Understanding Cancer Anorexia, Weight Loss, and Cachexia
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
MARCH 30, 2020
Cancer anorexia, weight loss, and cachexia are related conditions, yet quite different from one another. It is important to understand the nuances and how worried you should be about each.
Let's Start with Definitions
Anorexia signifies a major loss of appetite and aversion to food. Most of us are familiar with the eating disorder, anorexia nervosa; in cancer patients, it is a different version.
Weight loss can be a side effect of cancer treatments, such as chemotherapy. However, weight loss is also associated with cancer-caused anorexia, because cancers can secrete substances that change the body's metabolism.
Cancer cachexia, which usually happens to patients with advanced cancer, is sometimes referred to as a wasting syndrome. It is the result of marked weight and muscle loss, and is generally associated with fatigue, loss of appetite, and general ill health. Although I hesitate to use the simile, think of pictures you have seen of starving refugees or camp survivors; this is not much different in appearance. With starvation, the body usually loses fat tissue first and, after that is gone, then there is muscle loss. With cancer cachexia, muscle loss can occur prior to fat loss. If a patient's cancer is successfully treated, most people can gain weight.
Stress and Appetite
One way to divide the world is people who can't stop eating when they are stressed and people who don't eat in the same circumstances. The stressed person is probably not so concerned about his/her appetite. Think how you have felt during a stomach bug or virus: food was just not appealing, but you knew that you would soon be back to normal. When we are not feeling well, our appetites are naturally reduced and we may have to force ourselves to eat smaller, more frequent meals. Dieticians can recommend nutritious meals and snacks, and it can be helpful to make an appointment for this consultation. Learn more about BIDMC's Nutrition Services here.
My personal comment about food choices during chemo or other not-feeling-so-well times is to consider avoiding your usual favorites. You don't want them to be forever associated with this period of your life. I remember a formerly beloved vegetable soup that I made in bulk and expected to eat during chemo. I did have a few bowls of it and have subsequently never wanted to see or taste it again. This is probably because my mind associates this food with the side effects of the chemotherapy I was receiving.
Food: thinking about it, preparing it, sitting together to break bread, has monumental importance to us all. We are told that food is love, and we all consider what to cook and offer to our loved ones during tough times. When someone is too ill to eat, it is very hard for families to back off. It usually works much better to offer someone small treats: Would you like a little ice cream? rather than a full meal. If the patient declines the offer, don't push. It is important to offer fluids; keeping a thermos of warm, sweetened tea or a glass of juice nearby may be helpful.
If someone has advanced cancer and is suffering with cancer cachexia, considerations of food need to be part of a larger conversation with the doctor. Generally speaking, a patient's family is more distressed about appetite loss than the patient. If the medical situation is one that may improve (e.g., someone has an obstruction of the esophagus and is being treated) some other solution may be in order.
Other options include IV nutrition, NG tubes that are inserted through the nose, or a longer-lasting feeding tube that is surgically inserted through the abdominal wall. ASCO guidelines suggest that such strategies should not be routinely ordered for people without obstructions, but who are not eating. They can cause other difficulties, and there is no evidence that they improve either the quality or the quantity of life. At times it can be much more difficult to make a decision to remove such devices than it is to begin their use. Thoughtful and honest conversations with the doctor are vital if such options are being considered.
In summary, there are a range of appetite issues for cancer patients. In some situations, appetites return as treatments conclude or we generally feel better. In the most serious situations, considering nutritional choices should be part of a larger discussion with the focus on quality of life.