Advertisement

Current Oncology Reports

, 21:15 | Cite as

Communicating with Adolescents and Young Adults about Cancer-Associated Weight Loss

  • Joanne ReidEmail author
  • Clare McKeaveney
  • Peter Martin
Open Access
Palliative Medicine (A Jatoi, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Palliative Medicine

Abstract

Purpose of Review

Over the past two decades, advances have been made in understanding the pathophysiology of cancer-associated weight loss, termed “cachexia.” To date, there is no proven effective intervention to completely reverse cachexia and there are no approved drug therapies to treat it. This paper will review relevant literature in relation to communicating with adolescents and young adults about cancer-associated weight loss.

Recent Findings

Adolescents and young adults (AYAs) who have cancer are a unique group of patients due to their stage of development and maturity.

Summary

This article outlines issues specific to this patient cohort that need to be considered to better understand the impact of cachexia and explore pertinent matters when communicating with AYAs in relation to cachexia.

Keywords

Adolescents and young adults Cancer-associated weight loss Cachexia 

Introduction

Cancer-associated weight loss or cachexia is a “multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass, with or without loss of fat mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment” ( [1], p.489). The pathophysiology of cancer cachexia is multifarious and reflective of this a multimodal approach to its management has been advocated [2]. However, to date, a successful treatment regime has not been definitely tested and there is a dearth of local practice guidelines and approved treatments for cancer cachexia. Previous research has uncovered the holistic impact of cancer cachexia for both patients and their carers; however, the vast majority of this work has been conducted with adult cancer patients. For adolescents and young adults (AYAs), the impact of cancer cachexia is likely to be distinct from older age groups given the challenges of this development stage. How we communicate with this group in relation to cachexia is particularly relevant as AYAs are regarded as particularly vulnerable [3]. Adolescence and early adulthood is known to be a distinct and complex development stage in a person’s life not only because of cognitive, emotional, and physical changes but also because of psychosocial challenges related to self-identity, relationships with family and peers, development of autonomy, sexuality, and education/work-related issues [4].

Defining Adolescents and Young Adults

The term “adolescents and young adults” has been variously described in the literature with differing age ranges. For example, previous cancer research has operationally defined AYAs as follows: 10–19 [5] 10–26 [6]; 11–21 [7]; 11–24 [8]; 13–21 [9]; 13 plus [10]; 14–39 [11, 12]; 15–25 [13, 14]; 15–29 [15]; 15–30 [16]; 15–34 [17]; 15–39 [18, 19, 20, 21, 22, 23, 24, 25]; 15–29 [26]; 16–29 [27, 28]; 16–30 [29, 30]; 18–25 [31]; 18–35 [32]; 18–39 [33]; 18–40 [34]; 18–44 [35]; 18–45 [36].

No formal unified agreement of the age rage for AYAs exists within the literature reviewed. As a result, the aforementioned age ranges are used interchangeably and this makes comparisons across research studies all the more complex. However, what is clear is that this stage of life marks key transition years from adolescent to adulthood and for most persons are the most dynamic and confounding years of life [4]. It is recognized that AYAs with cancer are a unique cohort due to their distinct biology, maturing hormonal and personal development, transitions in autonomy, demands in education and the workplace, and their place within the family/family responsibilities [37].

Cancer Incidence and Research in Adolescents and Young Adults

Globally, cancer remains a major cause of both morbidity and mortality across all age groups. Given there are more than one million new diagnoses of cancer worldwide in AYAs per annum [38], the global burden is greater than in all other age groups. Cancer is generally a disease associated with increasing age and thus the majority of research has focused on such populations. As such, research into the impact of cancers that occur at the juncture between pediatric and adult oncology remains in its infancy [39]. It is widely accepted that AYAs with cancer should have age-appropriate care to meet their needs and such care should be evidence based [40]. However, research involving AYAs is seldom the focus of cancer studies and this population is known to be under-researched [37, 41]. This is in stark contrast to the fact that the number of life-years affected by cancer is greater for AYAs than in any other age group [42]. It is also worth noting that internationally, recruitment of AYAs above the age of 15 into cancer trials is poor. Most notable, this is seen to directly relate with deficits in survival gains for patients aged 15–39 years [43]. Thus, while acknowledging the needs for additional research with this cohort, any such research needs to focus on innovative ways of engaging AYAs by better understanding the barriers and facilitators to recruitment and retention to maximize scientific advances and understanding of cancer-associated weight loss in this population.

