Overview of Cachexia- Wasting Syndrome

Cachexia, or “wasting syndrome,” refers to the marked weight loss in patients diagnosed with a serious illness, like cancerHIV/AIDScongestive heart failurerheumatoid arthritis, tuberculosis, chronic obstructive pulmonary disease, cystic fibrosis, and Crohn’s disease. With cachexia, normal nutritional support isn’t effective at reversing the loss in mass. The syndrome is a serious one, as patients with cachexia generally respond poorly to treatments like chemotherapy and therefore have a shorter survival time.

According to Cancer Cachexia Hub, cachexia is a complex syndrome that can be caused by a combination of factors, including ones that are disease-related like digestive problems, treatment-related like the nausea and vomiting, and patient-related like distress and depression.

In early stages of cachexia, patients will notice just slight losses in appetite and body weight. Anorexia, while not a cause of cachexia, is commonly an associated with patients with cachexia.

Over time, as the condition gets worse, the patient consumes even less food and experiences greater weight loss. Severe stages are marked with obvious muscle wasting. Because of mass loss, those with cachexia also experience an overall poor quality of life due to weakness, fatigue, respiratory complications and a general disinterest in participating in social activities.

Cachexia is commonly associated with the final stages of cancer because of body’s immune system response. The interaction between the cancer cells and with the immune system’s pro-inflammatory cytokines (protein molecules that signal cells to produce an inflammatory reaction) lead to cachexia. This interaction can accelerate the loss of skeletal muscle.

Findings: Effects of Cannabis on Cachexia-Wasting Syndrome

Common treatment methods for cachexia include hypercaloric or intravenous feeding and the administration of appetite-stimulating medications like growth hormones, testosterone and progesterones. The cannabinoids found in medical cannabis has also proven to be effective at boosting appetite8. The cannabinoids interact with the body’s endocannabinoid system, a signaling system responsible for regulating food intake5,7,8. Cannabis contains the cannabinoid tetrahydrocannabinol, or THC, which influences the neural networks to convince the brain that it’s hungry.

THC has shown to significantly stimulate appetite in patients that have cachexia related to cancer6,9,11. In addition, medical marijuana has demonstrated effective at increasing appetite and stabilizing body weight in AIDS-cachexia patients1,3.

Evidence also suggests that cannabis may help cachexia patients increase their energy and physical activity levels, which in turn could lower the risk of atrophy and improve mood. A 2015 study found that adult women with severe anorexia nervosa treated with cannabis medication saw a modest increase in physical activity2.

In addition, medical marijuana may potentially help lower the risk of cachexia developing. Because of its anti-nausea effects, patients may be more inclined to eat regularly and because of a lack of vomiting, are more able to absorb nutrients and calories13.

References

  1. Abrams, D.I., Jay, C.A., Shade, S.B., Vizoso, H., Reda, H., Press, S., Kelly, M.E., Rowbotham, M.C., and Petersen, K.L. (2007, February). Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology, 68(7), 515-21. Retrieved from http://safeaccess.ca/research/pdf/hiv_pain_cannabis_abrams.pdf.

  2. Andries, A., Gram, B. and Stoving, RK. (2015, March). Effect of dronabinol therapy on physical activity in anorexia nervosa: a randomised, controlled trial. Eating and Weight Disorders, 20(1), 13-21. Retrieved from http://link.springer.com/article/10.1007%2Fs40519-014-0132-5.

  3. Beal, J.E., Olson, R., Laubenstein, L., Morales, J.O., Bellman, P., Yangco, B., Lefkowitz, L, Plasse, T.F., and Shephard, KV. (1995, February). Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. Journal of Pain and System Management, 10(2), 89-97. Retrieved from http://www.jpsmjournal.com/article/0885-3924(94)00117-4/pdf.

  4. Cachexia (n.d.). Patient. Retrieved from http://patient.info/doctor/cachexia.

  5. Cota, D., Marsicano, G., Lutz, B., Vicennati, V., Stalla, G.K., Pasquali, R., and Pagotto, U. (2003). Endogenous cannabinoid system as a modulator of food intake. International Journal of Obesity, 27, 289-301. Retrieved from http://www.nature.com/ijo/journal/v27/n3/full/0802250a.html.

  6. Jatoi, A., Windschitl, H.E., Loprinzi, C.L., Sloan, J.A., Dakhil, S.R., Mailliard, J.A., Pundaleeka, S., Kardinal, C.G., Fitch, T.R., Krook, J.E., Novotny, P.J., and Christensen, B. (2002). Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. Journal of Clinical Oncology, 20(2), 567-73. Retrieved from http://ascopubs.org/doi/full/10.1200/JCO.2002.20.2.567.

  7. Koch, M., Varela, L., Geun Kim, J., Dae Kim, J., Hernández-Nuño, F., Simonds, S.E., Castorena, C.M., Vianna, C.R., Elmquist, J.K., Morozov, Y.M., Rakic, P., Bechmann, I., Cowley, M.A., Szigeti-Buck, K., Dietrich, M.L., Gao, X.-B., Diano, S., and Horvath, T.L. (2015, March 5). Hypothalamic POMC neurons promote cannabinoid-induced feeding. Nature, 519, 45-50. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496586/.

  8. Mechoulam, R., Berry, E.M., Avraham, Y., Di Marzo, V., and Fride, E. (2006). Endocannabinoids, feeding and sucking – from our perspective. International Journal of Obesity, 30, S24-S28. Retrieved from http://www.nature.com/ijo/journal/v30/n1s/full/0803274a.html.

  9. Mechoulam, R., and Hanus, L. (2001). The cannabinoids: An overview. Therapeutic implications in vomiting and nausea after cancer chemotherapy, in appetite promotion, in multiple sclerosis and in neuroprotection. Cannabinoids, 6(2), 67-73. Retrieved from http://downloads.hindawi.com/journals/prm/2001/183057.pdf.

  10. Morgan, C.J., Freeman, T.P., Schafer, G.L., and Curran, H.V. (2010). Cannabidiol Attenuates the Appetitive Effects of Δ9-Tetrahydrocannabinol in Humans Smoking Their Chosen Cannabis. Neuropsychopharmacology, 35(9), 1879–1885. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906701/.

  11. Nauck, F., Klaschik,E. (2004, June). Cannabinoids in the treatment of the cachexia-anorexia syndrome in palliative care patients. Schmerz, 18(3), 197-202. Retrieved from http://link.springer.com/article/10.1007%2Fs00482-003-0277-z.

  12. What causes Cancer Cachexia? (n.d.). Cancer Cachexia Hub. Retrieved from http://www.cancercachexia.com/what-causes-cancer-cachexia.

  13. Woodridge, E., Barton, S., Samuel, J., Osario, J., Dougherty, A. and Holdcroft, A. (2005, April 20). Cannabis use in HIV for pain and other medical symptoms. Journal of Pain and Symptom Management, 29(4), 358-67. Retrieved from http://www.jpsmjournal.com/article/S0885-3924(05)00063-1/pdf.

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