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Generally speaking, cancer will give people the impression of losing weight and losing appetite. In fact, most cancer patients will experience this situation. So far, due to the side effects of anticancer drugs and the development of cancer, cancer patients can do nothing to lose weight and lose appetite.
But in recent years, it has been found that this is a complication of cancer cachexia, and the importance of treatment has begun to be paid attention to. Because early treatment of cancer cachexia can improve the quality of life (QOL) and improve the prognosis.
In April this year, its therapeutic drug "cancer cachexia" was listed in Japan for the first time, attracting worldwide attention.
Professor Koichi Takayama, president of cachexia department of Japanese Society for Cancer Support and Nursing and professor of respiratory medicine at kyoto prefectural university of medicine University, who conducted the drug test, said: "The weight of cancer patients is basically declining, but through the treatment of this drug, the weight of patients has increased. The patient himself is very happy, but it is also a very happy surprise for me. "
The name of the drug is "Erdogan (common name: epinephrine hydrochloride)". It was developed by Helsinn, a Swiss pharmaceutical company, and sold in Xiaoye pharmaceutical industry under a license contract.
What is "cancer cachexia"? To put it simply, you are not losing weight, but you have symptoms such as weight loss, muscle loss, loss of appetite, and various disorders and metabolic abnormalities. The etymology of cachexia means "bad state" in Greek. Cachexia sometimes occurs in heart disease, kidney disease and chronic obstructive pulmonary disease, but most of them are caused by cancer, which is called "cancer cachexia".
There are also risks of weight loss, weakness and pneumonia.
Internationally, it is defined as "multifactorial syndrome characterized by incomplete recovery through routine nutritional support, which leads to progressive sexual dysfunction and continuous reduction of skeletal muscle mass". Skeletal muscle refers to the muscle along the skeleton, which is needed for standing, walking and waiting for action.
"Malignant body fluids account for about 50-80% of patients with malignant tumors. Different types of cancer have different risks and are prone to pancreatic cancer, gastric cancer, esophageal cancer, head and neck cancer and lung cancer. In breast cancer and prostate cancer, it is difficult to occur before the disease develops to a serious degree. The problem of cancer fluid quality is that if you lose weight, you are weak, you can't get active treatment, and you are prone to pneumonia and other complications, so the prognosis is very poor. According to a paper, a quarter of cancer patients are killed by cancer fluid. " (Professor Takayama)
Once the liquid quality of cancer deteriorates, people will avoid meeting acquaintances or eating out because they don't want to be seen as slim and let others know that they can't eat. In addition, if the skeletal muscle is reduced, the walking speed will be reduced, and it will be difficult to walk, which will also bring obstacles to daily life.
Loss of appetite sometimes leads to friction between family members. The idea that family members want to give me food but can't give me food is opposite to the idea that patients want to eat but can't eat.
In order to eliminate the pressure among family members, not be isolated by society and not reduce the quality of life, it is very important to start treating cancer fluid as soon as possible.
Diagnostic criteria are
What is the mechanism of cancer fluid? Professor Gao Shan explained this.
"Cancer cachexia leads to weight loss because cancer promotes the decomposition of fat, and muscle synthesis is also reduced due to decomposition. Because of cancer, it will be chronically inflamed. As an immune response to protect the body, inflammatory cytokines will be activated, which will cause this metabolic abnormality. In addition, cancer cells themselves secrete substances that promote the decomposition of fat and muscle and accelerate metabolic abnormalities. In other words, once cancer cachexia occurs, even in a quiet state, energy will always be used to decompose into unburned skeletal muscle. "
To make matters worse, when the cancer fluid worsens, inflammatory cytokines and fat cells will secrete appetite-suppressing substances to the hypothalamus of the brain, so the appetite will also decrease. I have no appetite, and I have been losing weight even if I can eat.
So, how should cancer patients judge whether they are cancer cachexia? Because cancer fluid is always pathological, it can only be judged according to symptoms such as weight loss. According to the current diagnostic criteria, if one of the following three items is met, it is judged as cancer cachexia.
(1) The loss in the past six months exceeded 5%.
(2) The body mass index (body mass index, weight-height-height) is less than 20, and the weight loss exceeds 2%.
(3) The weight loss of carnosine exceeds 2%.
Three stages of performance improvement
In addition to these diagnostic criteria, the Japanese Society for Cancer Support and Nursing also suggested that doctors and nurses should consult immediately when they feel weight loss or loss of appetite.
"no appetite"
"I will be full soon after eating."
"I'm eating, but I'm losing weight."
"The pants and skirts I wore before I got cancer were all loose."
"I always feel tired"
"Decreased muscle strength"
"Grip strength and walking speed are declining"
"Abnormal taste and abnormal smell"
"Nausea and vomiting"
"I am not motivated and often depressed."
Wait a minute. Symptoms.
Professor Gao Shan said,
"Another problem with cancer cachexia is that cancer patients don't care much about losing weight. Previous online surveys showed that few people consulted doctors and nurses about loss of appetite and weight loss, and more than half of the patients answered the reason "I don't think it is necessary to consult". Weight loss is directly related to the prognosis of life. Don't take it lightly, pay attention to the change of weight. "
In addition, the cancerous liquid has three stages indicating the degree of progress. Although it is not enough to be diagnosed as cancer fluid, there are three kinds of cachexia, cachexia meeting the above diagnostic criteria and unresponsive cachexia which is difficult to be treated by anticancer drugs.
"In reality, the boundaries of these three stages are very vague, and gradually transition to unresponsive and evil liquid quality. Many medical staff have the impression that cancer cachexia is unresponsive cachexia, but it can be said that it is quite difficult here. Therefore, in order to continue to treat cancer, it is very important to start treatment as early as possible in the early stage of cachexia to prevent a sharp weight loss. " (Professor Takayama)
Therapeutic drugs have appeared.
