What Works Today — Nutrition, Exercise, Anti-inflammation, and Current Drugs

Part 5 is a how-to guide. We align home and clinic workflows and run nutrition, resistance exercise, inflammation/symptom control as a package. Medications are adjuncts—use purposefully and safely with your clinical team.

3 takeaways

• Start multi-modal together: nutrition + exercise + symptom/inflammation care, then review at two weeks.
• Match the first move to the phenotype: fat-first → appetite/nausea + energy; muscle-first → resistance + protein.
• Use drugs short-term with goals: low-dose olanzapine, megestrol, short-course steroids, anamorelin (JP) when appropriate.

1) Clinic workflow (15–20 min first visit; 10 min follow-up)

1. Home prep: two-week log (weight, intake, activity, function, symptoms) + one meal photo/day.
2. Quick assessment: update the Part-3 mini-dashboard (composition/function/PROs).
3. Phenotype: fat-first / muscle-first / mixed.
4. Same-day start: diet plan + home resistance + symptom/inflammation fixes + (if indicated) a short drug trial.
5. Two-week review: keep what helps, stop what doesn’t, iterate.

2) Nutrition: make protein and energy feasible

• Targets: protein 1.2–1.5 g/kg/day, energy 25–30 kcal/kg/day (individualize for age/activity/comorbidities).
• Pattern: 3 meals + 2 snacks; include a protein source each time.
• When intake is hard: cooler foods, a touch of acid/aroma, small frequent portions, short-term oral supplements.
• Fat-first tips: energy-dense foods (oils, nuts, avocado) + aggressive antiemetics.
• Muscle-first tips: leucine/EAA focus and post-exercise protein timing.

3) Home resistance: painless, breath-light, reproducible

Core set (≈3 days/week)

• Chair stands 10×2
• Heel raises 20×2
• Band curls/extensions 10×2
• Stair steps 1–2 flights

Intensity: RPE 3–4/10 (“somewhat easy–somewhat hard”). Skip on fever, severe nausea, or pain flares.

Safety flags (stop & call)

• Chest pain, severe dyspnea, presyncope/falls
• Fever, irregular pulse, perceived desaturation
• New/worse bone pain or disabling myalgia

4) Tame symptoms/inflammation: make eating possible

• Nausea/vomiting: bedtime low-dose olanzapine; tailor 5-HT3 blockers to regimen.
• Pain/sleep: relieving pain and improving sleep unlock activity.
• Constipation/diarrhea, mucositis: lower these barriers to intake quickly (laxatives, probiotics per team advice, mouthwashes).
• Anti-inflammation: consider NSAIDs short-term at minimal effective dose when appropriate; monitor GI/renal risks.

5) Positioning current drugs (always clinician-led)

Anamorelin (JP)

• Goal: improve appetite, weight, lean mass in eligible cancers.
• Best fit: fat-first → mixed with anorexia prominent.
• Watch: glucose, edema, CV history; define duration and stopping rules.

Low-dose olanzapine

• For anorexia/nausea symptom relief (often bedtime).
• Watch: somnolence, EPS/QTc per team guidance.

Megestrol acetate

• Expected: appetite↑, weight↑ (often fluid/fat).
• Caution: edema, VTE risk; be selective in frail/at-risk patients.

Short-course corticosteroids

• Expected: short-lived boosts in appetite/energy.
• Caution: long-term harms (infection, hyperglycemia, myopathy); set a clear taper/stop plan.

Rule of thumb: define goals, test briefly, keep if helpful, stop if not. Avoid open-ended monotherapy; reassess every two weeks.

6) First moves by phenotype (quick map)

Fat-first

• Antiemetics + appetite support first
• Energy-dense diet
• Anamorelin if eligible

Muscle-first

• Resistance + protein-forward plan
• Fix pain/sleep
• Address inflammation/metabolic tilt

Mixed

• Start multiple levers together
• Escalate symptom care
• Short drug trial when justified

7) What to review at two weeks

• Appetite/nausea scores (0–10)
• Function (chair stands count/effort; stairs breathlessness)
• Weight/edema, bowel status
• Behavior (outings, steps, naps)
• Safety (falls, hyperglycemia, edema, arrhythmia)

8) Pitfalls to avoid

• Chasing weight alone → always pair with function/PROs.
• Leaving “can’t eat” unaddressed → fix nausea/mucositis/constipation first.
• Zero or excessive exercise → target RPE 3–4 for sustainability.
• Medication drift → two-week goal-and-stop reviews.

My Perspective

Starting “eat–move–unblock” together outperforms single levers. Make the first move phenotype-specific, then in two weeks double down on what works and drop what doesn’t. The core win is reclaiming time-of-day windows when the patient can be active—meds smooth the road, but behavior + environment carry the distance.

Next in the Series

Part 6: “What’s Next — GDF15 Blockade and the Era of Precise Phenotypes.” We’ll explore biomarker-driven enrollment, composite endpoints, and home sensing for next-generation trials.

Edited by Morningglorysciences

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