Nutrition in Advanced Cancer Patients - Diagnostics and Decision Making

Background The anorexia/cachexia syndrome (ACS) affecting up to 80% of advanced cancer patients represents a wasting state on the basis of a chronic inflammatory status involving loss of muscle and fat tissue. The primary anorexia-cachexia-syndrome is caused by the tumor direct or via secreted products. Secondary, potentially correctable causes for reduced oral nutritional intake are for example mucositis, constipation or severe pain. The frequency and complexity of the anorexia-cachexia-syndrome requires a careful diagnostic and decision making process. Material and Methods This article is based on literature review, expert opinion and clinical practice. Results In the decision making process for diagnosis and treatment of the anorexia-cachexia-syndrome patients and relatives are involved. The process of prioritisation includes the following aspects: prognosis of the underlying disease, the price of a planned interventions, the probability that a given intervention will improve the problem, the prevention of prospective complications and last but not least patients preferences. Conclusion Treatments plans have to be adapted to the patients individual situation. Assessment instruments are currently being developed. Therapeutic options of ACS include pharmacotherapy, nutritional interventions, psychosocial-existential counselling, and improvement of physical activity.