Management of Anorexia-Cachexia Syndrome in a Community Palliative Care Support Team.

Background/

Objectives

Anorexia-Cachexia Syndrome (ACS) is a multifactorial condition common in advanced chronic illnesses, leading to significant impacts on prognosis and quality of life. This retrospective cohort study aimed to evaluate the prevalence, management strategies, and clinical and patient-centered outcomes of ACS in a home-based palliative care team.

Methods

Clinical records of 128 adult patients followed between 2021 and 2024 were analyzed. Data collected included sociodemographic variables, clinical diagnosis, nutritional parameters (Palliative Performance Scale (PPS), Mini Nutritional Assessment (MNA)), symptoms (anorexia, fatigue), interventions (enteral nutrition, psychological and rehabilitative support), and relevant medications. Statistical analysis included descriptive, inferential, and multivariable proportional hazard regression analysis to identify independent predictors of weight loss and anorexia.

Results

Manifestations of ACS were observed across both oncologic and non-oncologic conditions. The prevalence of weight loss and anorexia were interrelated and were not different between diagnostic groups. Using multivariable analysis, higher baseline MNA scores (HR = 3.797, p = 0.006) and the use of enteral nutrition (HR = 7.418, p = 0.014) were independently associated with an increased risk of significant weight loss. Lower baseline PPS scores (HR = 0.069), use of enteral nutrition (HR = -0.890), and the presence of psychological support were protective for subsequent anorexia. Dexamethasone use was associated with greater nutritional decline in univariate models.

Conclusions

The management of ACS in home palliative care requires the early identification of symptoms, multidisciplinary intervention, and personalized strategies beyond disease etiology. Risk of weight loss is associated with higher MNA scores, and these are best managed in the first week. In anorexia cases, psychological support is protective.