Loss of Appetite During Cancer Treatment

Loss of appetite, referred to by doctors as anorexia, is a common symptom during treatment for lung cancer (anorexia differs from the eating disorder anorexia nervosa, a psychological illness in which patients starve themselves). The importance of addressing lack of appetite with cancer cannot be overstressed, as cancer cachexia, a syndrome of unintentional weight loss and muscle wasting is thought to be the direct cause of 20% of cancer deaths. That said, while lack of appetite does not have a single simple solution, a combination of therapies addressing both the causes and appetite itself can often result in improved intake.

Many things can lower your appetite during cancer treatment. These include symptoms related to cancer, side effects of treatment, and your body’s response to the cancer.

Most people with advanced cancer have some degree of anorexia. Decreased nutrition due to appetite changes can lead to weight loss, malnutrition, loss of muscle mass, and wasting (cachexia). Knowing the effect of poor nutrition on treatment response, oncologists are increasingly addressing the role of nutrition in cancer patients. Nutritional support has been shown to result in:

• Fewer infections after surgery
• Better control of cancer-related symptoms
• Shorter hospital stays
• Greater ability of cancer survivors to tolerate treatments
• Better overall response to treatment
• Improved quality of life for those living with cancer

Several treatment options are available to help with appetite, and also help maintain your weight during cancer treatment. It's important to keep in mind that it is usually a combination of these modalities rather than a single approach that is most effective.

Many cancer centers are offering nutritional counseling and support for those living with cancer. Even if you are well-versed in nutrition, a good cancer nutritional may be able to provide some excellent tips to ensure you are getting the nutrition you need.

Other symptoms related to cancer or treatment can add to poor appetite. It is important to share any of these symptoms with your oncologist so they can be addressed:

• Mouth sores
• Taste changes
• Fatigue
• Depression
• Nausea or vomiting
• Difficulty swallowing (dysphagia)
• Shortness of breath
• Pain
• Medications: Some medications (such as pain medications) can interfere with appetite and may need to be changed, or the dosage altered.

Some oncologists will recommend nutritional supplements to boost your calorie intake. When these are used, however, it's currently thought that they should be used between meals rather than as a meal itself for the best results.

Other supplements may be recommended by some oncologists, such as omega-3 fatty acid supplements, and more.

Your physician may recommend a medication to stimulate your appetite, or help with transit through your digestive tract. A few of these medications used to increase appetite during cancer treatment include:

• Steroids such as Decadron (dexamethasone)
• Megace (megestrol)
• Reglan (metoclopramide)
• Cannabinoids (medical marijuana): Research on the precise role of medical marijuana is lacking due to difficulty studying the effect related to legalities in the past, but some research suggests medical marijuana may be a useful adjunct for some people with cancer suffering from a lack of appetite.

Artificial nutrition includes Enteral nutrition (tube feeding), or parenteral nutrition (nutrients delivered to the body via a catheter into a vein in the arm or chest) – Your physician may discuss these options with you if you are unable to eat due to swallowing difficulties or other problems.

Complimentary/alternative therapies (such as herbal supplements and meditation) are being looked at for their role in assisting with appetite in cancer survivors.

Cancer treatment not only decreases appetite, but you may become full more quickly when eating. A few tips may help you boost your calories when you don’t feel particularly hungry:

• Eat small portions frequently instead of 3 large meals daily
• Make your environment pleasing. Dine with family and friends. Play music. Use lighting that feels comfortable.
• Light exercise can actually often stimulate the appetite. Ask your oncologist for her recommendations.
• Eat nutritious snacks that are high in calories and protein: Good choices include nuts, cheese and crackers, ice cream, peanut butter, and puddings.
• Have food on hand that you enjoy and is easy to prepare
• Find foods that are comfortable to eat if you have mouth sores or taste changes
• Drink fluids between meals to avoid becoming full too fast
• Fatigue is a big factor for many cancer survivors when it comes to cooking: Accept your loved one’s willingness to bring meals, freeze leftovers for another meal, and ask your friends if they would mind preparing meals ahead of time that you can freeze for a quick dinner.
• Eat whenever you feel hungry, day or night
• Try different foods: Sometimes a change in routine can make food more “interesting” and tempting
• Eat with friends or family: Cancer can feel very isolating, and the social setting of eating with others may indirectly help with appetite.

Make sure you keep your doctor updated on your appetite, as well as anything that is interfering with your ability to eat. Call between visits if you:

• Are unable to eat for 24 hours (sooner if you are unable to swallow fluids)
• Have difficulty swallowing, or if eating is otherwise painful
• Develop abdominal pain
• Lose 3 pounds or more
• Vomits for more than 24 hours
• If you note any signs of dehydration such as loss of skin tone, strong smelling urine, or are not urinating as frequently as usual

Loss of appetite is one of the most frequent concerns among those who are undergoing treatment for lung cancer. There are several things you should know if this sounds like you. Loss of appetite is more than a nuisance. It can interfere with treatments, but also raise the risk of premature death from cancer. Yet you are not alone and there are things that can be one. Ask your oncologist for a referral to a nutritionist who specializes in treating people with cancer. Unlike a general nutrition evaluation, these people are familiar with the nuances of cancer and may have some excellent tips for either increasing your appetite, raising your caloric intake, or both.

As a final point, loved ones of those with cancer often struggle with awful feelings of helplessness. Placing your focus on finding tasty, nutritional foods is one way in which you can both express your love, and help your loved one cope with this more than annoying side effect of cancer. As a caveat, however, it's important not to feel offended if you work hard to prepare a tasty meal and your loved one just can't eat it. The act of loving your friend or family member enough to prepare a meal, rather than the calories alone, is priceless.