Cancer-Associated Weight Loss

Patients with cancer are known to experience weight loss for a variety of reasons including, stress/anxiety, poor symptom management, and treatment-related factors. However, cancer-associated weight loss or cachexia is multifactorial syndrome characterized by progressive and involuntary weight loss and loss of muscle mass. There are three main factors that influence this syndrome: metabolic dysregulation, creating a negative energy balance; catabolism; and neuro-hormonal dysregulation. It is beyond the scope of this review to discuss these in-depth, but previous literature has detailed the pathophysiology of cancer cachexia [1, 44]. As outlined by Fearon et al. [1], cancer cachexia is a continuum which has three key stages, namely precachexia, cachexia, and refractory cachexia (Fig. 1).
Fig. 1

Stages of cachexia. Reprinted from The Lancet Oncology, Volume 12, Fearon K, et al., “Definition and classification of cancer cachexia: an international consensus,” pages 489–95, ©2011, with permission from Elsevier

The hallmark of weight loss associated with cancer cachexia is that there is a preferential loss of lean muscle mass and that the weight loss cannot be reversed with conventional feeding alone [43]. Thus, and in accordance with the consensus definition of cancer cachexia [1], merely assessing weight loss does not reflect the multidimensional syndrome of cancer cachexia. Furthermore, BMI has previously been used to assess for cachexia if weight loss is not known [45]. However, caution should be exercised in relation to this given the rise in prevalence of overweight and obese adults and children, which rose by 27.5% and 47.1% respectively between 1980 and 2013 [46].

Research focusing on gaining insight and understanding into the metabolic anomalies associated with cancer cachexia has proliferated in the last two decades. In parallel to this, clinical research efforts have focused on the potential management of cachexia aimed at reversing or ameliorating the associated weight loss. Most recently, the international Pre-MENAC and MENAC trials [43, 47], using a multimodal approach to cancer cachexia management, are reflective of the multifactorial syndrome itself [48]. However, preventative and therapeutic treatment options thus far have been shown to be largely ineffective and currently there is no notable pharmacological agent that successfully halts and reverses the weight loss associated with cancer cachexia. Furthermore, the optimal treatment for cachexia in patients with cancer has yet to be determined and currently there is no licensed treatment for cancer cachexia [43]. In practice today, despite much time and investment into clinical research, standardized local guidelines for the assessment, classification, and treatment of cachexia have still not been developed [49]. This only serves to compound the relevance of cachexia in negatively affecting both morbidity and mortality. Globally, cachexia is directly responsible for 20% of all cancer deaths, equating to more than 7.4 million deaths worldwide annually [50, 51].

Cancer-Associated Weight Loss: Impact on Patients and Their Families

Cancer cachexia is associated with reduced functionality and adversely impacts on activities of daily living [52], unfavorable psychosocial impact [53], reduced tolerance to anticancer therapy [54], and reduced survival [55]. Furthermore, it impacts not only patients but also their family members [56]. In particular, the lack of understanding about the role of food in cancer cachexia management can lead to family conflicts and deleteriously affect family dynamics [57]. To date, the research which has explored the lived experience and impact of cachexia has focused on adult patients. While previous cancer studies with AYAs have highlighted cancer cachexia in relation to symptoms experienced [4, 58], no study has explored the impact of this syndrome in-depth with AYAs. Due to the developmental stage of AYAs, the holistic implications are likely to be far reaching and distinctive from adult patients. Most notably, the psychosocial challenges of this stage of maturity [4] coupled with the biopsychosocial ramifications of cancer cachexia [57] will make the impact unique from older age groups most commonly studied.

