Aminah Jatoi, MD

Many patients with advanced cancer undergo a wasting syndrome associated with cancer anorexia/cachexia and asthenia. In defining these terms a bit further, anorexia is associated with a marked loss of appetite and/or an aversion to food.

Epidermal growth factor receptor (EGFR) inhibitors have emerged as important drugs in cancer therapy, providing a proven survival advantage for some patients with non–small-cell lung cancer, colorectal cancer, head and neck cancer, and pancreas cancer.

Dr. McTiernan provides a comprehensive,thoughtful overviewof several studies thathave focused on obesity and cancer.She discusses the preponderance ofdata that have shown both a directrelationship between obesity and thedevelopment of cancer as well as adirect relationship between obesityand cancer recurrence. Although bothrelationships are clinically relevant,the latter is particularly important tocancer health-care providers. Today,more than ever before, cancer patientsare diagnosed early and treated effectively,thereby yielding a sizable cohortof cancer survivors and potentialcancer survivors.[1] Understandingthe relationship between obesity oroverweight status and cancer recurrenceis now more timely than it hasever been.

In a recent study, Wolfe and others interviewed 103parents of children who had died from cancer.[1]Approximately 80% of these children suffered anorexia,or loss of appetite. Over 35% of parents identifiedanorexia as a cause of distress for their child whena physician failed to recognize it. Wolfe and othersconcluded,"greater attention to symptomcontrol.…might ease…suffering." In adults, the syndromeof cancer anorexia/weight loss is no lesspervasive, and no less distressing. Anorexia is one ofthe most deleterious symptoms, surpassed only bypain and fatigue.[2] The majority of adults withadvanced cancer suffer from it toward the end of life.Among all cancer patients-regardless of age orcancer type-"greater attention to [the anorexia/weightloss syndrome]…might ease…suffering."

Loss of appetite and weight predict a poor prognosis for cancer patients. Although caloric supplementation might benefit subgroups of patients-specifically, perioperative, severely malnourished cancer patients, stem cell and