The management of anorexia by patients with advanced cancer: a critical review of the literature

Abstract

This report presents the results of a critical review of the literature on the experience of anorexia (loss of appetite) by patients with advanced cancer. Although several studies have investigated this experience, the adaptive strategies used by patients to compensate for appetite loss remain poorly elucidated. Based on the small body of extant research, it was concluded that, in many instances, a gap exists between the ability of patients and caregivers to come to terms and deal realistically with the emotional and social consequences of patient anorexia. Patients generally appear to suffer greater discord as a result of this disparity, than from the direct psychological impact of anorexia. A greater understanding of the management of anorexia by patients is essential for the development of dietary and psychosocial interventions that would aid both patients and caregivers to cope with this common symptom.

Keywords

adaptation anorexia appetite neoplasms palliative care psychological qualitative research

Get full access to this article

View all access options for this article.

References

Yavuzsen T , Davis MP , Walsh D , LeGrand S , Lagman R . Systematic review of the treatment of cancer-associated anorexia and weight loss . J Clin Oncol 2005; 23: 8500–8511 .

Sarhill N , Mahmoud F , Walsh D , et al. Evaluation of nutritional status in advanced metastatic cancer . Support Care Cancer 2003; 11: 652–659 .

Reuben DB , Mor V , Hiris J . Clinical symptoms and length of survival in patients with terminal cancer . Arch Intern Med 1988; 148: 1586–1591 .

Donnelly S , Walsh D . The symptoms of advanced cancer . Semin Oncol 1995; 22: 67–72 .

Maltoni M , Pirovano M , Scarpi E , et al. Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study . Cancer 1995; 75: 2613–2622 .

Vigano A , Dorgan M , Buckingham J , Bruera E , Suarez Almazor ME . Survival prediction in terminal cancer patients: a systematic review of the medical literature . Palliat Med 2000; 14: 363–374 .

Schonwetter RS , Teasdale TA , Storey P . The terminal cancer syndrome . Arch Intern Med 1989; 149: 965–966 .

Davis MP , Dreicer R , Walsh D , Lagman R , LeGrand SB . Appetite and cancer-associated anorexia: a review . J Clin Oncol 2004; 22: 1510–1517 .

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: 499–506 .

10.

Delmore G . Cachexia – quo vadis? Support Care Cancer 2000; 8: 165–166 .

11.

Jatoi A , Kumar S , Sloan JA , Nguyen PL . On appetite and its loss . J Clin Oncol 2000; 18: 2930–2932 .

12.

MacDonald N . Is there evidence for earlier intervention in cancer-associated weight loss? J Support Oncol 2003; 1: 279–286 .

13.

Loprinzi CL , Kugler JW , Sloan JA , et al. Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia . J Clin Oncol 1999; 17: 3299–3306 .

14.

Maltoni M , Nanni O , Scarpi E , Rossi D , Serra P , Amadori D . High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: a systematic review of randomised clinical trials . Ann Oncol 2001; 12: 289–300 .

15.

Brown JK . A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia . Oncol Nurs Forum 2002; 29: 517-517 .

16.

Rossi Fanelli F , Laviano A . Cancer anorexia: a model for the understanding and treatment of secondary anorexia . Int J Cardiol 2002; 85: 67–72 .

17.

Holden CM . Anorexia in the terminally ill cancer patient: the emotional impact on the patient and the family . Hospice J 1991; 7: 73–84 .

18.

Sola I , Thompson E , Subirana M , Lopez C , Pascual A . Non-invasive interventions for improving well-being and quality of life in patients with lung cancer . Cochrane Database Syst Rev CD004282, 2005.

19.

Jones ML . Application of systematic review methods to qualitative research: practical issues . JAdv Nurs 2004; 48: 271–278 .

20.

Persson C , Glimelius B . The relevance of weight loss for survival and quality of life in patients with advanced gastrointestinal cancer treated with palliative chemotherapy . Anticancer Res 2002; 22: 3661–3668 .

21.

Bruera E , Strasser F , Palmer JL , et al. Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study . J Clin Oncol 2003; 21: 129–134 .

22.

O'Gorman P , McMillan DC , McArdle CS . Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients . Nutr Cancer 1998; 32: 76–80 .

23.

Walsh D , Rybicki L , Nelson KA , Donnelly S . Symptoms and prognosis in advanced cancer . Support Care Cancer 2002; 10: 385–388 .

24.

Walsh D , Donnelly S , Rybicki L . The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients . Support Care Cancer 2000; 8: 175–179 .

25.

Komurcu S , Nelson KA , Walsh D , Ford RB , Rybicki LA . Gastrointestinal symptoms among inpatients with advanced cancer . Am J Hosp Palliat Care 2002; 19: 351–355 .

