Anorexia and cachexia are common in people with advanced illness. Sarcopenia is common in older people. They are significant concerns for many people with advanced illness.
The prevalence of cachexia ranges from 5-20 per cent in those with chronic heart failure to 60 per cent in those with COPD and as high as 85 per cent in those with advanced cancer, particularly pancreatic, gastric, and lung.
is loss of appetite or reduced nutritional intake.
is when a person wants to eat but can only take small amounts due to a sense of fullness. It is common in cancer patients and may be separate from other appetite problems, or it may co-exist with anorexia or nausea.
is a complex condition related to an underlying illness. It results in weight and muscle and generalised weakness, with or without loss of fat mass. It cannot be fully reversed by regular nutritional support and leads to progressive functional impairment.
syndrome is a complex metabolic syndrome that usually involves anorexia, significant weight loss, generalised weakness, and loss of skeletal muscle. It is commonly experienced by people with advanced cancer and chronic illnesses including advanced heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD) and HIV/AIDS.
is the loss of muscle mass with or without weight loss. It is associated with ageing and with loss of function. Most people with cachexia are sarcopenic, however, most people with sarcopenia are not cachectic.
Nurses have an important role in recognising, assessing, and managing symptoms related to appetite and weight loss. They can also help patients and families with sensitive and culturally appropriate education and support.
Anorexia and cachexia commonly occur
together in cancer and advanced disease.
cachexia will often have:
Preparing and eating food may have a powerful
cultural significance and is often an intimate part of the expression of love
and caring within a family or between partners. Family and carers may need help
in adjusting to changes in the person’s interest in food, their appetite and
It is important to remember that appetite is a subjective
symptom which means that it is something the person experiences without obvious
signs to anyone else and so it is best described by the person (self-reporting).
Tailor the assessment to the person’s
ability to tolerate and benefit from the assessment.
Use open-ended questions to explore specific characteristics of appetite and eating (nutritional intake) such as usual intake patterns, food likes and dislikes, and the meaning of food or eating to the person and family. Questions can lead to a broader discussion about why they cannot or do not want to eat, for example, painful gums, ill-fitting dentures, or altered sense of taste; or how they feel about the changes to their physical body. For example:
Cultural or religious beliefs about giving, taking, and refusing food may need to be explored.
Assess and monitor possible contributing factors which are reversible such as:
The Functional Assessment of Anorexia/Cachexia Treatment (FAACT) includes questions on appetite, taste and interest in food; whether the person has difficulty eating or is being pressured to eat; physical appearance and how the person feels about this. Other questions explore physical wellbeing, social wellbeing, emotional wellbeing, and functional wellbeing.
Care can include:
For cachexia, a clear explanation that weight loss is likely due to disease processes may help the person and the family understand how the person can best be supported.
Pay careful attention to oral care – regularly assess mouth and gums including dentures - and treat any oral pain. This video on oral health assessment can guide you.
With changes in weight and in body condition, the person may be concerned or distressed about their appearance. Understanding and validating their concerns can help their self-esteem and dignity.
In people with advanced dementia, loss of appetite and decreasing oral intake may mark the transition to end-stage disease; therefore, provide support for the person and families as they deal with this change.
Assistance from doctors and allied health professionals (nutrition, exercise, function, medication) may help. For example:
This information was drawn from the following resources:
Watch the Agency for Clinical Innovation video, Cachexia and anaemia: what action is needed?
Watch the Agency for Clinical Innovation video, Nutrition and palliative care
Access more Appetite and Weight Loss Resources
Last updated 09 October 2023