Anorexia and Cachexia

KEYPOINTS

  • Cancer and other diseases, such as HIV/AIDS, can often cause a lack of appetite (anorexia) and weight loss with muscle wasting (cachexia)
  • These are often accompanied by fatigue
  • The process of anorexia/cachexia is complex and involves numerous metabolic changes
  • Anorexia/cachexia is present in up to 80% of patients with cancer
child.png
  • Children with solid tumours are more likely to develop cachexia than children with haematological malignancies
  • Seeing a child not eating may be very distressing for the family

ASSESSMENT

(see Foreword)

  • A good history and clinical assessment is important to try and identify any reversible cause of the anorexia/cachexia
    • Assess appetite
    • Assess ability/difficulty in swallowing and chewing
    • Identify any other symptoms such as pain, constipation, depression, or nausea and vomiting that may be causing decreased appetite
    • Examine the mouth for any sores, lesions or infection
  • Treatable causes of anorexia/cachexia include:
    • Ongoing pain
    • Nausea and vomiting
    • Depression
    • Oral problems
      • Dry mouth
      • Mucositis secondary to chemotherapy
      • Thrush/candidiasis
      • Oral herpes
    • Gastrointestinal motility problems
      • Reflux oesophagitis
      • Gastric stasis
      • Constipation
child.png
  • As in adults: evaluate possible correctable conditions that affect appetite and feeding such as nausea, pain, oral conditions, constipation and depression

MANAGEMENT

  • Consider treatment of the underlying cause if one is identifiable
balance.png

Consider if patient is well enough to benefit

Nonpharmacological Approaches

  • Patient and family education
  • Eliminate dietary restrictions
  • Encourage patient to eat their favourite foods

Pharmacological Approaches

  • Ensure good pain and nausea/vomiting control, treat constipation
  • Stimulate appetite
child.png
  • As in adults: corticosteroids may help appetite. However, because of potential significant adverse side effects they should probably not be used if anorexia/cachexia is the only symptom they might benefit

PITFALLS/CONCERNS

child.png
  • Increasing calorie intake is unlikely to increase body weight and quality of life in advanced cancer cachexia

PALLIATIVE TIPS

  • Despite the appearance of malnutrition, anorexia/cachexia is usually not simply reversed with improved nutrition
  • Aggressive feeding can often make symptoms such as nausea, vomiting and pain worse
  • Educating the family that wasting is a part of the disease process and not the result of the family not providing enough nutrition for the patient is important
  • Anorexia can cause significant anxiety and distress for family members and caregivers who may not understand that loss of appetite is a common symptom of dying
  • There is no evidence that providing nutritional support either enterally or parenterally decreases morbidity or mortality in terminally ill patients
child.png
  • Smaller, more frequent meals of the child’s favourite foods may help
  • Small plates and using straws may also help

SOURCES/REFERENCES

  1. Del Fabbro E, Dalal S, Bruera E. Symptom control in palliative care - part II: Cachexia/anorexia and fatigue. J Palliat Med 2006;9(2):409-421. http://www.ncbi.nlm.nih.gov/pubmed/16629571
  2. Hardy J, Rees E, Ling J, Burman R, Feuer D, Broadley K, Stone P. A prospective survey of the use of dexamethasone on a palliative care unit. Palliat Med 2001;15(1):3-8. http://www.ncbi.nlm.nih.gov/pubmed/11212465
  3. Lopez A, Figuls M, Cuchi G, Berenstein E, Pasies B, Alegre M, Herdman M. Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. J Pain Symptom Manage 2004;27(4): 360-369. http://www.ncbi.nlm.nih.gov/pubmed/15050664
  4. Nelson KA, Walsh D. The cancer anorexia-cachexia syndrome: a survey of the prognostic inflammatory and nutritional index (PINI) in advanced disease. J Pain Symptom Manage 2002;24(4):424-8. http://www.ncbi.nlm.nih.gov/pubmed/12505211
  5. Poole K, Froggatt K. Loss of weight and loss of appetite in advanced cancer: a problem for the patient, the carer, or the health professional? Palliat Med 2002;16(6):499-506. http://www.ncbi.nlm.nih.gov/pubmed/12465697
  6. Plonk W, Arnold R. Terminal care: the last weeks of life. J Palliat Med 2005;8(5):1042-1050. http://www.ncbi.nlm.nih.gov/pubmed/16238518
  7. Shragge J, Wismer W, Olson K, Baracos V. The management of anorexia by patients with advanced cancer: a critical review of the literature. Palliat Med 2006;20(6):623-629. http://www.ncbi.nlm.nih.gov/pubmed/17060256
  8. Strasser F. Eating-related disorders in patients with advanced cancer. Support Care Cancer 2003;11(1):11-20. http://www.ncbi.nlm.nih.gov/pubmed/12527949
  9. Strasser F, Bruera ED. Update on anorexia and cachexia. Hematology/Oncology Clinics of North America 2002;16(3):589-617. http://www.ncbi.nlm.nih.gov/pubmed/12170570
  10. Sutton LM, Demark-Wahnefried W, Clipp EC. Management of terminal cancer in elderly patients. Lancet Oncol 2003;4(3):149-57. http://www.ncbi.nlm.nih.gov/pubmed/12623360
  11. Tomíska M, Tomisková M, Salajka F, Adam Z, Vorlícek J. Palliative treatment of cancer anorexia with oral suspension of megestrol acetate. Neoplasma 2003;50(3):227-33. http://www.ncbi.nlm.nih.gov/pubmed/12937858

Back to top of page Next page Previous page

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License

Subscription expired — please renew

Pro account upgrade has expired for this site and the site is now locked. If you are the master administrator for this site, please renew your subscription or delete your outstanding sites or stored files, so that your account fits in the free plan.