Anorexia

Definition

Anorexia is loss of appetite or desire to eat, accompanied by decreased food intake.

Onset/duration

The onset of anorexia may be within days or weeks of beginning cancer treatment.

Risk factors

Anorexia can be related to:

• treatment side effects (nausea and vomiting, diarrhoea, constipation, xerostomia, pain, taste and smell changes)
• other medication (opioids, antimicrobials, antidepressants, antibiotics)
• psychosocial factors (fatigue, lethargy, anxiety, depression, inability for self-care - lack of support)
• tumour related factors (type of cancer, presence of metastatic disease, hypercalcaemia, factors secreted by the tumour, gut involvement, metabolic abnormalities)
• dysphagia
• stomatitis
• infection
• aging.

General patient assessment is required in particular for:

• the presence of
  • stomatitis
  • dysphagia
  • nausea and vomiting
• compliance with antiemetic medications
• patient's weight and diet history
• dehydration.

Investigations and diagnosis

Monitor:

• patient's weight
• percentage change from baseline weight over time
• assess social support.

Grading

Common Terminology Criteria for Adverse Events (CTCAE) 

Prevention

Initiate early referral to a dietitian for nutritional assessment and intervention as indicated.

Treatment

• manage symptoms such as delayed nausea, dysphagia, stomatitis
• ensure patient is adequately hydrated - this may include intravenous energy and protein containing fluids
• consider medical interventions, such as
  • short term use of appetite stimulants:e.g. corticosteroids orsynthetic progestogens (megestrol acetate)
  • treatments for gastroparesis: e.g.metoclopramide, domperidone.

Educate patient:

• about the importance of reporting symptoms that can contribute to loss of appetite such as delayed nausea
• to consume food that is high in protein and calories
• to eat small portions frequently, throughout the day
• to avoid drinking fluids at meal times as this can cause early satiety
• take medication with high calorie/high protein fluids, e.g., milkshakes or nutrition supplements
• encourage an exercise regime (as tolerated by patient) as this can stimulate the appetite.

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