Unintended weight loss and anorexia (the loss of appetite or desire to eat) in patients with cancer is associated with decreased performance status, reduced response and tolerance to treatment, decreased survival, and reduced quality of life. Proactive nutrition screening for changes in body weight and decreased appetite and/or intake throughout the continuum of care is vital for improving patient outcomes.
Initial intervention strategies should include referral to a registered dietitian nutritionist and identification and management of contributing factors as treatment-related alterations in gastrointestinal (GI) function (e.g., nausea, constipation, diarrhea, mucositis, early satiety, taste changes) and the effects of supportive medications on the GI tract (e.g., opioids, antibiotics, antiemetics). However, if unintended weight loss and decreased appetite continue, the use pharmacologic agents should be considered. The following pharmacologic agents have been shown to have effectiveness in the management of anorexia and stimulating appetite in patients with cancer.
- Corticosterioids: dexamethasone, methylprednisolone, prednisolone
- Progestiantional agents: megestrol acetate, medroxyprogesterone acetate
Although the prokinetic agent metoclopramide does not directly improve appetite, it has been found to be effective for decreasing nausea and early satiety by stimulating gut motility. Of note, mitrazapine is currently under investigation by the National Cancer Institute to see if its use can improve appetite in patients with advanced cancer experiencing anorexia and weight loss.
Barbara L. Grant, MS, RDN, CSO, FAND, is the oncology outpatient registered dietitian nutritionist at Saint Alphonsus Cancer Care Center in Boise, Idaho.