Appetite

Loss of weight (cachexia) and appetite (anorexia) are common issues for many palliative care patients.

Key points

• Anorexia (loss of appetite / early satiety) and cachexia occur commonly together in cancer and other advanced diseases, and affect performance status.
• Cachexia and anorexia are strong independent prognostic predictors.
  Once fully established, or in late disease, cachexia is not reversible by nutritional interventions.
• Cachexia affects the person’s ability to tolerate treatment of cancer.
  Clinicians need to recognise the profound social, cultural and emotional importance of food and provide individualised support to patients and families.

Assessment

• Consider potentially reversible causes – including nausea, depression, medication side effects, mouth problems.
• Consider overall prognosis and stage of disease in deciding a management approach.

Approach to management

• Multidisciplinary intervention (nutrition, exercise, occupational therapy and pharmacological intervention) may help selected patients.
• Assist with adaptation to the symptom – including dietary modification, appropriate nutritional support, and psychological support.
• When prognosis is getting short: encourage transition to eating for comfort.