GoKawiilMealtimes were always a family affair for the Kochanczyks of Indiana. Dave Kochanczyk loved barbecuing, cooking Polish fare and preparing fresh vegetables from the garden. When not in the kitchen, he led an active life: working as an electrical contractor, serving as a volunteer firefighter and managing the family’s large country property.
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That all changed after he was diagnosed with pancreatic cancer in 2010. Over the next seven years, as he endured intensive treatment, his love of food remained but his appetite dwindled. He lost muscle mass and became gaunt. Weakened and fatigued, he could no longer chop wood for the home’s stove.
Kochanczyk’s struggles were not only the result of the tumour and treatments waging war against one another in his body, but also due to cachexia, a cancer-linked syndrome that causes reduced appetite and muscle wasting. “It’s very hard to watch,” recalls Dave’s son Martin Kochanczyk. Since his father’s death in 2017, Martin has become an advocate for cachexia awareness with the Cancer Cachexia Society, a community of scientists, people with the condition and others advancing research, awareness and treatment.
As Martin often explains to people with cancer and their families, his father was hardly an outlier. “Cachexia affects a lot of people,” he says. Between 50% and 80% of people with cancer, depending on the tumour type and disease stage, experience cachexia.
“I’ve heard people describe it as lying down under a thousand-pound blanket,” says sociologist Abigail Newell, senior director of research at the Cancer Support Community in Washington DC. “Sitting up feels like running a marathon.” And it’s more than a quality-of-life issue; cachexia affects survival. Exhaustion, hopelessness and other psychological symptoms can make people less willing to keep up with treatments. Severe cachexia can even make some therapies intolerable, or cause individuals to be excluded from clinical trials. Ultimately, 20–30% of cancer-associated deaths are attributable to cachexia, rather than the cancer itself.
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Although cachexia was long considered an inescapable part of cancer’s progression, it has now become a topic of study in its own right. In 2020, a global research initiative, Cancer Grand Challenges, asked scientists to propose projects on cachexia.
The initiative ended up funding an international team of clinicians, scientists and advocates — 16 research groups across 14 institutions — to the tune of £20 million ($US25 million) to study cancer cachexia, its drivers, subtypes and potential treatments. Now in its fifth year, the project, known as CANCAN, has released about 30 papers, which have appeared alongside a rising tide of research from independent efforts.
With the influx of fresh studies, the very concept of cachexia is changing. Where scientists once saw simple malnutrition, muscle wasting and weight loss, they now see a whole-body syndrome of metabolism gone haywire. Studies reveal how cachexia is more than physical symptoms; it affects not just appetite and metabolism, but also motivation and behaviour. And a handful of companies, including pharmaceutical giant Pfizer, are testing medicines for cachexia (see ‘Fighting cachexia’), raising hope that a treatment might be on the horizon.
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