Loss of weight (cachexia) and appetite (anorexia) are significant concerns for many palliative care patients, and independently predict a poorer prognosis. [1-3] The palliative conditions in which cachexia and anorexia occur most frequently are progressive malignancy, HIV/AIDS, end-stage cardiac failure, end-stage respiratory failure, chronic renal failure, chronic liver disease, and advanced dementia. A focus on weight gain on its own may not result in meaningful clinical changes for palliative care patients. 
Potentially reversible contributors to appetite problems should be sought and treated as appropriate. These may include:
The relationship between catabolic state, hyper-metabolism, anorexia and nutritional intake, is extremely variable, complex and unpredictable. Appetite is a subjective symptom. Simple validated assessment tools are available, such as the Patient Generated Subjective Global Assessment. [15,16] However, expert consensus does not recommend any one tool over others.  With better understanding of cachexia anorexia syndrome, future treatments are likely to be multidimensional and initiated earlier. They may include appetite stimulants, tailored nutritional support and exercise,  and treatments to reverse the inflammatory drive associated with the syndrome. 
Assessment and treatment issues related to Cachexia Anorexia Syndrome, Appetite Stimulants and Nutritional Support are covered in more detail in the respective sub-section pages.
See individual subsections for practice implications in Cachexia Anorexia Syndrome, Appetite Stimulants and Nutritional Support
Last updated 27 August 2021