TNF and cancer: Nonetheless, pre-clinical models show that cancer causes systemic metabolic alterations resulting in impaired cardiac function.19,20 Cachexia represents a systemic manifestation of both cancer and HF.21,22 In animal models, cancer promotes cardiac atrophy and a reduced heart weight with subsequent deterioration in cardiac function.23,24 Cardiac wasting appears to result from increased autophagy and myocyte apoptosis23 with proinflammatory cytokines including tumour necrosis factor-α (TNF-α), interleukin (IL) 1β, and IL-6 playing pathophysiological roles.24