Illustration by Heff O’Reilly
You might think malnourishment doesn’t exist anymore, or that it’s uncommon,” says Dr. Vickie Baracos, the Alberta Cancer Foundation’s chair in palliative medicine. But in western countries malnourished people are usually that way as a consequence of disease.
Cancer is the disease most associated with malnutrition, leading to wasting syndrome in patients. It affects nearly half of cancer patients and is the cause or strong contributing factor in many cancer-related deaths.
Wasting, also called “cachexia,” is disease-associated malnutrition. Its characteristic loss of body weight, particularly in loss of muscle, is involuntary and cannot be treated with conventional nutrition alone.
“Muscle wasting is not on people’s minds and people are not often aware of it,” says Dr. Baracos. “But many people with cancer can have terrible loss of muscle, causing weakness and fatigue, and loss of physical function to the point they need help to move about.”
The effect of this weakened state makes the body less resistant to stress, resulting in a lower tolerance to cancer treatment, sometimes to the point where the patient needs to stop treatment. The loss of independence combined with the inability to engage in normal daily activities, such as sitting at the dinner table and eating with others, can also present a psychological and social impact.
“Your ability to enjoy food is lost, your weight is lost,” Baracos says. “Your body image can be changed and reflect on your overall well-being.”
Her studies on the effects of malnutrition and weight loss in cancer patients have made her a leading expert on the topic. One of her significant contributions is in the use of imaging techniques to detect loss of muscle mass and diagnose cancer-related wasting, diagnosis being one of the primary challenges researchers face.
“Muscle wasting is difficult to detect since it is hidden behind the fat mass on the body and is not obvious to the naked eye,” she explains. “Using CT images and magnetic resonance imaging (MRI), we’re able to diagnose severe muscle wasting.”
Baracos finds advancements in the testing of nutritional and drug therapy encouraging and she predicts new treatments for cachexia are imminent. Her research team has played a role in developing nutritional status profiles and the use of supplements to reverse muscle wasting. Because nutritional intervention is only as effective as the state of a patient’s appetite, there are also clinical trials currently being conducted to test drugs which could increase appetite and even build muscle mass.
Dr. Michael Sawyer, medical oncologist at the Cross Cancer Institute who has partnered with Dr. Baracos in the study of drug therapies to reduce muscle wasting, says the impact of the research has garnered lots of international interest.
“It’s not applicable to all cancers, but it could potentially reverse muscle wasting in a few patients. This would be very important, as progressive muscle wasting is how most patients die,” he says. “It can lead to respiratory failure.”
Pinpointing the factors that increase susceptibility to wasting is another crucial step since it could lead to a more tailored and effective approach to assessing and treating cancer patients. Published findings by Baracos’s team revealed some cancer patients are more likely than others to experience malnutrition and weight loss.
“If you know the markers for susceptibility, you can test those markers and can tell in advance who is at risk,” she says. “It becomes extremely important to find out whether individual cancers or individual people are going to need more care, more attention and more specific treatment.”
Team members in cancer and nutrition research who worked together towards this common purpose made progress possible, says Baracos. Describing herself as the “mother hen,” she has worked hard to connect efforts around the world to develop an international cancer cachexia network.
“There’s never been a huge focus on this, so someone has to increase the research capacity and potential,” she says. Collaboration is the key to Baracos’s efforts.
“Together we bring a lot of approaches and methods to advance quickly.”
Patients will be the real beneficiaries.