Management of Cancer Cachexia: ASCO Guideline.
Level 1 - systematic review of randomized trials
Systematic review of randomized controlled trials informing a clinical practice guideline
PubMed 32432946 · doi:10.1200/JCO.20.00611
What was done
An American Society of Clinical Oncology (ASCO) expert panel conducted a systematic review of PubMed and Cochrane Library databases (1966 through October 17, 2019) to evaluate nutritional, pharmacologic, and exercise interventions for cancer cachexia in adults with advanced cancer. The search was restricted to randomized controlled trials (RCTs) and systematic reviews of RCTs. The panel synthesized findings from 20 systematic reviews and 13 additional RCTs to establish clinical recommendations.
What was found
The abstract reports no numerical effect sizes, risk ratios, or confidence intervals. Progesterone analogs and short-term (weeks) corticosteroids were associated with improvements in appetite and/or body weight. Dietary counseling, with or without oral nutritional supplements, improved body weight in some trials. Other evaluated interventions showed no clear benefit or lacked sufficient evidence. The panel recommended against routine enteral feeding tubes and parenteral nutrition, and concluded that no pharmacologic intervention can be recommended as a standard of care.
Why it matters
This guideline clarifies that invasive artificial nutrition is not routinely indicated for cancer cachexia, while limiting acceptable pharmacologic options to cautious, short-term trials of progesterone analogs or corticosteroids.
Limits
The abstract provides no quantitative data. The underlying evidence base is constrained by high patient dropout rates typical of advanced cancer populations, substantial heterogeneity in outcome definitions, and variable assessment methods across trials.
Cited by
- supports Nutritional and supplement interventions have shown limited success in treating or reversing cancer cachexia.