In relation to nutritional problems in cancer, previous descriptive research conducted with children and their parents (n = 69) has highlighted that parents as well as children need comprehensive and regular information [59]. Indeed, information on both diet and nutrition have been reported as an unmet among AYA patients with cancer [12]. This is reflective of work that has previously been conducted with an adult cancer cachexia population, where the patient and also the patient’s family needs support to cope with and provide care with nutritional issues [60]. The role of family may be all the more important for AYAs, as they may still be dependent on their families for food purchase and preparation and may experience “pressure to eat” from both family at home and through peer pressure from their social circle [61].

Previous research conducted in relation to communication about weight with adolescents outlines the sensitivities that need to be considered when engaging in communication about weight with this cohort. In particular, the need to avoid communication which induces negative emotional reactions is outlined [62]. This is a key message as previous research conducted with an adult cachectic population outlined negative labelling that family used and which inadvertently caused hurt or sadness such as “the look of someone from Belsen” [63]. Such terminology may be particularly damaging for AYAs with cachexia, particularity in relation to self-image and sexuality due to their stage of maturity. Thus, when providing additional information in relation to cancer cachexia to AYAs, both health care professionals and parents should be educated to identify and desist from using such negative terminology and assist in promoting a supportive dialogue in relation to the role of food and cancer-associated weight loss.

One of the defining characteristics of cachexia is weight loss that manifests as preferential loss of lean muscle mass, which is obvious visually. Given that AYAs are particularly concerned with how others see them and they often do not want to be seen as someone who is “sick,” addressing the visuality of cachexia is a key area of concern for future care consideration to support AYAs adjustment of body changes. The mode of delivery of such future care also needs to be addressed as many AYAs turn to the internet for both information and for support from peers [64]. Providing age-appropriate information and a forum for discussion in relation to cachexia is a necessity alongside age-appropriate person-centered health care [65] ensuring the values, goals, and preferences unique to this population are understood.

Cancer-associated weight loss is known to resonate with patients and family members and indeed health care professionals in terms of mortality [57, 66]. Progressive cachexia is indicative of a poorer prognosis and shorter survival time [67]. Within an adult cancer population, addressing cachexia may be avoided by health care professionals due to concern of it leading into an end of life conversation [68]. In relation to AYAs (with and without chronic illness), research has demonstrated that they are willing to discuss end of life decision-making so it is vital that it is addressed in clinical practice to provide quality end of life care [69]. The timeliness of such conversation is particularly relevant as previous AYAs with advanced cancer outlined that discussions about end of life were close to death and this negatively impacted on their ability to psychologically prepare for death [70]. Advance care planning is an essential part of care and this should encompass cachexia and its management, if this is relevant. The uniqueness of the AYAs population pertains to this aspect of care and end of life care preferences as these patients may differ from those of the adult population. Additional research is warranted to explore this further and develop age relevant resources to assist this process.

Conclusion and Future Research Direction

There is a current dearth of information in relation to cancer-associated weight loss and AYAs. While previous work has been conducted in relation to cancer-associated weight loss in an adult population, this may not highlight the nuances in the AYAs population. Reflective of this, the management strategies’ needs for AYAs with cancer-associated weight loss are likely to be very different from an adult population. To help empower and optimize quality of life for AYAs with cancer-associated weight loss, person-centered care which recognizes and responds to the needs of AYAs with cancer-associated weight loss needs to be developed. Such care must be evidence based. To achieve this, it is essential to determine AYAs experience of cancer-associated weight loss and in particular, the role of their family and peers coupled with their age-related development (including bio-psycho-social-sexual domains) are key areas that require additional research. In planning future work in this area, a consensus definition of AYAs is needed to allow comparison across work and prevent unnecessary duplication of efforts. Given the social impact already known in relation to cancer cachexia and its impact on family dynamics (58; 54) and the psychosocial developmental stage that AYAs are at, it would be prudent to assess social functioning, family dynamics in AYAs with cancer-associated weight loss.

