ABSTRACT
Cachexia is a common cause of involuntary weight loss in advanced cancer. It is defined by muscle loss and leads to declined physical function. A classification of three stages (precachexia, cachexia and refractory cachexia) is proposed. Manifest cachexia requires both standard management and pharmacologic and nutritional interventions. Cachexia becomes refractory if the underlying disease is far advanced, rapidly progressive, and unresponsive to treatment, and catabolism so increased that weight loss management is not possible or indicated. Refractory cachexia can often only be diagnosed after a defined treatment attempt. The emotional and existential burden of the patients and their carers is often underestimated and can be overwhelming. In refractory cachexia therapeutic interventions focus on alleviating symptoms and avoiding complications. This often includes discontinuation of nutritional treatment attempts. Psychosocial counseling at this stage becomes essential.
