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CANCER ANOREXIA/CACHEXIA Downloadable
PDF file
Robin L. Fainsinger, MD Clinical Director,
Regional Palliative Care Program - Issue #2 (Collect them all)
(Re-issued April 2005)
CANCER ANOREXIA/CACHEXIA: occurs in 80%-90% of patients
with advanced cancer.
Anorexia - Loss of appetite, poor food intake
Cachexia - Weight loss
1. Ideal management:- remove underlying cause; rarely possible
2. Realistic management: - improve "quality of life":
- a) relieve nausea; b) improve appetite; c) maintain or increase
weight; d) patient and family understanding of treatment aims
and limitations
3. Role of dietitian
•assess
nutritional status
•maximize
nutritional intake
•advise
on dietary options
4. Enteral and parenteral nutrition (refer to Palliative
Care TIPS Issue #24)
•
consensus that it is not appropriate for most advanced cancer
patients
•
metabolic abnormalities usually not reversible by nutritional
support
•
exclude few patients with weight loss due to starvation
•highly
selected patients may have time limited benefits, eg: head
and neck cancer with dysphagia; malignant bowel obstruction
with slow growing primary cancer (see
Clinical Practice Guideline on Parenteral Nutrition)
5. Pharmacological management
•
control nausea with gastric motility agents, eg: Metoclopramide
10 mg qid
Domperidone 10 mg qid
•
dexamethasone 4-10 mg bid may benefit patients but prolonged
use not recommended
•megestrol
acetate starting at 480 mg/day and increasing up to 800 mg/day
depending upon response (expensive option: 480 mg/day costs
± $554/month; generic (APO) now available: $350/month)
(remember, most of this could be covered by the Palliative
Care Drug Benefit Plan)
6. Areas to discuss with patient and family
•forcing
patient to eat will have no impact on well-being or survival
•
encourage favourite foods for comfort and ability to enjoy
eating. Nutritional value often of limited importance.
•
where enteral or parenteral nutrition clearly not indicated,
explanation of associated morbidity and proven lack of benefit
helpful to dissuade most families except in rare circumstances.
7. Ethical issues
•
does the patient have the right to a medically futile treatment
(autonomy)?
•
will parenteral nutrition do more good than harm (beneficence/non-maleficence)?
•how
is access to health care and treatment costs impacted by society
limitations (justice)?
REMEMBER: For referrals, questions, or telephone consultations
call 496-1300 weekdays and weekends
Palliative Care Tips are now available on our Website:
www.palliative.org
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