26.

Curtis EB , Krech R , Walsh TD . Common symptoms in patients with advanced cancer . J Palliat Care 1991; 7: 25–29 .

27.

Strasser F . Eating-related disorders in patients with advanced cancer . Support Care Cancer 2003; 11: 11–20 .

28.

Laviano A , Meguid MM , Rossi Fanelli F . Cancer anorexia: clinical implications, pathogenesis, and therapeutic strategies . Lancet Oncol 2003; 4: 686–694 .

29.

Inui A . Cancer anorexia-cachexia syndrome: current issues in research and management . Cancer J Clin 2002; 52: 72–91 .

30.

Potter J , Hami F , Bryan T , Quigley C . Symptoms in 400 patients referred to palliative care services: prevalence and patterns . Palliat Med 2003; 17: 310–314 .

31.

Krech RL , Walsh D . Symptoms of pancreatic cancer . J Pain Symptom Manage 1991; 6: 360–367 .

32.

Laviano A , Meguid MM , Rossi Fanelli F . Improving food intake in anorectic cancer patients . Curr Opin Clin Nutr Metab Care 2003; 6: 421–426 .

33.

Armes PJ , Plant HJ , Allbright A , Silverstone T , Slevin ML . A study to investigate the incidence of early satiety in patients with advanced cancer . Br J Cancer 1992; 65: 481–484 .

34.

Hughes N , Neal RD . Adults with terminal illness: a literature review of their needs and wishes for food . JAdv Nurs 2000; 32: 1101–1107 .

35.

McGrath P . Reflections on nutritional issues associated with cancer therapy . Cancer Pract 2002; 10: 94–101 .

36.

Hopkinson JB , Corner JL . Helping patients with advanced cancer live with concerns about eating: a challenge for palliative care professionals . J Pain Symptom Manage 2006; 31: 293–305 .

37.

McClement SE , Degner LF , Harlos MS . Family beliefs regarding the nutritional care of a terminally ill relative: a qualitative study . J Palliat Med 2003; 6: 737–748 .

38.

Orrevall Y , Tishelman C , Herrington MK , Permert J . The path from oral nutrition to home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families . Clin Nutr 2004; 23: 1280–1287 .

39.

Souter J . Loss of appetite: a poetic exploration of cancer patients' and their carers' experiences . Int J Palliat Nurs 2005; 11: 524–532 .

40.

McCann RM , Hall WJ , Groth Juncker A. Comfort care for terminally ill patients: the appropriate use of nutrition and hydration . JAMA 1994; 272: 1263–1266 .

41.

Feuz A , Rapin CH . An observational study of the role of pain control and food adaptation of elderly patients with terminal cancer . J Am Diet Assoc 1994; 94: 767–770 .

42.

Meares CJ . Primary caregiver perceptions of intake cessation in patients who are terminally ill . Oncol Nurs Forum 1997; 24: 1751–1757 .

43.

McClement SE , Degner LF , Harlos M . Family responses to declining intake and weight loss in a terminally ill relative. Part 1: fighting back . J Palliat Care 2004; 20: 93–100 .

44.

Ganzini L , Goy ER , Miller LL , Harvath TA , Jackson A , Delorit MA . Nurses' experiences with hospice patients who refuse food and fluids to hasten death . N Engl J Med 2003; 349: 359–365 .

45.

Meares CJ . Nutritional issues in palliative care . Semin Oncol Nurs 2000; 16: 135–145 .

46.

Hopkinson JB , Wright DNM , Corner JL . The experience of weight loss in people with advanced cancer . JAdv Nurs 2006; 54: 304–312 .

47.

Gallagher-Allred CR . Nutritional care of the terminally ill. Rochville, Md: Aspen Publishers 1989.

48.

Holden CM . Nutrition and hydration in the terminally ill cancer patient: the nurse's role in helping patients and families cope . Hospice J 1993; 9: 15–35 .

49.

Hawkins C . Anorexia and anxiety in advanced malignancy: the relative problem . J Hum Nutr Diet 2000; 13: 113–117 .

50.

Addington-Hall J , McCarthy M . Dying from cancer: results of a national population-based investigation . Palliat Med 1995; 9: 295–305 .

51.

Oi-Ling K , Man-Wah DTSE , Kam-Hung DNG . Symptom distress as rated by advanced cancer patients, caregivers and physicians in the last week of life . Palliat Med 2005; 19: 228–233 .

52.

Morita T , Hirai K , Sakaguchi Y , Tsuneto S , Shima Y . Family-perceived distress about appetite loss and bronchial secretion in the terminal phase . J Pain Symptom Manage 2004; 27: 98–99 .