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489–95 This is the first paper to develop a framework to define and classify cancer cachexia. This work was informed by a panel of experts who participated in a formal consensus process. PubMedGoogle Scholar
  2. 2.
    Maddocks M, Hopkinson J, Conibear J, Reeves A, Shaw C, Fearon KC. Practical multimodal care for cancer cachexia. Curr Opin Support Palliat Care. 2016;10(4):298.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Thomas DM, Albritton KH, Ferrari A. Adolescent and young adult oncology: an emerging field. J Clin Oncol. 2010;28(32):4781–2.PubMedGoogle Scholar
  4. 4.
    Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, et al. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res. 2017;26(7):1659–72.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Stern M, Krivoy E, Foster RH, Bitsko M, Toren A, Ben-Arush M. Psychosocial functioning and career decision-making in Israeli adolescent and young adult cancer survivors. Pediatr Blood Cancer. 2010;55(4):708–13.PubMedGoogle Scholar
  6. 6.
    Haase JE, Kintner EK, Monahan PO, Robb SL. The Resilience in Illness Model (RIM) part 1: exploratory evaluation in adolescents and young adults with cancer. Cancer Nurs. 2014;37(3):E1.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Arpawong TE, Oland A, Milam JE, Ruccione K, Meeske KA. Post-traumatic growth among an ethnically diverse sample of adolescent and young adult cancer survivors. Psycho-Oncology. 2013;22(10):2235–44.PubMedGoogle Scholar
  8. 8.
    Docherty SL, Robb SL, Phillips-Salimi C, Cherven B, Stegenga K, Hendricks-Ferguson V, et al. Parental perspectives on a behavioural health music intervention for adolescent/young adult resilience during cancer treatment: report from the Children’s Oncology Group. J Adolesc Health. 2013;52(2):170–8.PubMedGoogle Scholar
  9. 9.
    Burns DS, Robb SL, Phillips-Salimi C, Haase JE. Parental perspectives of an adolescent/young adult stem cell transplant and a music video intervention. Cancer Nurs. 2010;33(4):E20–7.PubMedGoogle Scholar
  10. 10.
    Cohen-Gogo S, Marioni G, Laurent S, Gaspar N, Semeraro M, Gabolde M, et al. End of life care in adolescents and young adults with cancer: experience of the adolescent unit of the Institut Gustave Roussy. Eur J Cancer. 2011;47(18):2735–41.PubMedGoogle Scholar
  11. 11.
    Kwak M, Zebrack BJ, Meeske KA, Embry L, Aguilar C, Block R, et al. Trajectories of psychological distress in adolescent and young adult patients with cancer: a 1-year longitudinal study. J Clin Oncol. 2013;31(17):2160–6.PubMedGoogle Scholar
  12. 12.
    Zebrack BJ, Block R, Hayes-Lattin B, Embry L, Aguilar C, Meeske KA, et al. Psychosocial service use and unmet need among recently diagnosed adolescent and young adult cancer patients. Cancer. 2013;119(1):201–14.PubMedGoogle Scholar
  13. 13.
    O’Callaghan C, Barry P, Thompson K. Music’s relevance for adolescents and young adults with cancer: a constructivist research approach. Support Care Cancer. 2012;20(4):687–97.PubMedGoogle Scholar
  14. 14.
    Thompson K, Dyson G, Holland L, Joubert L. An exploratory study of oncology specialists’ understanding of the preferences of young people living with cancer. Soc Work Health Care. 2013;52(2–3):166–90.PubMedGoogle Scholar
  15. 15.
    Santacroce SJ, Crandell JB. Feasibility and preliminary findings from a pilot study of allostatic load in adolescent-young adult childhood cancer survivors and their siblings. J Pediatr Oncol Nurs. 2014;31(3):122–34.PubMedGoogle Scholar
  16. 16.
    Casillas J, Kahn KL, Doose M, Landier W, Bhatia S, Hernandez J, et al. Transitioning childhood cancer survivors to adult-centered healthcare: insights from parents, adolescent, and young adult survivors. Psycho-Oncology. 2010;19(9):982–90.PubMedGoogle Scholar
  17. 17.
    Carpentier MY, Fortenberry JD, Ott MA, Brames MJ, Einhorn LH. Perceptions of masculinity and self-image in adolescent and young adult testicular cancer survivors: implications for romantic and sexual relationships. Psycho-Oncology. 2011;20(7):738–45.PubMedGoogle Scholar
