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The Global Cachexia Pathway Navigating from Early Recognition to Therapeutic Horizons: Module 2 Optimizing Supportive Care

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Description

This program is supported by an independent education grant from Pfizer. This education program is available to healthcare professionals globally.

Credits: 0.25 AMA PRA Category 1 Credits™ (0.25.00 hours)

Type of activity: Enduring material (On-demand)

Launch date: September 28th 2026

Expiration date: March 1st 2028

Estimated time to complete this activity: 15 minutes

Prefer to read instead? Read our Key Clinical Summaries in your preferred language:

This is Module 2 of a three-part on-demand series: Module 1 and Module 3.

Join expert Dr Eric Roeland, MD, FASCO, FAAHPM, for a practical, case-based exploration of how to move from recognising cancer cachexia to taking meaningful action. This session examines how nutrition, exercise, symptom management, and pharmacological strategies can be integrated alongside anticancer treatment to provide comprehensive, patient-centred supportive care. Through a real-world clinical case, participants will explore how to tailor interventions to functional status and treatment goals, address common barriers to supportive care, and embed earlier multidisciplinary intervention into routine oncology practice.

Session Highlights

Explore a practical multimodal approach to managing cancer cachexia alongside anticancer treatment.
Discover how nutrition, exercise, symptom management, and pharmacological strategies can work together to support patients.
Consider how interventions can be tailored to functional status, individual needs, and treatment goals.
Identify practical ways to integrate earlier supportive care and multidisciplinary collaboration into routine oncology workflows.

Who Should Participate?

This program is designed for healthcare professionals directly involved in the diagnosis, treatment, supportive management, and longitudinal follow-up of people with cancer across oncology care settings, who seek to strengthen their recognition and management of cancer cachexia and incorporate earlier assessment and multidisciplinary support into routine clinical practice.

Medical Oncologists
Oncology Nurses
Nurse Practitioners
Physician Associates/Assistants
Pharmacists
Dietitians/Nutrition Specialists
Supportive Care and Palliative Care Clinicians
Rehabilitation and Physical Therapy Professionals
Other Multidisciplinary Cancer Care Team Members

Faculty

Dr Eric Roeland

Dr Eric Roeland is an Associate Professor of Medicine, medical oncologist, and palliative care specialist at the Knight Cancer Institute. His clinical practice focuses on caring for patients with cancer, particularly those experiencing poorly controlled symptoms. His research focuses on symptom science, supportive care, and improving quality of life, with particular expertise in cancer cachexia, treatment-related toxicity, and symptom management. Dr Roeland’s work aims to develop evidence-based approaches that reduce treatment burden, address debilitating cancer-related symptoms, and improve outcomes for patients living with advanced cancer.

Continuing Education Information

Commercial support: This activity received monetary support through an independent education grant from Pfizer.

This continuing education activity will be provided by AffinityCE and MedAll. This enduring material will provide continuing education credit for physicians. A statement of participation is available to other attendees.

Disclosures

Dr Eric Roeland has disclosed financial relationships within the past 24 months with the following ineligible companies: Research Funding Aveo, Pfizer. Scientific Advisory Board, Aveo, Napo, Pfizer. Dr Roeland does not intend to discuss non-FDA uses of drug products and/or devices only in relation to products for which he has no financial relationships.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose.

Mitigation of Relevant Financial Relationships

AffinityCE adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all financial relationships with ineligible companies. All financial relationships for anyone associated with the content of this activity were mitigated prior to the release of this program.

Activity Accreditation for Health Professions

Physicians

This enduring material has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

This enduring material has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education enduring material will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE enduring material.

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

CME Inquiries

For all CME policy-related inquiries, please contact us at ce@affinityced.com.

Participation Costs

There is no cost to participate in this program.

This continuing education activity is active starting September 28th 2026, and will expire on March 1st 2028.

Estimated time to complete this activity: 15 minutes.

