Stephanie M. Harman, MD, FACP

Delirium is a common symptom in patients with advanced cancer; studies note the incidence of delirium as high as 88% in inpatient deaths due to cancer. It is an independent risk factor for poorer prognosis and a predictor of impending death when patients are in the last phase of their illness. It is a source of much distress for patients and families and can preclude a patient’s wish to die at home due to the challenges in treating these patients. Up to half of delirium episodes go unrecognized or misdiagnosed.

Anorexia-Cachexia Syndrome, or ACS, affects up to 80% of patients with advanced cancer. Although definitions vary, ACS is often described as a weight loss of 5% of a patient’s pre-illness weight over a two-month to six-month period. ACS causes both physical and psychological distress and is often associated with other symptoms, including nausea, early satiety, fatigue and change in body image. In a 1980 retrospective study of over 3,000 ECOG trial participants by Dewys et al, pretreatment weight loss of 5% was associated with early mortality independent of staging, functional status or tumor histology. ACS can be categorized as primary or secondary. Primary ACS results from a hypermetabolic state caused directly by the cancer. Secondary ACS results from cancer-related barriers that reduce dietary intake, such as nausea/vomiting, mucositis, changes in taste/smell from chemotherapy, etc. This article will focus on primary ACS.

Stephanie Harman