Appetite

Key points

• Anorexia (loss of appetite / early satiety) and cachexia occur commonly together in cancer and other advanced diseases, and affect performance status.
• Cachexia and anorexia are strong independent prognostic predictors.
• Once fully established, or in late disease, cachexia is not reversible by nutritional interventions.
• Cachexia affects the person’s ability to tolerate treatment of cancer.
• Clinicians need to recognise the profound social, cultural and emotional importance of food and provide individualised support to patients and families.

Assessment

• Consider potentially reversible causes – including nausea, depression, medication side effects, mouth problems.
• Consider overall prognosis and stage of disease in deciding a management approach.

Approach to management

• Multidisciplinary intervention (nutrition, exercise, occupational therapy and pharmacological intervention) may help selected patients.
• Assist with adaptation to the symptom – including dietary modification, appropriate nutritional support, and psychological support.
• When prognosis is getting short: encourage transition to eating for comfort.