Loss of Appetite

Also called: anorexia

Loss of appetite (anorexia) is common in people with cancer. This occurs when food does not seem to be appealing or a person does not feel like eating. These changes can cause a person to lose weight – one of the most common side effects of cancer and its treatment. Having cancer and being treated for it may mean that the body needs more energy. If a person doesn't meet their body's energy needs with food, they may lose weight.

Causes

Loss of appetite is due to a number of factors, many of them related to cancer or its treatment. These factors include:

• the cancer itself, especially advanced cancer
• cancer treatments
  • nausea and vomiting, caused by anesthesia used during cancer surgery, chemotherapy, radiation treatments or other medications
  • sore mouth, difficulty chewing or swallowing, caused by head and neck surgery, chemotherapy or radiation treatments
  • changes in the way food tastes or smells, caused by surgery, chemotherapy or radiation therapy to the head and neck
• constipation or diarrhea
• pain or pain medications
• fatigue
• being less active
• feeling depressed or anxious

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Symptoms

Loss of appetite can range from being very mild to very severe and can lead to weight loss, malnutrition and loss of muscle mass or muscle wasting (cachexia).

A decrease in appetite can be temporary. Appetite often returns when treatments such as radiation therapy or chemotherapy are completed, but it may take several weeks after treatment is finished for the appetite to fully recover.

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Diagnosis

Height and weight are often measured when a person is first seen by the healthcare team and before cancer treatments are given. Weights may then be done from time to time to see if there are any changes. A nutritional assessment may be done for people who are at higher risk for cancer-related nutrition problems because of treatment.

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Management

It is important for a person with cancer to maintain their weight even if their appetite has changed. Proper nutrition helps the body fight disease and cope with the effects of cancer treatment.

If poor appetite and losing weight are a problem, the following tips may be helpful:

• Eat smaller amounts of food every 1 to 2 hours.
• Make every mouthful count by choosing foods and drinks that are high in protein and high in calories, especially if you are losing weight. Add whole milk or cream to cooked cereals or soups, use sauces and gravies on meats and vegetables, or add extra butter or margarine to potatoes.
• Keep a variety of nutritious foods that are high in protein and calories, as well as quick and easy snacks, on hand so they are ready to eat when you are. Examples include milk (or milkshakes), instant breakfast preparations, ice cream, cheese and crackers, muffins, peanut butter, nuts and puddings.
• Eat well during times when your energy level is high.
• Eat favourite foods anytime of the day but don't eat your favourite foods if you are feeling nauseated. You may end up disliking them. Eat breakfast food at suppertime if you feel like it.
• Eat the biggest meal when you feel most hungry.
• Don't skip meals. Make an effort to eat regularly, even if it is only a few bites. Eat or drink on a schedule.
• Try a variety of new tastes and textures to find those that are most appealing.
• Avoid drinking too much water or other fluids with a meal. This can make you feel full sooner.
• Use drinks that are high in calories and protein such as milkshakes, smoothies and commercial nutrition supplements between meals.
• Clean your mouth before and after eating, to help get rid of any tastes and freshen your mouth.
• Use soft lights, quiet music or brightly coloured table settings when eating – whatever makes mealtimes relaxed and pleasurable.
• Have meals with family or friends.
• Light exercise or fresh air before meals can help increase appetite.
• Check with the healthcare team or a registered dietitian for other suggestions on how to improve appetite.
• Check with your doctor or healthcare team about taking vitamin and mineral supplements to help improve your nutritional status.
• Some people find that drinking small amounts of alcohol, such as a glass of wine or beer, helps stimulate their appetite and helps them enjoy their meal. Alcohol is low in nutrition and high in calories and a drink or two may make a person feel full and not feel like eating anything else. Alcohol can also interfere with some drugs or cancer treatments and may make them less effective or cause side effects to become worse. Be sure to check with your doctor or healthcare team before drinking any alcoholic beverages. Alcohol increases the risk of developing certain types of cancer.

Note: People with a weakened immune system or low white blood cells counts may have to take some basic food safety precautions.

Nutritional supplements

Commercial nutritional supplements may be recommended if a person is unable to meet their nutritional needs from food or drink alone. There are lots of different supplements available and they come in a number of forms and flavours:

• ready-to-use beverages
• powders
• puddings
• bars

These supplements can be used alone or in addition to small meals to provide more calories or protein. Many commercial nutritional supplements can be purchased from a pharmacy or grocery store. Some supplements are made to accommodate special needs like lactose intolerance or diabetes. Talk to a registered dietitian about commercial nutritional supplements and which ones would be best to use.

Some commercially available supplements include:

• Boost
• Ensure

Drugs

Sometimes drugs such as megestrol (Megace) or corticosteroids (steroids) can be used to help stimulate appetite. Occasionally dronabinol (Marinol), which is a synthetic form of delta-9-tetrahydracannabinol (THC), the active ingredient in marijuana, may be prescribed. This is a controlled substance and is only available with a doctor's prescription. Some people may want to try other forms of medical marijuana to improve appetite after talking to their doctor about it.

Tube or intravenous feedings

If loss of appetite becomes severe and malnutrition becomes a risk, the healthcare team may suggest using a feeding tube. This is a thin, flexible tube that is usually placed into the stomach or intestine. Once the tube is in place, liquid nutritional supplements are delivered through it (enteral feeding). Feeding tubes can help people meet their nutritional needs when they find it too difficult to eat or drink or have had significant weight loss. Total parenteral nutrition (TPN) may be given in certain situations.

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