Writing about a newly diagnosed, pre-treatment Stage IV Lung Cancer patient (most likely NSCLC, biopsi to confirm soon). He lost some weight quickly a couple of months ago and then was able to stop the loss. He is frail with a BMI < 18. Now again he seems to be loosing weight. We are wondering if the tumor is becoming more active?
1- Are there any drugs that can help slow the cachexia while we wait for biopsi results and a possible treatment plan? I've seen a couple of small studies on effectiveness of ATP. Is this used in clinical practice?
2- Are there Lung Cancer specific nutrition guidelines in terms of how much extra calories are needed and mix of Protein vs.Carbs and fat? His current diet is over 60% carbs, about 20% Protein. I saw one study suggesting increase of Proteins might be beneficial.
3- what regular blood tests does he need to keep track of his nutrition status. I'm guessing Albumin, pre-Albumin?
thank you.
Reply # - April 21, 2014, 08:59 PM
Reply To: Cachexia and Nutrition in NSCLC patients
It doesn't really need to be that fancy. We want someone to maintain their weight by whatever means necessary. The concern is that this is driven by the cancer, and there is no specific medication that is significantly helpful. ATP is not used clinically, and in truth, the only intervention that is likely to be meaningfully beneficial in this situation is effectively treating the underlying cancer. Even appetite stimulants tend to be of minimal value in the face of a cancer causing diminishing appetite and catabolism (breakdown of energy sources).
There are no lung cancer-specific guidelines -- just more calories. Adding Boost or Ensure to a milkshake is a way to get a lot of nutrition in a reasonably small volume.
Albumin and pre-albumin are certainly tests to follow, but the main thing that matters is whether weight is still dropping or not.
Good luck.
-Dr. West
Reply # - April 22, 2014, 09:25 AM
Reply To: Cachexia and Nutrition in NSCLC patients
Thank you Dr. West. It's priceless to have access to you and other colleagues and wonderful people on this board.
Anorexia is a big problem for him (my father). Just can not get him enough calories even in the liquid format with shakes.
Should we consider a feeding tube as a temporary measure while still in pre-treatment ?
The idea is just not to loose as much ground, knowing the real "fix" can only come via treatment and a possible response.
Reply # - April 22, 2014, 12:47 PM
Reply To: Cachexia and Nutrition in NSCLC patients
I understand you are waiting for biopsy and planning but I wanted to share this info with you. From Dr. West, "A feeding tube is pretty rarely advised in the setting of advanced cancer. The rare occasion when I might recommend it is when there is some local problem with swallowing, such as a mechanical obstruction of the esophagus, or a bad esophagitis. But in someone who is declining and losing weight, that diminished intake is really extremely likely to be a manifestation of the overall cancer-induced decline, so to me it feels like you're just putting on a band-aid." http://cancergrace.org/forums/index.php?topic=9348.0
As Dr. West mentioned earlier in one of your threads his declined wellness as suggested by ECOG 4 is a big factor and may even suggest any intervention may not be advisable on the other hand there may be an underlying cause that can be addressed. These decisions are so individual that only persons directly involved with the case can answer appropriately.
I am so so sorry about this situation.
Janine
Reply # - April 22, 2014, 07:17 PM
Reply To: Cachexia and Nutrition in NSCLC patients
I agree that a feeding tube is not likely to be very fruitful here. The problem is the underlying cancer more than anything else.
Good luck.
-Dr. West
Reply # - April 23, 2014, 06:01 PM
Reply To: Cachexia and Nutrition in NSCLC patients
remihelios - -
It also might help if you had snacks just laying around within arms reach that he could just nibble on. We always had nuts, raisins, fruit, etc. around my Mom. She found it overwhelming to eat big meals. We also gave her Ensure over ice chips, or made yogurt drinks/shakes with some protein powder in them.
Wishing your dad all the best. . .
Laya
Reply # - April 25, 2014, 02:24 PM
Reply To: Cachexia and Nutrition in NSCLC patients
Thank you Laya.
He likes Ensure, Boost and also a special Protein Berry Milk shake I make for him.
He has swallowing problems too (maybe due to age) So supplementing with liquids is the way to go for us.