However, although it is said that treatment should be started, so far, there are only nutrition therapy and exercise therapy, and there is no effective drug to treat cancer cachexia. Because of this, the therapeutic drugs that are recognized and sold for the first time in the world are highly anticipated.
"Erdo? an (common name: epinephrine hydrochloride)" is considered as a hunger hormone-like drug. Auxin refers to hormones related to appetite and body structure. When hungry, it is mainly secreted by the stomach, which acts on the brain to increase appetite and promote the secretion of growth hormone, thus increasing muscle mass. In other words, "Erdogan" is a drug, which plays the same role as a useful hormone.
"The idea of using puerarin as medicine has a long history, but it is difficult to develop puerarin into medicine because its active time in blood is too short. Adrenaline is very useful because it plays the same role as it and exists stably in the blood for a long time. " (Professor Takayama)
Erdo? an is an oral drug, which is taken twice a day on an empty stomach (100mg). At present, it is suitable for cancer fluids of non-small cell lung cancer, gastric cancer, pancreatic cancer and colorectal cancer.
Professor Gao Shan has been engaged in clinical trials of this drug since about 20 10. First, 174 patients with malignant ascites from non-small cell lung cancer were divided into 84 adrenaline groups and 90 placebo (counterfeit drugs) groups, and were given 12 weeks.
The experimental results showed that the average fat-free weight (skeletal muscle) of adrenaline group increased by 65438±0.38kg. The average weight loss of placebo group was 0. 17 kg, with significant difference. Adrenaline group gained weight in the first 3 weeks, and maintained 12 weeks weight in this state. In this experiment, QOL was also investigated and it was found that appetite increased significantly.
There are also cases where the weight has increased by 8 kilograms.
In addition, 49 cancer cachexia patients with digestive organ cancers (gastric cancer, colorectal cancer and pancreatic cancer) were tested. After injection of epinephrine 12 weeks, it was found that the "responders" (patients with confirmed curative effect) who gained or maintained fat weight before injection reached 63.3%, with an average increase of 1.89 kg.
"Patients with quick response, 1~2 days will improve their appetite. Some patients also reported that "doctor, I am eating very well now" and it was also welcomed by my family. Through the experiment, it not only becomes easy to absorb energy, but also leaves a refreshing impression on me as a whole. In the case of obvious weight gain, people who lost 45 kilograms recovered to 53 kilograms. The increase of 8 kilograms, we did not expect to increase to that extent. "
Professor Gao Shan recalled in surprise.
In addition, as the side effects of drugs, there are abnormal ECG, worsening diabetes, abnormal liver function and so on. Abnormal ECG is mainly manifested as bradycardia, slow pulse and basically unconscious symptoms. As for the deterioration of diabetes, one example is that the blood sugar level rises at a frequency of about 5%. In addition, although there are abnormal liver function test values, no patients need treatment.
"Although there are side effects, the greater role of drugs is the result of experiments. However, in clinical trials, the subjects are relatively healthy people, so there is no data to show how much side effects patients with poor cancer will have. In this regard, I think it is necessary to carefully judge the drug supervision while observing the after-sales survey data. "
In addition, due to heart diseases such as myocardial infarction and angina pectoris, it is impossible to take therapeutic drugs, and it is necessary to inform the attending doctor of the treatment experience when taking them.
"Eating is the vitality of survival"
Although it seems to be a successful experiment, it also creates a problem. Due to drug treatment, the amount of skeletal muscle increased, but the muscle strength did not improve. In the experiment, the grip strength and 6-minute walking were investigated, but there was no significant difference between adrenaline group and placebo group.
"As a big topic, this still exists today. In our opinion, if we don't exert a certain degree of load on muscles, we can't restore muscle strength that is useful for daily life. I guess it is not enough to increase the amount of skeletal muscle to improve muscle strength. You need exercise training. Therefore, now we have developed an exercise program to improve muscle strength, and we are still conducting clinical trials to introduce this exercise while injecting adrenaline. "
Professor Gao Shan said that we should deal with this problem.
If the effectiveness of improving muscle strength through exercise training is confirmed, it will be recommended as a supplementary therapy for therapeutic drugs.
In any case, for cancer patients, cancer cachexia can be improved by therapeutic drugs, which is good news. Now, as mentioned above, the therapeutic drug "Erdogan" is suitable for a limited number of cancers. Because it is aimed at the type of cancer being tested, it is possible to expand the adaptive cancer types if the results are obtained from other types of cancer in the future.
"This drug is not a drug that directly treats cancer, but if you have a good appetite and can eat it, the weakness caused by weight loss will be alleviated, and the number of patients who expect to continue to treat cancer that has to be interrupted will increase. Therefore, it is possible to improve prognosis and prolong life. However, I think it is a great advantage to improve the quality of life of patients. Eating will bring vitality to survival. I strongly felt this through this trial of therapeutic drugs. "
Professor Gao Shan said with true feelings.
Being thin because of cancer is not a force majeure, but a disease that can be improved. Indeed, the side effects of anticancer drugs and radiotherapy, as well as the depression caused by the development and recurrence of cancer, will lead to loss of appetite and weight loss. But if the treatment comes to an end, the appetite does not recover and the weight continues to drop, that is the liquid cause of cancer.
Only by correctly understanding this point and using therapeutic drugs to improve the condition can we solve the problems of cancer patients. If you find yourself thin, how about consulting the doctor and nurse in charge first? Therefore, it is also important to support the understanding of the families of cancer patients.