abstract: Inflammation in cancer cachexia: To resolve or not to resolve (is that the question?)

Inflammation in cancer cachexia: To resolve or not to resolve (is that the question?)

Abstract

Background & aims
Cachexia is associated with poor prognosis and shortened survival in cancer patients. Growing evidence points out to the importance of chronic systemic inflammation in the aetiology of this syndrome. In the recent past, chronic inflammation was considered to result from overexpression and release of pro-inflammatory factors. However, this conception is now the focus of debate, since the importance of a crescent number of pro-resolving agents in the dissolution of inflammation is now recognised – leading to the hypothesis that chronic inflammation occurs rather due to failure in the resolution process. We intend to put forward the possibility that this may also be occurring in cancer cachexia.

Methods
Recent reviews on inflammation and cachexia, and on the factors involved in the resolution of inflammation are discussed.

Results
The available information suggests that indeed, inflammation resolution failure may be present in cachexia and therefore we speculate on possible mechanisms.

Conclusions
We emphasise the importance of studying resolution-related mechanisms in cancer cachexia and propose the opening of a new venue for cachexia treatment.

open access: JNCI - Commentary Improved Outcomes in the Malnourished Patient: We’re Not There Yet

".......By outlining the limitations, the authors provide direction for future researchers. A key point made by the authors is that despite the statistical significance of some aspects of QOL, it is unclear how meaningful these changes are to the patient. The challenge that researchers face is explaining how improved emotional well-being resulted from taking an oral nutritional supplement and/or receiving dietary counseling. Was the improvement from the nutritional counseling, the supplement, the combination, or the extra attention to and clinical involvement with the patient....."

"....Nutritional supplements may indeed improve outcomes for some patients experiencing malnutrition but not cachexia. Dietary counseling may be beneficial for patients at high risk for malnutrition and their caregivers. However, the research conducted to date is fraught with limitations; hence, it is challenging for clinicians to apply these results to everyday practice."

open access: The nutritional risk in oncology: a study of 1,453 cancer outpatients

 "In 2003, during a scientific meeting in Milan, which involved both oncologists and nutritionists, it was clearly appreciated that there was a substantial discrepancy of view between these specialists as regard the impact that malnutrition might have on the outcome of the cancer patient and the potential role of the nutritional support. As a consequence, an open working group was constituted with the aim of steering a protocol to prospectively screen the nutritional status of the oncologic outpatients (hence the acronym SCRINIO, that is SCReenIng the Nutritional status In Oncology)."


"...Such a percentage of nutritionally at risk outpatients is especially remarkable and worrisome when considering that patients able to attend an ambulatory consultation or therapy should represent a favourably selected segment of the cancer population..."

Table 1 Patient distribution according to demographic and disease characteristics
Table 2 Mean NRS score and percentage of patients with nutritional risk (NRS score ≥3), according to main patients’ characteristics
Table 3 Frequency of patients at nutritional risk (NRS score ≥3), estimated by the multivariable logistic model

Canadian Health Reference Guide: Heavy lifting for cancer research Increasing muscle mass can enhance quality of life

Blogger's Note:  sometimes when we think research is stupid - well, it just is - opinion of which is based obviously on the limited information available here


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“Although many cancer patients are in a palliative care situation, we want to maintain their quality of life as much as possible,” says co-author Antonio Vigano, a palliative care physician at the MUHC. “Participation would be high because activity gives patients control over their situation — control they feel they’ve lost. In addition we know there are other positive benefits to exercise, such as increased appetite.”

Partners in research:
This work was supported by the Canada Foundation for Innovation, the Canadian Institutes of Health Research, the Research Institute of the MUHC, the Fonds de recherche du Québec - Santé, and the Canadian Hypertension Society.

A randomized phase III clinical trial of a combined treatment for cachexia in patients with gynecological cancers: Evaluating the impact on metabolic and inflammatory profiles and quality of life

Objectives

Gynecological neoplastic disease progression is characterized by specific energy metabolism alterations and by symptoms including fatigue, anorexia, nausea, anemia, and immunodepression, which result in a cachexia syndrome and a marked decrease in patient quality of life (QoL). Therapeutic protocols associated with appropriate and effective psychological and social support systems are essential to counteract the symptoms of neoplastic disease in incurable patients.

Highlights

► Progression of gynecological cancers is characterized by specific alterations of energy metabolism and symptoms that impact quality of life.
► We compared a combined versus a single-agent approach for the treatment of advanced gynecological cancer-associated symptoms.
► Multimodal regimen was more effective in improving both immunometabolic alterations and quality of life in advanced gynecologic cancer patients.