  18. 18.
    Bellizzi KM, Smith A, Schmidt S, Keegan TH, Zebrack B, Lynch CF, et al. Positive and negative psychosocial impact of being diagnosed with cancer as an adolescent or young adult. Cancer. 2012;118(20):5155–62.PubMedGoogle Scholar
  19. 19.
    Keegan TH, Lichtensztajn DY, Kato I, Kent EE, Wu XC, West MM, et al. Unmet adolescent and young adult cancer survivors information and service needs: a population-based cancer registry study. J Cancer Surviv. 2012;6(3):239–50.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Kirchhoff AC, Spraker-Perlman HL, McFadden M, Warner EL, Oeffinger KC, Wright J, et al. Sociodemographic disparities in quality of life for survivors of adolescent and young adult cancers in the Behavioural Risk Factor Surveillance System. J Adolesc Young Adult Oncol. 2014;3(2):66–74.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Brunet J, Love C, Ramphal R, Sabiston CM. Stress and physical activity in young adults treated for cancer: the moderating role of social support. Support Care Cancer. 2014;22(3):689–95.PubMedGoogle Scholar
  22. 22.
    Kent EE, Smith AW, Keegan TH, Lynch CF, Wu XC, Hamilton AS, et al. Talking about cancer and meeting peer survivors: social information needs of adolescents and young adults diagnosed with cancer. J Adolesc Young Adult Oncol. 2013;2(2):44–52.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Parsons HM, Harlan LC, Lynch CF, Hamilton AS, Wu XC, Kato I, et al. Impact of cancer on work and education among adolescent and young adult cancer survivors. J Clin Oncol. 2012;30(19):2393.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Smith AW, Parsons HM, Kent EE, Bellizzi KM, Zebrack BJ, Keel G, et al. Unmet support service needs and health-related quality of life among adolescents and young adults with cancer: the AYA HOPE study. Front Oncol. 2013;3:75.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Zebrack B, Bleyer A, Albritton K, Medearis S, Tang J. Assessing the health care needs of adolescent and young adult cancer patients and survivors. Cancer. 2006;107(12):2915–23.PubMedGoogle Scholar
  26. 26.
    Phillips-Salimi CR, Andrykowski MA. Physical and mental health status of female adolescent/young adult survivors of breast and gynecological cancer: a national, population-based, case-control study. Support Care Cancer. 2013;21(6):1597–604.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Doshi K, Kazak AE, DeRosa BW, Schwartz LA, Hobbie W, Ginsberg J, et al. Measuring health-related beliefs of mothers of adolescent and young adult childhood cancer survivors. Fam Syst Health. 2011;29(1):55.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Schwartz LA, Kazak AE, DeRosa BW, Hocking MC, Hobbie WL, Ginsberg JP. The role of beliefs in the relationship between health problems and posttraumatic stress in adolescent and young adult cancer survivors. J Clin Psychol Med Settings. 2012;19(2):138–46.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Dyson GJ, Thompson K, Palmer S, Thomas DM, Schofield P. The relationship between unmet needs and distress amongst young people with cancer. Support Care Cancer. 2012;20(1):75–85.PubMedGoogle Scholar
  30. 30.
    Kazak AE, DeRosa BW, Schwartz LA, Hobbie W, Carlson C, Ittenbach RF, et al. Psychological outcomes and health beliefs in adolescent and young adult survivors of childhood cancer and controls. J Clin Oncol. 2010;28(12):2002.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Cooke L, Chung C, Grant M. Psychosocial care for adolescent and young adult hematopoietic cell transplant patients. J Psychosoc Oncol. 2011;29(4):394–414.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Zebrack B, Chesler MA, Kaplan S. To foster healing among adolescents and young adults with cancer: what helps? What hurts? Support Care Cancer. 2010;18(1):131–5.PubMedGoogle Scholar
  33. 33.
    Geue K, Sender A, Schmidt R, Richter D, Hinz A, Schulte T, et al. Gender-specific quality of life after cancer in young adulthood: a comparison with the general population. Qual Life Res. 2014;23(4):1377–86.PubMedGoogle Scholar
