ACS The Context

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ACS The Context

• Dr. Colette Hawkins
• Macmillan Consultant in Palliative Medicine

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What are we talking about?

• Cachexia
• presence of involuntary weight loss
• percentage weight loss compared with pre-illness
  weight
• speed of weight loss over time
• preferential loss of muscle and visceral protein
• Occurs in diseases other than cancer

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Underlying pathophysiology

• Complex!
• Cytokines and tumour products lead to
• inflammation, lipolysis, proteolysis and
  disordered metabolism (energy wasting)
• Anorexia / early satiety (reduced energy intake)
• Tumour Necrosis Factor
• Proteolysis Inducing Factor
• Lipid Mobilising Factor
• Interleukins
• Macrophage inhibitory cytokine-1 (Nat Med 11/07)

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What are we talking about?

• Anorexia-cachexia syndrome
• Anorexia
• Cachexia
• Range of additional symptoms
• chronic nausea
• early satiety (feeling full quickly)
• muscle weakness
• fatigue
• mouth problems

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Remember

• Underlying pathophysiology is well established
  before the patient loses weight.
• Even patients without weight loss may be at risk
  of rapidly progressive ACS
• Ideal to catch patients before weight loss
• Good basic care
• Block the underlying pathophysiology (the future)

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Scale of the problem

• 80 of patients with upper GI cancer and 60 with
  lung cancer have established ACS at diagnosis
• 36 of patients and 87 of their carers find
  anorexia worrying for many carers, this is their
  greatest source of concern

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The key issues

• Significant symptom burden for patients (IA)
• Major psychosocial issues affecting both patients
  and carers (JH)
• Uncertain approaches to the assessment and
  management of ACS by healthcare professionals (DC)

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Macmillan Durham Cachexia Project

• 3 year funding multi-disciplinary input
• Series of projects
• Auditing symptom burden/prescribing
• Questionnaire study of staff approaches to
  assessment and management of ACS
• Development of assessment/management tools
• Studies of impact of standardised assessment and
  management tools on symptom burden for patients
  and their experience of ACS generally
• Development of Durham Cachexia Pack

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Where do we go from here?

• Tools not the sole answer
• AWARENESS
• MORE POSITIVE APPROACH TO ASSESSMENT/MANAGEMENT
• BETTER COMMUNICATION WITH PATIENTS AND CARERS
  ABOUT THE PROBLEMS THEY FACE
• Tools are a step to facilitating these.

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Today

• May challenge you
• Comments welcome
• Share ideas for good practice
• Encourage you to drive an improvement in
  standards in your place of work
• Share our passion and determination and leave
  knowing that YOU CAN make a difference