・悪液質の定義 Cancer cachexia is a multi-factorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. The pathophysiology is characterized by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism.
Refractory cachexia is characterised by a low performance status (WHO 3 or 4) and life expectancy less than 3 months.
不応性悪液質診断基準も図に示しましたが、以下の通りです。
Fulfil critera for cachexia definition:悪液質の診断基準に該当 Prognosis < 3 months:生命予後が3カ月未満 Performance status WHO 3 or 4:PSが3か4 Unresponsive to anti-cancer therapy:抗がん治療の効果がない Ongoing catabolism at increasing rate:異化が進んでいる Unsuitable for artificial nutritional support:人工的栄養サポートの適応がない
Recommendation In cancer patients, physical training and other physical treatment options are beneficial as a preventive procedure to maintain functional status. The activities and training interventions have to be individualized (overall level of recommendation: strong positive; mean consensus 7.92). However, most research has been done in patients treated with curative intent, and it is not clear to what extent physical training is appropriate in patients with advanced cancer/refractory cachexia.