Patient profile: Male, 62 years old.

Presentation: The patient had metastatic colorectal cancer with disease progression despite several lines of chemotherapy. He had severe fatigue, loss of appetite, cachexia, neuropathic pain, insomnia and anxiety.

Assessment: The review covered cancer status, current medicines, analgesia, nutritional status and likely reversible causes of fatigue. He had lost 12% of his body weight over 3 months. Baseline bloods showed albumin at 28 g/L and CRP at 12 mg/L, with low prealbumin.

Clinical picture: This was advanced cancer with inflammation, cachexia and probable chemotherapy-related neuropathic pain. The main goals were comfort, symptom relief, preservation of function and improved quality of life.

Support plan: The support plan was agreed with the palliative care team. It focused on small, frequent, energy-dense, protein-rich meals, including oral nutritional supplements where appropriate. His analgesia was reviewed and neuropathic pain options such as gabapentin or pregabalin were considered with the palliative team. A short course of dexamethasone 4 mg daily was also considered to support appetite and fatigue. Nutraceutical support included omega-3 at 2 g daily and vitamin D repletion if low. Medical cannabis was only considered where legal and after specialist approval. Gentle physiotherapy and functional movement were used to help preserve muscle mass, alongside energy-conservation techniques. Counselling, family support, hospice referral and relaxation techniques were also included. Acupuncture was considered for pain and nausea support.

Outcome at 8 weeks: Appetite improved and weight stabilised modestly. Neuropathic pain reduced enough to improve sleep. Opioid use reduced by 20%. Functional status improved slightly, with ECOG moving from 3 to 2. Quality-of-life scores also improved.

Key point: In advanced disease, the aim is not aggressive intervention but coordinated support that improves comfort, dignity and daily function.