Pharmacological and non-pharmacological interventions improve food intake in cancer related anorexia and cachexia.

Main results 7 clinical trials of non-pharmacological interventions, 4 reviews of pharmacological interventions and exercise, 1 meta-analysis of nursing symptom management, and 3 general overviews met the selection criteria. Nonpharmacological interventions: 7 randomised controlled trials (RCTs) (n=558) compared nutritional counselling and/or commercial oral liquid supplements with various control interventions. All 7 studies reported improved caloric intake with nutritional counselling and oral liquid supplementation. No differences were found for survival, tumour response, or nutritional status. 4 of 5 studies found no differences for weight loss, and 1 study (n=26) reported that progressive weight loss was stopped in patients with advanced cancer who received nutritional counselling and liquid oral supplementation. 2 of 2 studies found no differences for quality of life. Pharmacological interventions: 3 reviews addressed the effectiveness of 4 drug classes: progestational agents (megestrol acetate and medroxyprogesterone), corticosteroids, hydrazine, and cyproheptadine. Megestrol acetate, 160–1600 mg/day, improved appetite, caloric intake, body weight (mostly fat), and sensation of wellbeing (11 placebo controlled studies). Studies of medroxyprogesterone acetate, 300– 1000 mg/day, showed similar results. Both drugs commonly caused oedema as a side effect. A review of 5 randomised placebo controlled trials found that corticosteroids improved appetite, food intake, performance, and quality of life in the short term ( ≤ 4 wks), but did not affect weight. This review also identified 6 placebo controlled trials of hydrazine and reported that recent large placebo controlled trials found no increases in body weight, but did find toxicity and a decline in quality of life. 1 placebo controlled trial (n=295) found that cytoheptadine resulted in small increases in appetite, food intake, and sedative effects.Physical activity interventions: in a review of 18 small studies (10 quasi-experimental and 8 experimental, mean 25 participants/study), 16 studies found that aerobic exercise improved quality of life, functional capacity, muscle strength, body composition, and haematological indicators, and reduced nausea, fatigue, diarrhoea, anxiety, and depression.