Loss of Appetite
Early disclaimer: this is not an upbeat entry about finding delicious little tidbits that will appeal when you are not feeling so well. This is about the loss of appetite that often accompanies advanced cancer, not the kind that lasts for a few days after a chemotherapy treatment or surgery or a medication that disagrees with your stomach. This is about a condition called anorexia-cachexia that happens, sometimes, in people who are very ill. If you imagine the stereotype of a dying cancer patient, thin and pale and bald, this is about the thin part.
I came across this very excellent essay by Ann SIlberman when I had some time yesterday to do some catch up reading of her very excellent blog, But Doctor, I Hate Pink. She writes honestly about living with metastatic breast cancer, and she sometimes addresses topics that otherwise get lost. This is one of them.
We all know about our complicated relationships with food. Among other things, in most families, food=love. When someone is ill, out instinct is to cook their favorite things and try very hard to get them to eat. Through the years, I have had a number of painful conversations with families who are frustrated and sad and even angry that they can't tempt their mother/father/spouse to eat. One piece of important information is that it takes a long time to starve to death, meaning that an ill person's not eating won't likely make much of a difference in the length of her life. It does matter that people keep drinking, but the food is less important. It is all too easy for food battles ("Please just try a bite" or "You have to eat") to become common and stressful in the last period of live.
Ms. SIlberman writes about this from the patient's perspective and lays out some very clear guidelines for families. To summarize, she suggests that tiny (e.g. three grapes and an inch of cheese) plates be offered periodically, but that nothing be said about them. Don't ask if the patient wants them and don't comment on whether or not they are eaten.
Here is the beginning and then a link to this remarkable essay. You would also benefit from reading other entries in her blog.
Loss of Appetite in Cancer Patients - Part Two
So, your loved one has advanced cancer, is not eating, and you want to help.
First, please read part one. You must understand that what you think is a loss of appetite is more than that - it's a true physical inability to eat. It's a symptom and a complication of disease and not something we control with willpower. No matter how much you beg and cajole, eating regular, normal meals is a medical impossibility and will only cause more stress. You might as well be begging somebody with a broken femur to get up and run a marathon.
I also want to make clear that I am not talking about the common loss of appetite that happens in an early stage cancer patient due to chemo, surgery, or as a medication side effect. Depression and some medications can also cause a lack of appetite in early stage cancer patients, and so appropriate diagnosis and medications may help. Any lack of appetite should be discussed with a doctor.