Learning objectives

Implement standardized assessment and documentation strategies to identify cancer cachexia earlier in patients with weight loss, muscle wasting, and functional decline: ➔ Apply consensus diagnostic criteria and structured cachexia screening approaches in oncology practice. ➔ Differentiate cachexia from sarcopenia, malnutrition, and treatment-related weight loss. ➔ Integrate assessment and documentation of weight loss, appetite, muscle mass, and functional status into routine patient evaluation.
Integrate evidence-based multimodal supportive care strategies into management plans for patients with cancer cachexia to improve appetite, physical function, lean body mass, and treatment tolerance: ➔ Apply nutritional, rehabilitative, pharmacologic, and symptom-management approaches within multidisciplinary oncology care. ➔ Align supportive care interventions with patient functional status and anticancer treatment goals. ➔ Incorporate earlier supportive intervention strategies into routine oncology workflows.
Apply emerging evidence on GDF-15 biology and investigational cachexia therapies when evaluating patients for clinical trial opportunities: ➔ Recognize the mechanism of GDF-15 in appetite dysregulation, metabolic dysfunction, and cancer cachexia progression. ➔ Interpret evolving evidence on targeted therapies and biomarker-driven approaches in cancer cachexia, including the latest trials evaluating the GDF-15–GFRAL pathway as well as other pathways. ➔ Identify patients who may be appropriate for cachexia-focused clinical trials and emerging therapeutic strategies.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, my name is Doctor Eric Roland, and I'm an associate professor of medicine at and director of symptom Science at Oregon Health and Science University in Portland, Oregon. Before I begin, here are my disclosures. So today we're gonna be talking about optimizing supportive care and focusing on multimodal management for the, from the point of diagnosis. In our learning objections, uh, by the end of the presentation, you should all be able to, one, apply nutritional, rehabilitative, and pharmacologic, uh, as well as symptom management approaches within multidisciplinary oncology care. To align uh supportive care interventions with patient. Functional status and anti-cancer treatment goals, and incorporate earlier supportive intervention strategies into routine oncology workflows. And for clarity, we define supportive care here in this presentation as everything done alongside standard anti-cancer treatment to preserve nutrition, function, and symptom control from the diagnosis onwards, not only at the end of life. For a little background, cachexia, once it's recognized. Then what? Uncertainty about what to do next is a very large gap for many clinicians. For example, a patient, Mr. A, who's 64 years old, with stage 4 pancreatic cancer and has lost 6% weight loss in the last three months, with a BMI of 24.3 and an ECOG performance status of 1, albumin of 31, CRP of 22, um, now has cachexia documented. And it's about to start modified folfirinox next week. Overall, about three-quarters of healthcare providers report uncertainty in selecting and integrating supportive care strategies for cancer cachexia. And over 80% wait until the weight loss reaches more than 10%. Uh, before intervening, um, which actually is double the diagnostic weight loss criteria, uh, for, uh, the definition of cancer cachexia. And 61-77% do not prescribe any pharmacologic interventions until uh stage 4 disease. So why does this delay persist? Well, cachexia is still read as an end-stage event rather than a treatable complication, and I would say a lot of uh clinicians view cachexia through the lens of someone who's severely emaciated and near the end of life. And dietitians and pharmacists and rehabilitative specialists are frequently outside of our normal pathways of care. And so incorporating them um in a routine and early fashion, uh, describes, uh, a possible opportunity and challenge. And there are few uh licensed uh interventions or approved interventions. So, so guidance that differ really differs between regions and disciplines, um, and I would even say between institutions. And there's really limited formal training and no institutional protocols to prompt early action. So here's a polling question for everyone. Mr. A starts modified FOLFIRInox next week with documented cachexia, and ECOG performance status of 1, and CRP of 22. Which single approach is most likely to preserve his lean body mass and treated tolerance? A high energy oral nutritional supplements alone. B. Magestrel acetate to stimulate appetite. C. Dietary counseling, resistance and aerobic exercise, and anti-inflammatory support delivered together alongside his chemotherapy. D, dexamethasone continued for the duration of chemotherapy, and E, deferring supportive care until his weight loss exceeds 10%. So here, I believe the correct answer is this multi-modal approach, Choice C, dietary counseling, resistance and aerobic exercise, and anti-inflammatory support delivered together alongside his chemotherapy. This would be most ideal, um, yet we remain challenged in our ability to combine these efforts simultaneously and early in the cancer care trajectory. So cancer cachexia is a syndrome, and I think it's important to name it as a hypermetabolic syndrome for our patients, so they know how it is different than typical weight loss. And it has 4 simultaneous drivers. So clearly we have to treat the tumor and treat the patient. Um, and each driver needs its own lever. So the first is uh reduced food intake, um, where we really need to focus on individualized dietary counseling. Um, energy and protein targets, as well as oral nutritional supplements when targets are missed. We also need to focus on nutritional impact symptoms. I think a critical role of any practicing clinician in this space is try to reverse any uh potential side effects or symptoms that are impacting their ability to eat. This could be early satiety, nausea, taste changes, constipation. And even pain. And notably within pancreatic cancer. Exocrine insufficiency, which we will talk about uh later on here in more detail. Each needs to be considered and uh addressed when When when appropriate. The third is systemic inflammation and catabolic drive. Here, the role of effective anti-cancer therapy is critical, and there is some data to support the inclusion of omega-3 fatty acids and anti-inflammatory agents, but of low certainty as adjuncts. And there, um, these have been tested within these multimodal protocols. 4, inactivity and anabolic resistance. So patients have progressive resistance training and aerobic activity. This can be a challenge to get thing, uh, get going, uh, but for, for patients, um, who are capable, we match these. Exercise training and activities to the performance status. And so in an ideal situation, these would be delivered together, uh, not in sequence. As any one of these alone leaves 3 drivers still running. So we're trying to surround our patients with all the help and care that they need in this space. For example, in the MAC trial, uh, we learned more about testing the multimodal hypothesis. This was a phase 3 randomized open label study in 212 patients at 17 sites in 4 countries. The design included patients with stage 3 and 4 lung or pancreatic cancer starting uh antineoplastic therapy with non-curative intent. Weight loss was required for entry onto the study, and the aim was not only prevention of weight loss, um, but also attenuation of weight loss. The intervention included nutritional counseling, plus fish oil containing supplements, home-based exercise program, and anti-inflammatory medication, all added to standard of care. And the primary endpoint was change in body weight at 6 weeks. Here are the results at 6 weeks, and you can see that in the multimodal interventional arm that uh weight was maintained with slight increase of 0.05 kg, whereas in standard of care, there was nearly a kilogram of uh weight loss. But we did not observe any uh difference in muscle mass or daily step count. So what, what does this all mean? How do we put this together? I would say that the multimodal intervention was feasible, safe, and stabilized weight. However, it didn't shift muscle mass or physical activity at 6 weeks. Therefore, I frame these findings as a platform on which targeted agents can now be tested, but probably not the complete answer. Oh Now as we take each of these one by one nutrition, uh, counseling first, um,