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Education in Palliative and End-of-life Care - Oncology

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

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Education in Palliative and End-of-life Care - Oncology

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  1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-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 •  Lean tissue •  Performance status • Altered resting energy expenditure •  Appetite

  4. . . . Anorexia / cachexia CachexiaStarvation Lean tissue  - Fat mass   Impact of feeding - + +

  5. Anorexia / cachexia Epidemiology • Incidence varies with site • Incidence increases with stage

  6. Anorexia / cachexia Impact • ≥ 5% weight loss and poor prognosis • Trend toward lower chemotherapy response rates • Anorexia and poor prognosis •  QOL, function • 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 • Identify 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 • Favorite foods / nutritional supplements / counseling • Treat reversible causes (eg, early satiety, mucositis)

  12. Anorexia / cachexiawhat does not work • Feeding (enteral or parenteral) ACP. Ann Int Med, 1989. Ovesen. J Clin Oncol, 1993.

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

  14. Management of cachexia • Investigational • Anabolic steroids • Omega-3-fatty acids • Amino acids • NSAIDs • Multi-vitamins • 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

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