  34. 34.
    El-Jawahri A, Pidala J, Inamoto Y, Chai X, Khera N, Wood WA, et al. Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2014;20(9):1341–8.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Zebrack BJ, Casillas J, Nohr L, Adams H, Zeltzer LK. Fertility issues for young adult survivors of childhood cancer. Psychooncology. 2004;13(10):689–99.PubMedGoogle Scholar
  36. 36.
    Geue K, Richter D, Schmidt R, Sender A, Siedentopf F, Brähler E, et al. The desire for children and fertility issues among young German cancer survivors. J Adolesc Health. 2014;54(5):527–35.PubMedGoogle Scholar
  37. 37.
    Fernandez CV, Barr RD. Adolescents and young adults with cancer: an orphaned population. Pediatric Child Health. 2006;11(2):103–6.Google Scholar
  38. 38.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Fidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20–39 years worldwide in 2012: a population-based study. The Lancet Oncology. 2017;18(12):1579–89.PubMedGoogle Scholar
  40. 40.
    Weston C, Soanes L, Chisholm J, Wiseman T. ‘Out There’: Developing a transition pathway for adolescents and young adults with cancer using Experience-Based Co-Design. J Health Des. 2018;12:13.Google Scholar
  41. 41.
    Quinn GP, Gonçalves V, Sehovic I, Bowman ML, Reed DR. Quality of life in adolescent and young adult cancer patients: a systematic review of the literature. Patient Relat Outcome Meas. 2015;6:19.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Bleyer A, Ferrari A, Whelan J, Barr RD. Global assessment of cancer incidence and survival in adolescents and young adults. Pediatr Blood Cancer. 2017;64(9):e26497 This paper gives a current overview of incidence and survival of AYAYs with cancer and highlights the specific challenges related to this population. Google Scholar
  43. 43.
    Solheim TS, Laird BJ, Balstad TR, Stene GB, Bye A, Johns N, et al. A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer. J Cachexia Sarcopenia Muscle. 2017;8(5):778–88.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Bruggeman AR, Kamal AH, LeBlanc TW, Ma JD, Baracos VE, Roeland EJ. Cancer cachexia: beyond weight loss. J Oncol Pract. 2016;12(11):1163–71.PubMedGoogle Scholar
  45. 45.
    Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr. 2008;27(6):793–9.PubMedGoogle Scholar
  46. 46.
    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Solheim TS, Laird BJ, Balstad TR, Bye A, Stene G, Baracos V, Strasser F, Griffiths G, Maddocks M, Fallon M, Kaasa S. Cancer cachexia: rationale for the MENAC (Multimodal—Exercise, Nutrition and Anti-inflammatory medication for Cachexia) trial. BMJ Support Palliat Care. Published Online First: 09 February 2018.  https://doi.org/10.1136/bmjspcare-2017-001440. This papers provides a justification and rationale of the importance of developing multimodal interventions to treat the multifactorial syndrome of cancer cachexia.
  48. 48.
    Fearon KCH. Cancer cachexia: Developing a multimodal therapy for a multidimensional problem. Eur J Cancer. 2008:1124–32.Google Scholar
  49. 49.
    Muscaritoli M, Bossola M, Aversa Z, Bellantone R, Fanelli FR. Prevention and treatment of cancer cachexia: new insights into an old problem. Eur J Cancer. 2006;42(1):31–41.PubMedGoogle Scholar
  50. 50.
    Dodson S, Baracos VE, Jatoi A, Evans WJ, Cella D, Dalton JT, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265–79.PubMedGoogle Scholar
  51. 51.
    Vaughan VC, Martin P, Lewandowski PA. Cancer cachexia: impact, mechanisms and emerging treatments. J Cachexia Sarcopenia Muscle. 2013;4:95–109.PubMedGoogle Scholar
  52. 52.
    Naito T, Okayama T, Aoyama T, Ohashi T, Masuda Y, Kimura M, et al. Unfavourable impact of cancer cachexia on activity of daily living and need for inpatient care in elderly patients with advanced non-small-cell lung cancer in Japan: a prospective longitudinal observational study. BMC Cancer. 2017;17(1):800.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Hopkinson JB. Psychosocial impact of cancer cachexia. J Cachexia Sarcopenia Muscle. 2014;5:89–94.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Bachmann J, Heiligensetzer M, Krakowski-Roosen H, Büchler MW, Friess H, Martignoni ME. Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg. 2008;12(7):1193.PubMedGoogle Scholar
