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Journal of Clinical Oncology : Official... May 2023Anorexia occurs in 30%-80% of patients with advanced malignancies, which may be worsened with chemotherapy. This trial assessed the efficacy of olanzapine in stimulating... (Randomized Controlled Trial)
Randomized Controlled Trial
Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in Patients With Locally Advanced or Metastatic Gastric, Hepatopancreaticobiliary, and Lung Cancer.
PURPOSE
Anorexia occurs in 30%-80% of patients with advanced malignancies, which may be worsened with chemotherapy. This trial assessed the efficacy of olanzapine in stimulating appetite and improving weight gain in patients receiving chemotherapy.
METHODS
Adults (≥18 years) with untreated, locally advanced, or metastatic gastric, hepatopancreaticobiliary (HPB), and lung cancers were randomly assigned (double-blind) to receive olanzapine (2.5 mg once a day for 12 weeks) or placebo along with chemotherapy. Both groups received standard nutritional assessment and dietary advice. The primary outcomes were the proportion of patients with weight gain > 5% and the improvement in appetite (assessed by the visual analog scale [VAS] and the Functional Assessment of Chronic Illness Therapy system of Quality-of-Life questionnaires Anorexia Cachexia subscale [FAACT ACS]). Secondary end points were change in nutritional status, quality of life (QOL), and chemotherapy toxicity.
RESULTS
We enrolled 124 patients (olanzapine, 63 and placebo, 61) with a median age of 55 years (18-78 years), of whom 112 (olanzapine, 58 and placebo, 54) were analyzable. The majority (n = 99, 80%) had metastatic cancer (gastric [n = 68, 55%] > lung [n = 43, 35%] > HPB [n = 13, 10%]). The olanzapine arm had a greater proportion of patients with a weight gain of > 5% (35 of 58 [60%] 5 of 54 [9%], < .001) and improvement in appetite by VAS (25 of 58 [43%] 7 of 54 [13%], < .001) and by FAACT ACS (scores ≥37:13 of 58 [22%] 2 of 54 [4%], = .004). Patients on olanzapine had better QOL, nutritional status, and lesser chemotoxicity. Side effects attributable to olanzapine were minimal.
CONCLUSION
Low-dose, daily olanzapine is a simple, inexpensive, well-tolerated intervention that significantly improves appetite and weight gain in newly diagnosed patients on chemotherapy.
Topics: Adult; Humans; Middle Aged; Olanzapine; Anorexia; Quality of Life; Lung Neoplasms; Double-Blind Method; Weight Gain
PubMed: 36977285
DOI: 10.1200/JCO.22.01997 -
Trends in Cancer May 2022The cachexia syndrome in cancer is characterized by weight loss resulting from the combination of anorexia and atrophy of adipose and skeletal muscle. For decades,... (Review)
Review
The cachexia syndrome in cancer is characterized by weight loss resulting from the combination of anorexia and atrophy of adipose and skeletal muscle. For decades, inflammatory circulatory factors have been identified to regulate wasting, but inhibitors of these factors have not yielded the same clinical benefit as in animal models. Therefore, additional mediators of cachexia likely regulate this syndrome, and such factors might be more suitable for targeted intervention. We highlight several anorexia-cachexia signaling mediators, including activin A, myostatin, GDF15, and lipocalin-2. We discuss current evidence that these factors associate with cachexia in cancer patients, and summarize translational efforts including essential early-phase clinical trials. We conclude with thoughts on targeted and personalized approaches for future anti-cachexia treatments.
Topics: Adipose Tissue; Animals; Anorexia; Cachexia; Humans; Neoplasms; Signal Transduction
PubMed: 35190301
DOI: 10.1016/j.trecan.2022.01.004 -
Endocrine, Metabolic & Immune Disorders... 2018Anorexia Nervosa (AN), Bulimia Nervosa (BN) and their variants are characterized by persistent alteration of eating behaviour, such as restricted intake or bingeing and... (Review)
Review
BACKGROUND AND OBJECTIVE
Anorexia Nervosa (AN), Bulimia Nervosa (BN) and their variants are characterized by persistent alteration of eating behaviour, such as restricted intake or bingeing and purging, as well as excessive concerns about body shape and body weight. Purging behaviour may include self induced vomiting and/or abuse of laxatives, diuretics and physical hyperactivity. Unlike other psychiatric disorders, patients suffering from AN and BN have a high prevalence of many different medical complications, through the sequelae of undernutrition and purging, often with a serious impairment of health status and quality of life. This article describes the main diagnostic and clinical aspects of medical complications in AN and BN.
