Several classes of medication have been studied in the role of appetite stimulants. The best established are the progestogens - megestrol acetate and medroxyprogesterone acetate, and corticosteroids. Their mechanism of action is not well understood.
This is an active area of clinical research, and a number of other agents are also being investigated, including metoclopramide, dronabinol, EPA (fish oil), erthythropoietin, thalidomide, ghrelin, interferon, melatonin, non-steroidal anti-inflammatories, nandrolone, antidepressants such as mirtazepine, and atypical antipsychotics such as olanzapine.
What is known
- There is good evidence that megestrol acetate improves appetite and weight gain in advanced cancer, but insufficient evidence that it has benefit in AIDS or other diseases causing anorexia and weight loss. [1] A smaller number of studies have investigated medroxyprogesterone acetate, and they also support its use in patients with cancer. [2]
- The duration of most studies was six to twelve weeks. It was not possible to draw a conclusion about the impact on patients’ quality of life, or what dose should be used. There was a low incidence of adverse effects in these studies. [1, 2]
- Dexamethasone, prednisolone and methylprednisolone have all been shown to improve appetite, and some studies have also shown increases in quality of life and wellbeing. There is not enough evidence to recommend doses or duration of treatment, and it is suggested that the effects tend to diminish after four weeks, while side effects increase, although one study showed that benefits continued at eight weeks. [2]
- Hydrazine sulphate has been shown to be ineffective in numerous studies, and should not be used as an appetite stimulant. [2]
What it means in practice
- Stimulating appetite often does not reverse cachexia. [3]
- Progestogens or corticosteroids can be used to improve appetite in palliative care patients. The benefits in terms of quality of life and well-being have not been established, and clinicians should assess these regularly in individual patients being treated. There are no recommendations to guide the choice of dose or the duration of treatment.
- Choice of drug should take into account the side effect profile, cost and burden of treatment. [3]
- It is recommended that other agents only be used in the setting of a clinical trial. [4]
Finding out more
Guidelines
Evidence based practice guidelines for the nutritional management of cancer cachexia
Bauer et al Nutrition & Dietetics, Volume 63, Supplement 2, September 2006 , pp. S3-S32(1)
Link to prescribing information
NB Prescribing information may not yet have been updated to include the most recent evidence.
Overview articles
Inui, A (2002) The cancer anorexia cachexia syndrome –current issues in research and management
Cherny N (2004) Taking care of the terminally ill cancer patient – management of gastrointestinal symptoms in patients with advanced cancer
Related CareSearch pages
Cachexia anorexia syndrome
Artificial nutrition
Nausea
Depression
References
- Berenstein EG, Ortiz Z. Megestrol acetate for the treatment of anorexia-cachexia syndrome. Cochrane Database of Systematic Reviews. 2005 Apr 18;(2):CD004310.
- Yavuzsen T, Davis MP, Walsh D, Le Grand S, Lagman R. Systematic review of the treatment of cancer-associated anorexia and weight loss. Journal of Clinical Oncology. 2005 Nov 20;23(33):8500-11.
- Del Fabbro E, Dalal S, Bruera E. Symptom control in palliative care--Part II: cachexia/anorexia and fatigue. Journal of Palliative Medicine. 2006 Apr;9(2):409-21.
- Desport JC, Blanc-Vincent MP, Gory-Delabaere G, Bachmann P, Beal J, Benamouzig R, et al. Standards, Options and Recommendations (SOR) for the use of appetite stimulants in oncology. Work group. Federation of the French Cancer Centres (FNCLCC)]. Bulletin du Cancer. 2000 Apr;87(4):315-28.
This page was created on 6 May 2008 and will be reviewed in May 2010
Last updated 26 May 2008