Management of Cancer Cachexia: ASCO Guideline
- Study type
- Clinical guideline
- Study name
- ASCO Cancer Cachexia 2020
- Design
- Clinical practice guideline based on a systematic review of the literature (randomised controlled trials and their systematic reviews) and consensus of an ASCO expert panel
- Sample size
- 20 systematic reviews and 13 additional randomised controlled trials (RCTs)
- Source
- JCO · 2020
In plain words
Cancer cachexia means weight loss and muscle weakness with loss of appetite in people with advanced cancer. This guideline says that advice on nutrition for patients and their carers can help, but feeding tubes or nutrition through a vein should not be used routinely. No medicine has yet been approved as the standard treatment for cachexia; but if the doctor wants to try a medicine for appetite or weight, they can use progesterone-like medicines or corticosteroids for a few weeks. Always make the final decision with your treating doctor.
Key points
Key guideline recommendations
- Level and strength of recommendation in the full guideline
Dietary counselling may be offered with the goal of providing patients and caregivers with advice on managing cachexia.
- Level and strength of recommendation in the full guideline
Enteral feeding tubes and parenteral nutrition should not be used routinely.
- Level and strength of recommendation in the full guideline
In the absence of stronger evidence, no specific pharmacological intervention can be recommended as standard of care; clinicians may therefore choose not to prescribe a drug specifically for the treatment of cancer cachexia.
- Level and strength of recommendation in the full guideline
When a decision is made to try a drug to improve appetite and/or increase weight, the available pharmacological interventions that may be used include progesterone analogues and short-term corticosteroids (a few weeks).
Study population
Adult patients with advanced cancer who have cancer cachexia.
Endpoints
This guideline reviewed the evidence on nutritional, pharmacological and other interventions (such as exercise) for cancer cachexia. According to the abstract, the outcomes of interest included appetite and/or body weight. Details of other outcomes are given in the full guideline.
Safety and side effects
The guideline abstract gives no data on adverse events of the interventions; see the full guideline for details.
Clinical significance and place in guidelines
This ASCO guideline states that dietary counselling may be offered, enteral tube feeding and parenteral nutrition should not be used routinely, and no drug is recommended as standard of care for cachexia. If a drug trial for appetite and/or weight is decided on, progesterone analogues and short-term corticosteroids are the available options. As this guideline was published in 2020, the status of later guideline updates and of new drugs should be checked separately.
Limitations
Limitations of the evidence include high attrition rates (consistent with advanced cancer) and heterogeneity between studies in the outcomes of interest and methods of outcome assessment. Evidence on dietary counselling is also limited.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.