormonal aberration. The patients affected appear chronically ill and emaciated. The patient may be normothermic, febrile, or hypothermic.
Is cancer cachexia fatal? ›
Cancer-related cachexia, the main cause of death in 22–30% of cancer patients, is still a poorly diagnosed condition [1]. It affects up to 74% of cancer patients, being directly responsible for 20–30% of cancer deaths [5].
What triggers cachexia? ›
Cachexia is characterized by a persistent increase in basal metabolic rate that is not compensated by increased caloric/protein intake. Factors involved in this abnormal metabolic cascade include digestive factors, tumor factors and hormonal responses to the primary disease.
What does cachexia do to the brain? ›
The brain. Inflammatory cytokines released from tumours can infiltrate the brain, where they interfere with the levels of hormones responsible for appetite. It causes people with cachexia to not feel hungry despite burning through so much energy.
How long can you live with muscle wasting disease? ›
The average lifespan for duch*enne muscular dystrophy is 18 to 25 years. With early treatment, it can reach 30 years. But recent technological advances have made it possible to improve treatment.
What is the end of life muscle wasting? ›
Cachexia can be life-threatening. For example, this condition accounts for 20% of all cancer-related deaths. The muscle loss it causes can affect your heart and your ability to breathe. In general, a cachexia diagnosis often means the end of life is near.
How is cancer cachexia diagnosed? Blood tests may be used to check for inflammation. The tests may also be used to check for anemia (not enough red blood cells), or for low protein or electrolyte levels. Blood tests can also show if you have insulin resistance (your body cannot use insulin easily).
How much weight loss is considered cardiac cachexia? ›
Cardiac cachexia definition
proposed that cardiac cachexia should be diagnosed when body weight loss is > 6% regardless of other criteria and in the absence of other severe diseases. More recently, investigators have used a body weight loss cutoff > 5% to characterize cardiac cachexia.
At what stage of cancer do you lose weight? ›
The majority of cancer patients lose weight at some point in the course of the disease. Weight is sometimes the sign that leads someone to get diagnosed with cancer, but it may occur at any time, such as during treatment or in the advanced stages of the disease. The patient's eating habits may change.
What is the staging of cachexia? ›
Researchers have also developed a cachexia staging score (CSS) for advanced cancer patients consisting of five components in order to clarify the three-level staging system (13): Weight loss in 6 months (score range, 0–3); A simple SARC-F questionnaire assessing muscle function and sarcopenia (score range, 0–3);
What is the criteria for cachexia in cancer patients? ›
Definitions of cachexia
According to Fearon et al a patient could be diagnosed with cachexia based on one out of three weight loss definitions: weight loss of at least 5% during the past 6 months in the absence of simple starvation or weight loss of at least 2% together with either a BMI<20 kg/m2 or sarcopenia.
What is the hallmark of cancer cachexia? ›
Cancer cachexia is a multifactorial syndrome, characterized by weight loss due to skeletal muscle and adipose tissue (AT) depletion, and is associated with high resting energy expenditure (REE), progressive functional impairment, poor quality of life and survixval (1,2).