RESULTS
The medical complications of ED are extremely variable and can occur with only modest biological and physical damage up to extremely serious and life-threatening conditions; the mortality rate of young subjects with AN is 4 - 11% with a risk of death about 12 times higher than that of subjects of the same age of the general population. The management of the medical-internship aspects of AN and BN is rightly placed within complex and articulated programs of interdisciplinary treatment with different levels of intensity of care (outpatient, semi-residential/residential, hospital in cases of emergency/medical and/or psychiatric emergency).
CONCLUSION
the results of the investigations carried out, describe the functions of the various organs and apparatuses and the alterations detected, the possible complications and physiological adaptations to malnutrition.
Topics: Anorexia; Bulimia Nervosa; Feeding Behavior; Humans; Malnutrition; Nutritional Status; Prognosis; Quality of Life; Risk Factors
PubMed: 29848283
DOI: 10.2174/1871530318666180531094508 -
Clinics in Geriatric Medicine Aug 2015The anorexia of aging is common, leading to adverse health consequences. As populations age, the impacts from anorexia in the older population are set to increase. Only... (Review)
Review
The anorexia of aging is common, leading to adverse health consequences. As populations age, the impacts from anorexia in the older population are set to increase. Only greater awareness will allow for prevention or early intervention. This article discusses the physiologic anorexia of aging, highlights contributing factors, and proposes management strategies, including screening, especially in primary care. Many neuroendocrine factors have been implicated in the pathophysiology; it is clear that further human research is necessary if there is to be a pharmacologic breakthrough. There are currently no approved pharmacologic treatment strategies to prevent or treat the anorexia of aging.
Topics: Aged; Aging; Anorexia; Appetite Regulation; Geriatric Assessment; Humans; Motor Activity; Nutrition Assessment; Nutritional Requirements; Risk Assessment; Sarcopenia
PubMed: 26195100
DOI: 10.1016/j.cger.2015.04.012 -
Journal of Pain and Symptom Management Dec 2021Few pharmacological interventions are available for cancer-associated anorexia and cachexia. Mirtazapine has been suggested for use in cancer-associated anorexia and... (Randomized Controlled Trial)
Randomized Controlled Trial
CONTEXT
Few pharmacological interventions are available for cancer-associated anorexia and cachexia. Mirtazapine has been suggested for use in cancer-associated anorexia and cachexia.
OBJECTIVES
This study was conducted to assess the efficacy and tolerability of mirtazapine in cancer-associated anorexia and cachexia.
METHODS
A double-blind placebo-controlled randomized trial. The study included 120 incurable solid tumour patients with anorexia (appetite loss ≥4 on 0 - 10 scale, 10 = maximum appetite loss), cachexia (>5% body weight loss over 6 months or >2% plus body mass index <20) and depression score ≤3 on 0-6 scale (6 = extreme feelings of depression). Patients were 1:1 randomized to receive mirtazapine 15mg daily at night for 8 weeks or placebo. The primary endpoint was change in appetite from baseline to day 28. Other outcomes included changes in quality-of-life, fatigue, depressive symptoms, body weight, lean body mass, handgrip strength, inflammatory markers, adverse events and survival.
RESULTS
48 (80%) patients in the mirtazapine arm and 52 (87%) in the placebo were assessable for the 1ry endpoint. Appetite score increased significantly with mirtazapine as well as with placebo (P < 0.0001 each). The increase in appetite score did not differ significantly between the two arms in the per-protocol and intention-to-treat analysis (P = 0.472 and 0.462, respectively). Mirtazapine was associated with significantly less increase in depressive symptoms and higher prevalence of somnolence. The change in other outcomes did not differ significantly between mirtazapine and placebo.
CONCLUSION
Mirtazapine 15mg at night for 28 days is no better than placebo in improving the appetite of incurable solid tumor patients with cancer-associated anorexia and cachexia.
