Numerous patients with advanced, incurable cancer suffer from loss of appetite, or cancer-associated anorexia. Cancer-associated loss of appetite is not an isolated symptom but often occurs in association with pain, fatigue, and weakness. Cancer-associated anorexia has a robust impact on patient satisfaction in terms of health and physical function. A recent review summarized the ways to best manage this symptom.

Several studies have shown that in advanced incurable cancer, some forms of nutrition support can have adverse effects. A meta-analysis of trials in cancer patients showed no survival benefit from parenteral nutrition. The American Society for Parenteral and Enteral Nutrition (ASPEN) has recommended that nutrition support should not be routinely used as an adjunct to chemotherapy or irradiation to the head and neck, abdomen, or pelvis. The society has also warned against the use of such nutrition support in terminally ill cancer patients. The decision to provide medically assisted nutrition is a complex one and should be guided on a case-by-case basis by cancer type, treatment, anticipated duration and reversibility of nutritional deficit, prognosis, and patient preferences. However, in patients with advanced, incurable cancer, the use of invasive nutrition support is largely discouraged.

Nutritional supplements are often advised to tackle the weight loss seen in several of these patients. Some studies have shown beneficial effects with amino acid supplements. Evidence points to an increase in free-fat mass and increased muscle protein synthesis following consumption of oral proteins. However, other trials have pointed to the contrary. While amino acid derivative carnitine has been shown in preclinical studies to have a role in the treatment of cancer associated loss of appetite, further investigation is needed before recommending the routine use of this derivative.

Dietary counseling forms a part of the multimodal approach to cancer-associated weight loss. Dietary counseling can have a positive impact on certain aspects of nutritional intake; however, the available data fail to show a consistent impact on treatment response or survival. Despite the lack of a benefit on clinically significant outcomes, dietary counseling has still been shown to yield higher perceived health benefits and overall satisfaction in patients receiving it than patients receiving usual care.

Certain cancer patients may find an appetite stimulant helpful. Such stimulants seem helpful in improving appetite, but may have no role in improving global quality of life or survival.

The role of these palliative treatments in improving the quality of life and survival is limited. Therefore, there is a need to evaluate novel approaches for stimulating appetite in patients with advanced cancer.

Source: Childs DS, Jatoi A. A hunger for hunger: A review of palliative therapies for cancer-associated anorexia. Ann Palliat Med. 2019 Jan; 8(1): 50–58.