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ONS Role in Cancer Cachexia — SCE Palliative Medicine MCQ

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ModerateGI SymptomsONS Role in Cancer CachexiaSCE Palliative Medicine

A 70-year-old man with advanced colorectal cancer and liver metastases develops cachexia. He asks about appetite stimulants. His family have been buying protein supplements from the pharmacy. What is the role of oral nutritional supplements (ONS) in cancer cachexia?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — ONS can help maintain caloric intake but do NOT reverse the metabolic changes of cancer cachexia — they are most useful early when intake or absorption is still relatively preserved

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

Option E is correct. NICE acknowledges that cancer cachexia is a progressive metabolic syndrome that conventional nutritional support cannot reverse, though ONS can help maintain energy intake, weight and quality of life, particularly when used early in the cachexia trajectory. The evidence update shows ONS improve weight and quality of life but do not impact mortality. The remaining options are implausible: A is incorrect as benefits are not limited to patients with BMI >30; B is wrong—ONS are not harmful; C is false—ONS should supplement, not replace, normal intake; D is incorrect—ONS do not cure cachexia nor are they universally indicated.

Reference: NICE NG85 (Pancreatic cancer and cachexia) 2018; NICE evidence update on oral nutrition support in cancer 2013.