Cancer cachexia and targeting chronic inflammation: a unified approach to cancer treatment and palliative/supportive care.

Chronic inflammation often acts as a tumor promoter, resulting in aggressive cancerous growth and spread. Many of the same inflammatory factors that promote tumor growth also are responsible for cancer cachexia/anorexia, pain, debilitation, and shortened survival. A compelling case may be made for mounting an attack on inflammation with other anticancer measures at initial diagnosis, with the consequent probability of improving both patient quality of life and survival. High serum levels of the inflammatory marker C-reactive protein or fibrinogen and an elevated white blood cell count correlate with poor prognosis and may be used as a prognostic index to establish the need for nutritional/metabolic intervention. At the author's institution, a concerted effort is being made to screen all newly diagnosed patients with non-small cell lung cancer for the presence of nutritional problems, inflammatory markers, and related symptoms. Interventions include dietary counseling; nutritional and, if warranted, vitamin supplementation; exercise concordant with the patient's physical condition; a prescription for omega 3 fatty acids if inflammation is present, and general symptom management. To establish the value of early nutritional/metabolic intervention, clinical trials are needed that combine measures that combat cachexia and inflammation with first-line chemotherapy in patients who present with weight loss, fatigue, and deteriorating function.