Topics: Anorexia; Cachexia; Double-Blind Method; Hand Strength; Humans; Mirtazapine; Neoplasms
PubMed: 34051293
DOI: 10.1016/j.jpainsymman.2021.05.017 -
Current Opinion in Clinical Nutrition... Jan 2017The purpose of this review is to examine the concept of anorexia of aging, including its complex pathophysiology and the multifaceted interventions required to prevent... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to examine the concept of anorexia of aging, including its complex pathophysiology and the multifaceted interventions required to prevent adverse health consequences from this geriatric syndrome.
RECENT FINDINGS
Anorexia of aging is extremely common, occurring in up to 30% of elderly individuals; however, this diagnosis is frequently missed or erroneously attributed to a normal part of the aging process. With aging, impairments in smell and taste can limit the desire to eat. Alterations in stress hormones and inflammatory mediators can lead to excess catabolism, cachexia, and reduced appetite. In addition, mood disorders, such as anxiety and depression, are powerful inhibitors of appetite. Anorexia of aging, with its negative consequences on weight and muscle mass, is a risk factor for the development of frailty and is important to screen for, as early intervention is key to reversing this debilitating condition.
SUMMARY
Anorexia of aging is a complex geriatric syndrome and a direct risk factor for frailty and thus should not be accepted as normal consequence of aging. Early diagnosis and formulating a plan for targeted interventions is critical to prevent disability and preserve function in elderly patients.
Topics: Aged; Aged, 80 and over; Aging; Anorexia; Appetite; Cachexia; Depression; Female; Frailty; Humans; Male
PubMed: 27749690
DOI: 10.1097/MCO.0000000000000336 -
Journal of Palliative Care 1994
Review
Topics: Anorexia; Appetite; Gastrointestinal Motility; Humans; Neoplasms; Terminal Care
PubMed: 8035257
DOI: No ID Found -
Clinics in Geriatric Medicine Aug 2017Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of... (Review)
Review
Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as "anorexia of aging." Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults.
Topics: Aged; Aging; Anorexia; Disease Management; Geriatric Assessment; Humans; Nutritional Status
PubMed: 28689565
DOI: 10.1016/j.cger.2017.02.004 -
Nutrition (Burbank, Los Angeles County,... 2004In many sports, athletes with low body weight have a distinct advantage over their opponents; however, this advantage can easily turn into a noticeable disadvantage... (Review)
Review
In many sports, athletes with low body weight have a distinct advantage over their opponents; however, this advantage can easily turn into a noticeable disadvantage because low body weight may also be associated with health problems. The present review focuses on the problem of anorexia athletica, with its emphasis on leanness and thinness in female and male sports athletes. Athletes often restrict calories and/or overexercise to achieve or maintain low body and fat masses. There is a growing body of evidence that several metabolic and endocrine disturbances are the result of prolonged energy restriction. However, the long-term outcome of such sport-related disordered eating has not been thoroughly studied. Effective methods of treatment are scarce and similar to treatment of eating disorders. Scientific studies are needed that help establish alternative regulations for sports in which a low body weight is a primary advantage for performance.
Topics: Adipose Tissue; Anorexia; Body Composition; Body Weight; Energy Intake; Feeding and Eating Disorders; Female; Humans; Male; Sports; Thinness
PubMed: 15212748
DOI: 10.1016/j.nut.2004.04.019 -
Nursing Children and Young People Mar 2021Anorexia nervosa is characterised by significantly low body weight, a fear of weight gain and persistent efforts to prevent the restoration of normal weight. It has... (Review)
Review
Anorexia nervosa is characterised by significantly low body weight, a fear of weight gain and persistent efforts to prevent the restoration of normal weight. It has potentially life-threatening physical and psychological complications, and many young people with anorexia present to hospital in a seriously compromised physical condition. While their physical symptoms require urgent treatment, addressing their emotional and psychological needs is equally important if they are to progress towards recovery. However, the conflicting thoughts common in anorexia mean that young people often feel highly ambivalent about treatment, which makes the disorder particularly challenging to treat. This article details a literature review undertaken to explore the perceptions and experiences of young people who have received hospital treatment for anorexia, with the aim of offering children's nurses insights into how they can optimally support these patients. The findings demonstrate the importance of listening to young people, treating them as individuals and understanding their experiences, in addition to addressing their physical health needs.
Topics: Adolescent; Anorexia; Anthropology, Cultural; Child; Female; Humans; Quality of Health Care
PubMed: 33283489
DOI: 10.7748/ncyp.2020.e1313