Radbruch, L., Elsner, F., Trottenberg, P., Strasser, F., & Fearon, K. (2010). Clinical practice guidelines on cancer cachexia in advanced cancer patients. Retrieved from www.epcrc.org/getpublication2.php?id=TERNkkdssZelXeVZGTkB

 

Purpose & Patient Population

PURPOSE: To provide a consensus and evidence-based set of clinical guidelines for management of cachexia in patients with advanced cancer
 
TYPES OF PATIENTS ADDRESSED: Patients with advanced cancer and refractory cachexia

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: Development according to NICE recommendations. An international expert group identified clinical priorities and questions to scope literature reviews. The draft was made available for public input. GRADES was used to identify the level of evidence and formulate draft recommendations. Consensus on recommendations was obtained using a Delphi technique. The specifics of the literature search strategy are not provided.

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life/palliative care
 
CLINICAL APPLICATIONS: Palliative care

Results Provided in the Reference

No information about results of literature searching are provided.

Guidelines & Recommendations

The majority of recommendations are for the treatment of cachexia. Those recommendations that speak to anorexia are:
  • Cannabinoids may increase appetite in selected patients, but there is insufficient overall evidence to support their use.
  • Progestins seem to stimulate appetite and increase body weight. Progestins should be considered for patients with anorexia.
  • Steroids may be beneficial for stimulation of appetite; however, they should be used for short periods, with a maximum of two weeks.

Limitations

There was limited reporting and no summary of the evidence base for recommendations in this document.

Nursing Implications

This review provides weak evidence that shows no support for use of cannabinoids to improve appetite in patients with cancer. Individual patients may report some benefit of cannabinoids in terms of appetite, but there is no real evidence to support efficacy for this symptom.