Anorexia/cachexia syndrome is a complex metabolic process found in many end stage illnesses. This is characterised by the loss or absence of appetite (anorexia) with weight loss and muscle wasting (cachexia). This impacts significantly on quality of life and can cause anxiety and distress for patients, perhaps even more so for carers.
The assessment is much more than the patient’s calorific intake versus their body weight. It is worth considering if recording the patient’s weight is necessary as this may result in increasing anxiety regarding their weight loss. Be aware that the ongoing loss of lean body mass may occur with or without loss of fat mass.
A nutritional assessment needs to be holistic and acknowledge the emotional, social, cognitive and biochemical aspects of nutrition and diet. Each assessment should be individualised taking the patient’s condition and stage of illness into consideration.
Look for any reversible problems that may exacerbate anorexia including Pain, Breathlessness, Depression, Ascites, Nausea & Vomiting, Constipation, Dysphagia, Heartburn, Gastritis, Anxiety & Medication.
Oral problems: such as dry mouth, ill-fitting dentures, ulcers, candidiasis
Ask the patient and the carer about their perspectives on weight, body image, nutrition and dietary intake.
The aims are prevention or early identification as well as the treatment of contributory symptoms. This includes acknowledging the psychological impact on the patient and carer, together with providing information and supportive care.
In nutritional support, the emphasis is based upon eating within the limits of the patient’s condition and capability.
Offer information and practical advice about nutrition, diet and managing anorexia in advanced illness.
Address patient and carer concerns about the importance of providing nourishment.
Encourage patients and their carers to focus on enjoying food and the social interaction associated with eating and drinking.
Explain that a gradual reduction in oral intake is a natural part of the illness.
The following drugs are of limited or temporary benefit but worth considering as may improve quality of life. The potential side effects and risks of medication should be taken into account when prescribing.
Metoclopramide 10mg or domperidone 10mg given three times a day, 30 minutes before meals.
Supplementary drinks are expensive but can help selected patients after careful assessment of nutritional status, prognosis and alternative options. (See local formulary for recommended preparations and advice).
Previous dietary advice given regarding diabetes and high cholesterol may be relaxed.
Consider referral to a dietitian if appropriate.
Patient/carer advice points
Gently encourage the patient to take what he or she can manage. Provide small portions, attractively presented, offered frequently through the day.
Offer soft, easy to swallow foods such as soup, pudding and nutritious drinks. If tolerated increase intake of higher calorie foods such as butter, cream, cheese.
Try not to talk about food all the time and try to keep the person involved in the social aspects of meals.
Further information available at Macmillan Cancer Support
Check local policies and guidelines for further advice and information.
Information booklets are produced by Macmillan Cancer Support and are available via their website http://www.macmillan.org.uk or via the helpline 0808 808 0000.