What Is Cachexia?

Cachexia—which is sometimes called wasting syndrome—is a condition that causes your body’s muscles to waste away. Characterized by involuntary weight loss and a loss of body fat, cachexia is a response to fighting diseases like cancer, HIV, congestive heart failure, and chronic obstructive pulmonary disease (COPD).

If you have cachexia, you will likely experience muscle weakness, fatigue, and loss of appetite. You also might experience high levels of inflammation. 

Overall, cachexia impacts more than 160,000 people in the U.S. each year. At the time of cancer diagnosis, 40% of people are estimated to have cachexia. That percentage jumps to 70% among people with advanced cancer. Meanwhile, 5% to 15% of people with COPD or heart failure will experience cachexia.

There is no cure for cachexia. And while the management techniques for cachexia are limited—largely due to the fact that it has not been studied much—there are some potentially promising treatments on the horizon, such as drugs that can help you maintain muscle mass and various nutrition-based options.  

Cachexia Symptoms

The main sign of cachexia is the loss of muscle mass. You might notice that your muscles are no longer defined. Muscle loss might also be accompanied by a loss of fat mass.

Whether or not you lose fat, muscle loss will affect your weight. That makes it so involuntary weight loss is the other main sign of cachexia. Even though you may be taking in enough calories for your age and body type, you are still losing weight. This occurs even when your calorie intake is greater than the number of calories you burn through exercise and movement.

Other signs of cachexia include:

• Loss of appetite
• Physical weakness
• Lack of energy
• Increase in inflammatory markers, including an elevated C-reactive protein and low serum albumin

What Causes Cachexia?

You can experience cachexia as part of your body’s immune response to diseases like cancer, COPD, or heart failure. The immune response increases your metabolism.

The metabolism increase can happen for different reasons. With cancer specifically, your immune system releases chemicals called cytokines into the bloodstream. These chemicals are thought to speed up your metabolism and contribute to your body’s inflammation, ultimately resulting in muscle and fat loss, the hallmarks of cachexia.

Even though your metabolism increases, your calorie intake doesn’t.

Risk Factors

Cachexia is particularly common if you are in the late stages of the disease. Some illnesses and diseases that put you at risk for developing cachexia include:

• Cancer, especially advanced pancreatic and lung cancer
• COPD
• Chronic heart failure
• HIV
• Liver failure
• Rheumatoid arthritis
• Kidney failure
• Diabetes

How Is Cachexia Diagnosed?

When determining if you have cachexia, your healthcare provider typically looks at your weight in comparison to what it was a year prior. The first diagnostic criterion for cachexia is that you have a chronic illness and have involuntarily lost 5% of your body weight over the past 12 months or have a body mass index (BMI) of 20kg/m² or lower. On top of that, you must also:

• Have lost muscle mass
• Have a lack of energy
• Have lost body fat and your blood tests show inflammation

Because some exam findings may appear normal early on in cachexia, your healthcare provider may also use a variety of tools when making a diagnosis. Assessments that may be used include:

• Food diary or nutritional assessment to determine your nutritional intake and to look for a loss in appetite 
• ECOG Performance Status Scale to determine your quality of life including your mobility and your tolerance for physical activity
• SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire to look for a loss of muscle tissue due to age (sarcopenia)
• Body composition and weight measurements to determine body fat loss and weight loss
• Blood tests to look for abnormal biological markers such as an elevated C-reactive protein, a low serum albumin, and other inflammation markers 

Stages of Cachexia

Cachexia—particularly cachexia related to cancer—can be divided in three clinical stages. Not everyone will experience all three stages. Here are the stages of cachexia and the characteristics of each.

Pre-cachexia

Pre-cachexia is considered the initial phase of cachexia. In this phase, you may begin to experience metabolic changes such as systemic inflammation that causes minor weight loss. In this stage, you probably have not yet experienced significant muscle mass loss or impaired physical function.

