It’s Not Just Loss of Arm Strength But Also Your Heart Strength That’s Affected
At First Dayton Cancer Care, I see and treat many patients with head and neck cancer each and every week. I tell them that the big battle ground will be nutrition. I tell them I don’t want to see them lose weight because it will be muscle rather than fat that they will lose. After I tell my patients about all the side effects of chemotherapy and radiation treatment, an overwhelming experience to say the least, many patients just smile and say “I need to lose a few pounds anyway.”
Unintentional weight loss in cancer patients-called cachexia-not only results in loss of muscle mass but also may account for loss of heart muscle function. Cachexia is defined as >5% weight loss and 3 of 5 other factors-loss of muscle strength, fatigue, lack of appetite, loss of muscle mass, low albumin and high C-reactive protein. In a remarkable summary of many studies, Dr. Couch and colleagues showed the cachexia is a major factor in the death of many head and neck cancer patients (Head Neck; 2015; 37: 594-604). The surprising finding is that heart trouble related to cancer weight loss may account for up to 20-30% of head and neck cancer patient’s deaths. Even if they are first cured of their cancer.
My clinical instinct over the years was that nutrition was one key to survival. But I never thought that weight loss in cancer patients could affect their hearts to such an extent. If Dr. Couch’s studies hold up, head and neck cancer specialists will lose up 30% of patients from cachexia, not cancer. But even more frustrating is the fact that while intentional weight loss is fixable by good nutrition alone, cachexia or unintentional weight loss in cancer patients, is not. So much more medical work and research is needed here.
Don’t get me wrong. The medical and technological breakthroughs in head and neck cancer care have been nothing short of miraculous over the past decade. But I think head and neck cancer specialists need to take nutrition, especially new ways to battle cachexia, much more seriously than in the past.
Diagnosing Cachexia-Related Muscle Loss Is Not As Easy As You May Think
Diagnosing muscle loss seems easy, doesn’t it? Plain and simple. Just have the doctor or nurse weigh you and examine you. And taking a good medical history may help. But it’s not just that easy.
As head and neck cancer doctors, we rely “heavily” on BMI or body mass index-a formula based on height and weight. The BMI alone may mislead cancer doctors, especially in men who have more muscle mass than women. That’s also true in men and women who are obese – underestimating loss of muscle mass. The change in BMI alone is likely to be misleading as a measure of loss of muscle mass or cachexia. In fact, the gold standard for body composition assessment- a CT scan of the lower spine and pelvis- is rarely used to diagnose cachexia related loss of muscle mass. I know of not a single cancer clinic in the country that uses CT scans to assess body composition to diagnose cachexia in cancer patients.
CANCER CACHEXIA =
3 or more symptoms + Weight Loss > 5% within 12 months
- Loss of Appetite
- Decreased Muscle Strength
- ↑CRP or ↓ Albumin
- Low Fat-Free Muscle Mass on CT Scan
So What Can A Head and Neck Cancer Patient Do to Diagnose Cachexia?
First and foremost, be upfront and honest with your head and neck cancer specialist. Do tell your doctors about any loss of muscle strength, fatigue, and lack of appetite. Ask your doctor about blood tests that measure if you are anemic, have a low level of the blood protein called albumin, or increase in the level of the broad protein called C-reactive protein or CRP for short.
The syndrome of cachexia in head and neck cancer patients-unintentional weight loss, loss of muscle mass, anemia, lack of appetite, and fatigue-is all too common. But what is starting to be learned about this cancer syndrome may also have profound effects on your heart muscle, resulting in 20-30% of deaths in head and neck cancer patients.
So much more time and money for medical research into cachexia is long overdue.