How does cachexia influence survival in cancer, heart failure and other chronic diseases?

PURPOSE OF REVIEW: Metabolic, immunological and neurohormonal disturbances, body wasting, and poor patient performance frequently accompany chronic disease. Ultimately, cachexia may develop in 10-15% of patients, who usually perish soon after. We currently have neither a globally accepted definition of cachexia nor any treatment to prevent or treat cachexia.

RECENT FINDINGS: Cachexia remains an unresolved issue in modern medicine. Despite its significant prevalence and poor prognosis, debate on the global definition of cachexia continues. We require a clinical definition, which should include the significant weight loss and its dynamics. There is accumulating evidence that various chronic diseases share pathophysiological mechanisms that lead to wasting and ultimately cachexia. Reversal of traditional cardiovascular risk factors is of value not only in chronic heart failure but also in chronic kidney disease and chronic obstructive pulmonary disease.

SUMMARY: Future trials to improve prognosis in patients with cachexia will require a global definition of cachexia and identification of key underlying mechanisms. Results with neurohormonal antagonists are intriguing, and clinical use of these agents would be feasible. While searching for treatments for full-blown cachexia, we should also aim to identify treatments directed at the causes in order to prevent its development.