Cachexia

With cachexia, you will have involuntarily lost more than 5% of your body weight in 12 months—six months with cachexia specific to cancer—and have a known illness or disease. You also will have lost muscle strength and have a decreased appetite, fatigue, and inflammation.

Refractory Cachexia

This type of cachexia applies primarily to cancer and is based on your performance status score, which measures your activity level. At this stage, you are nearing the end of life with a survival period of less than three months. The focus now is no longer on controlling your underlying illness but instead on improving your quality of life.

At this point, you have lost more than 15% of your weight if you have a BMI less than 23kg/m² or more than 20% of your weight if your BMI is less than 27kg/m².

Treatments for Cachexia

Because cachexia cannot be reversed or cured, the goal of treatment is usually to improve the overall quality of your life as well as slow down the progression of the condition. There are a few options for how to do this.

Nutritional Interventions

Often, healthcare providers will encourage you to meet with a registered dietitian for assessment and counseling. The goal is to educate you on what types of food might benefit you, such as high-protein, high-calorie, and nutrient-dense food.

Pharmacological Interventions

There are currently no U.S. Food and Drug Administration-approved medications for treating cachexia. But sometimes medications are used to stimulate appetite or to combat nausea. Decisions regarding these medications are made in partnership with a healthcare provider.

Strength and Endurance Activities

While research is limited on the benefits of exercise on cachexia, some healthcare providers might suggest building your strength and endurance. While these activities do not reverse cachexia, they can improve your quality of life and allow you to participate in more activities with loved ones.

Psychosocial Support

Living with cachexia can be overwhelming and stressful. For this reason, healthcare providers sometimes recommend receiving mental health intervention either through a support group or individual counseling. In fact, studies have shown that psychosocial support can alleviate distress, treat anxiety and depression, boost body image, and improve quality of life among people with cachexia.

How to Prevent Cachexia

Because cachexia is tied to an underlying illness or disease, the first step in its prevention is to manage and treat the illness. This is done through different drugs and treatment plans.

Nutrition counseling along with physical therapy and exercise regimens also may be useful in preventing the onset of cachexia. But if your underlying illness or disease progresses, cachexia may not be preventable.

Comorbid Conditions

When it comes to cachexia, there are several conditions or illnesses that can occur alongside cachexia. These include:

• Sarcopenia: A decline of skeletal muscle that usually occurs with age can sometimes occur as a comorbidity to cancer. However, many people with sarcopenia do not go on to develop cachexia unless they have an underlying illness or disease.
• Pain syndromes: Pain may occur alongside cachexia in people with cancer and chronic heart failure. In fact, one study found that 98% of the participants described unspecified pain in the past month while 66% had pain in the last 24 hours. 
• Swallowing issues: Having difficulty swallowing is a comorbidity of chronic heart failure and may occur in people with cachexia—especially if their condition is at the end stages of the disease.
• Depression: Chronic illness and poor quality of life often exacerbate or trigger depression. Consequently, depression is a comorbidity for people with cancer who have cachexia. One study found that depression increased depending on the state of cachexia.

Living With Cachexia

If you have advanced cancer, having cachexia can make your cancer symptoms like dry mouth, vomiting, diarrhea, sleep disturbances, and anxiety worse. Recognizing and addressing cachexia in its earlier stages can help avoid the worsening of such symptoms. Ultimately, it’s estimated that cachexia is directly responsible for as many as 30% of cancer-related deaths.

Researchers are learning more about the body’s processes that cause cachexia. A number of studies have focused on developing treatments that would protect and rebuild muscles while encouraging weight gain. While there is currently no cure for cachexia, there are things you can do to improve your quality of life.

Nutrition counseling can help you learn how to fuel your body. Mental health support could empower you to take a more active role in your overall health and well-being as well as learn ways of managing your feelings and emotions.

And despite the poor prognosis associated with having cachexia, studies show that exercise programs also may have a positive impact and give you renewed hope. Exercise allows you to take back control and better manage your physical and mental wellbeing.