• Weight losing patients who achieve weight stabilisation have longer survival and improved quality of life when compared to those who continue to lose weight. [1]  
• EPA (omega 3 fatty acid from fish oil) has been studied as part of a nutritional supplement in patients with cachexia anorexia from pancreatic cancer. Despite promising results in several studies, a systematic review has not shown it to be better at improving weight or quality of life than a nutritional supplement without EPA. [2] 
• Weight loss due to primary cachexia anorexia syndrome from progressive malignancy is not reversed by supplying additional nutrition. [3] 
• In patients with advanced dementia and cachexia artificial feeding (by tube) does not prolong life or prevent aspiration. [4]

What it means in practice 

• The optimal timing and strategy for providing nutritional support is not known. 
• There is limited evidence about the effects of nutritional counseling on palliative care patients, but non-sustained improvements in intake have been shown in one study. [5] 
• Weight stabilization with effective nutrition counseling may improve survival and quality of life. 
• Decisions about artificial nutrition in palliative care patients should include an assessment of both the benefit and burden of treatments. 
• The use of enteral and parenteral nutrition in terminally ill cancer patients approaching the end of life is rarely indicated. Dying patients lose their ability to swallow safely in the last few days of life. Studies support the view that dying patients require only minimal amounts of food and fluids to reduce thirst and hunger. [3, 6] 
• The use of enteral and parenteral nutrition in patients with advanced cancer and a life expectancy of months or more is controversial [3]. Clinical guidelines for use of parenteral nutrition in the palliative care setting are evolving. [7] The proposed guidelines suggest criteria for identifying who might benefit, including nutritional criteria, life expectancy, quality of life, and functional capability. 
• Artificial feeding in advanced dementia does not provide good palliation, and the focus should instead be on offering whatever oral intake the patient will accept, and on good mouth care. However families and aged care staff may both require support and education in this area. [8]

Finding out more
Guidelines

• Mirhosseini et al 2005 Parenteral nutrition in advanced cancer: indications and clinical practice guidelines
  Bauer et al 2006  Evidence based practice guidelines for the nutritional management of cancer cachexia 

Link to prescribing information
NB Prescribing information may not yet have been updated to include the most recent evidence.

• Online Palliative Medicine Handbook 
  Click on “Notes on Prescribing”
  This prescribing information is from the UK and some medications may not be available in Australia
• Therapeutic Guidelines for Palliative Care
  An Australian source of prescribing information not available directly online through CareSearch, but can be accessed online in most hospitals, or purchased

Overview

• Inui, A (2002) The cancer anorexia cachexia syndrome –current issues in research and management 

Related CareSearch pages
Appetite stimulants
Cachexia anorexia syndrome
Nausea

References

1. Davidson W, Ash S, Capra S, Bauer J, Cancer Cachexia Study Group  Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer: Clinical Nutrition 2004; 23 (p239-247) 2004 
2. Berenstein EG, Ortiz Z. Megestrol acetate for the treatment of anorexia-cachexia syndrome. Cochrane Database of Systematic Reviews. 2005 Apr 18;(2):CD004310. 
3.  Arends J, Bodoky G, Bozzetti F, Fearon K, Muscariotoli M, Seslga G, et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clinical Nutrition. 2006 Apr;25(2):245-259.
4. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA. 1999 Oct 13;282(14):1365-70. 
5. 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.
6.  ASPEN, American Society for Parenteral and Enteral Nutrition: Specific guidelines for disease - adults. J Parenter Enteral Nutrition, 2002. 26(1 (Suppl)): p. 61SA - 96SA.
7. Mirhosseini N, Fainsinger RL, Baracos V. Parenteral nutrition in advanced cancer: indications and clinical practice guidelines. Journal of Palliative Medicine. 2005 Oct;8(5):914-8. 
8. Edith Cowan University.Guidelines for a palliative approach in residential aged care: enhanced version. Canberra; National Health & Medical Research Council & National Palliative Care Program:2006.