  55. 55.
    Temel JS, Abernethy AP, Currow DC, Friend J, Duus EM, Yan Y, et al. Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials. Lancet Oncol. 2016;17(4):519–31.PubMedGoogle Scholar
  56. 56.
    Cooper C, Burden ST, Cheng H, Molassiotis A. Understanding and managing cancer-related weight loss and anorexia: insights from a systematic review of qualitative research. J Cachexia Sarcopenia Muscle. 2015;6(1):99–111.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Reid J, McKenna H, Fitzsimons D, McCance T. The experience of cancer cachexia: a qualitative study of advanced cancer patients and their family members. Int J Nurs Stud. 2009;46(5):606–16.PubMedGoogle Scholar
  58. 58.
    Van Doren BA, Roy D, Noone JM, Blanchette CM, Arthur ST. Cachexia & debility diagnoses in hospitalized children and adolescents with complex chronic conditions: evidence from the Kids’ Inpatient Database. Drugs Context. 2015;4:212277.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Arpaci T, Toruner EK, Altay N. Assessment of nutritional problems in pediatric patients with cancer and the information needs of their parents: a parental perspective. Asia Pac J Oncol Nurs. 2018;5:231–6.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Reid J, Mc Kenna HP, Fitzsimons D, Mc Cance TV. An exploration of the experience of cancer cachexia: what patients and their families want from healthcare professionals. Eur J Cancer Care. 2010;19(5):682–9.Google Scholar
  61. 61.
    Coccia PF, Altman J, Bhatia S, Borinstein SC, Flynn J, George S, et al. Adolescent and young adult oncology. J Natl Compr Cancer Netw. 2012;10(9):1112–50.Google Scholar
  62. 62.
    Puhl RM, Himmelstein MS. A word to the wise: adolescents reactions to parental communication about weight. Child Obes. 2018;14(5): ahead of print).  https://doi.org/10.1089/chi.2018.0047.
  63. 63.
    Reid J, McKenna H, Fitzsimons D, McCance T. Fighting over food: patient and family understanding of cancer cachexia. Oncol Nurs Forum. 2009;36(4):439–45.PubMedGoogle Scholar
  64. 64.
    Perales MA, Drake EK, Pemmaraju N, Wood WA. Social media and the adolescent and young adult (AYA) patient with cancer. Curr Hematol Malig Rep. 2016;11(6):449–55.PubMedPubMedCentralGoogle Scholar
  65. 65.
    Moore PM, Rivera S, Bravo-Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev. 2018;7.Google Scholar
  66. 66.
    Millar C, Porter S, Reid J. Healthcare professionals’ response to cachexia in advanced cancer: a qualitative study. Oncol Nurs Forum. 2013a;40(6):E393–402.PubMedGoogle Scholar
  67. 67.
    Penet MF, Bhujwalla ZM. Cancer cachexia, recent advances, and future directions. Cancer J. 2015;21(2):117–22.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Millar C, Porter S, Reid J. Refractory cachexia and truth-telling about terminal prognosis: a qualitative study. Eur J Cancer Care. 2013;22(3):326–33.Google Scholar
  69. 69.
    Wiener L, Zadeh S, Battles H, Baird K, Ballard E, Osherow J. Allowing adolescents and young adults to plan their end-of-life care. Paediatrics. 2012;130(5):897–905 This work highlights that AYAs are willing to discuss end of life decision-making; this is important in relation to cachexia and relevant to clinical practice to ensure the provision of quality end of life care. Google Scholar
  70. 70.
    Bell CJ, Skiles J, Pradhan K, Champion VL. End-of-life experiences in adolescents dying with cancer. Support Care Cancer. 2010;18(7):827–35.PubMedGoogle Scholar

Copyright information

© The Author(s) 2019

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  1. 1.School of Nursing and MidwiferyQueen’s University BelfastBelfastUK
  2. 2.School of MedicineGeelong Waurn Ponds CampusGeelongAustralia

Personalised recommendations