Anorexia

Anorexia is the loss of appetite: a lack of hunger or desire to eat because of how you feel overall. Loss of appetite is one of the most challenging symptoms for people with cancer and their families.
 

Appetite can be affected in people who have had surgery, especially surgery of the digestive system or head and neck area, as well as people who receive chemotherapy or radiation therapy. People who receive cisplatin, cyclophosphamide, doxorubicin, fluorouracil, paclitaxel, or vincristine are most likely to have changes in taste (bitter or metallic taste), which can affect the desire to eat.

Anorexia is usually caused by other side effects of treatment, such as nausea and vomiting, mouth sores, pain, fatigue, diarrhea, constipation, or taste changes. These symptoms affect your overall well-being and desire to eat.
 

The timing of anorexia varies widely. Loss of appetite may occur mostly on treatment days or throughout treatment, improving 1 to 2 weeks after treatment has ended. Sometimes, however, a decreased appetite may last for a longer period of time after the end of treatment.
 

The focus of managing anorexia is to treat the symptoms that are causing it. For example, controlling nausea and vomiting can improve appetite; treating mouth sores can make it more comfortable to eat; and taking pain medication 30 to 60 minutes before a meal may improve your desire to eat. In addition, changes in eating habits can help ensure adequate nutrition and avoid weight loss (Table 1). For example, if you have mouth sores or difficulty swallowing, choose soft foods and beverages that are high in calories and nutritional value. Several cookbooks are available for people with cancer; the recipes in these cookbooks are nutritional as well as easy to prepare (see box). Your doctor or nurse may suggest that you see a dietician or nutritionist to help you select foods that provide good nutrition and are easy to eat.

Physical activity can help stimulate your appetite; being as active as possible may make you feel like eating more.Drugs that enhance appetite, such as megestrol acetate (Megace) and corticosteroids (dexamethasone) are available. These drugs have side effects, and your doctor will help you decide whether an appetite enhancer is appropriate in your individual case.
 

Talk to your doctor about changes in your appetite and especially about other symptoms you have that may be related to difficulty eating. Tell your doctor if you have lost 5 pounds or more since the beginning of treatment. Anorexia should be addressed as early as possible because adequate nutrition is needed to help you tolerate treatment and heal.
 

• Oncology Nursing Society: www.cancersymptoms.org, Anorexia
• National Cancer Institute: www.cancer.gov, Nutrition in Cancer Care (PDQ^®), Eating Hints for Cancer Patients: Before, During and After Treatment
• Betty Crocker’s Living with Cancer Cookbook: Easy Recipes and Tips through Treatment and Beyond. Kris Ghosh, Linda Carson and Elyse Cohen. Betty Crocker, 2001.
• Eating Well Through Cancer: Easy Recipes & Recommendations During and After Treatment. Holly Clegg and Gerald Miletello. Favorite Recipe Press, 2006.
• One Bite at a Time: Nourishing Recipes for Cancer Survivors and Their Friends, 2nd edition. Joan Fishman, Rebecca Katz and Mat Edelson. Celestial Press, 2008.
• Something’s Got to Taste Good: The Cancer Patient’s Cookbook. Joan Fishman. Andrews Mcmeel, 1981.
• The Cancer Survival Cookbook: 200 Quick & Easy Recipes with Helpful Eating Hints.Donna Weihofen. Wiley, 1997.