1 / 15

The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

TM. The EPEC-O Project Education in Palliative and End-of-life Care - Oncology. The EPEC TM -O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

nixie
Download Presentation

The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPECTM-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC– Oncology Education in Palliative and End-of-life Care – Oncology Module 3b: Symptoms – Anorexia / Cachexia

  3. Anorexia / Cachexia . . . Cachexia – wasting syndrome • Decreased lean tissue • Diminished performance status • Altered resting energy expenditure • Diminished appetite

  4. . . . Anorexia / Cachexia

  5. Anorexia / Cachexia Epidemiology in cancer: • Incidence varies with site • Incidence increases with stage

  6. Anorexia / Cachexia Impact: • ≥ 5% weight loss associated with poor prognosis • Trend toward lower chemotherapy response rates • Anorexia associated with poor prognosis • Diminished function and quality of life • Adversely affects caregivers MacDonald N, et al. J Am Coll Surg. 2003. Dewys WD, et al. Am J Med. 1980. Loprinzi CL, et al. JCO. 1994.

  7. Key points • Pathophysiology • Assessment • Management

  8. Pathophysiology • Chronic inflammation • Metabolic changes • Lipolytic / proteolytic substances • Hormonal changes • Role of neurotransmitters • Cytokine impact on hypothalamus Todorov P, et al. Nature. 1996. Todorov P, et al. Cancer Research. 1998. Zigman JM, et al. Endocrinology. 2003. Balkwill F, et al. Lancet. 2001.

  9. Assessment • Appetite / weight loss history • Reversible causes • Physical signs of wasting • Biochemical markers • Radiographic studies as indicated

  10. … AssessmentReversible causes of weight loss: • Psychological factors • Mucositis • Nausea / vomiting • Constipation • Early satiety • Malabsorption • Pain • Endocrine • Comorbid conditions • Social / economic

  11. Management . . . • Treat comorbid conditions • Educate, support • Provide favorite foods / nutritional supplements / counseling • Treat reversible causes (e.g., early satiety, mucositis)

  12. Anorexia / cachexia:what does not work • Feeding (enteral or parenteral) ACP. Ann Int Med. 1989. Ovesen. J ClinOncol. 1993.

  13. Management of anorexia • Dexamethasone • Megestrol acetate • Tetrahydrocannabinol (THC) • Androgens Loprinzi CL, et al. JCO. 1999. VonRoenn JH, et al. ASCO. 2003. Moertel CG, et al. Cancer. 1974.

  14. Management of cachexia • Investigational • Anabolic steroids • Omega-3-fatty acids • Amino acids • NSAIDs • Multivitamins • Exercise Von Roenn JH, et al. ASCO. 2003. Jatoi A, et al. ASCO. 2003. Fearon KCH, et al. Gut. 2003. McMillan DC, et al. Br J Ca. 1999 .

  15. Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience.

More Related