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Combination therapy was reported to be significantly superior to the individual interventions with respect to appetite and performance status, with toxicity similar to the toxicity profiles observed in the monotherapy arms of the trial.[50] Another combination trial in 104 cachectic patients with gynecologic malignancies evaluated a combination of megestrol acetate, L-carnitine, celecoxib, and antioxidants vs treatment with megestrol acetate alone, reporting improvements in lean body mass, fatigue, and global quality of life in the combination arm.[51] Cachexia Clinics Arguably, the additional levels of assessment and expertise needed to personalize therapy for cancer patients with anorexia/cachexia syndrome-with the healthcare team including a nutritionist, nursing personnel trained in assessing patients with weight loss, and clinicians with expertise in cancer cachexia-would be best coordinated in specialty cancer cachexia clinics.[10] Cancer cachexia clinics could evaluate patients who are anticipated to experience decreased caloric intake and weight loss (for example, those undergoing chemotherapy and/or radiation treatment to the neck and chest, putting them at risk for mucositis) in order to offer prophylactic treatment to minimize or prevent weight loss

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