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Anorexia
Maintain a healthy appetite during treatment
Anorexia is the loss of appetite, or a lack of hunger or desire to eat because of how you feel overall. Loss of appetite is one of the most challenging symptoms for people with cancer and their families.
Why does anorexia occur?
Anorexia is usually caused by side effects of treatment, such as nausea and vomiting, mouth sores, pain, fatigue, diarrhea, constipation or taste changes. These symptoms affect your overall well-being and desire to eat.
Who is most likely to be affected?
Appetite can be affected in people who have had surgery, especially surgery of the digestive system or head and neck area, as well as people who receive chemotherapy or radiation therapy. People who receive cisplatin, cyclophosphamide, doxorubicin, fluorouracil, paclitaxel or vincristine are most likely to have changes in taste (such as a bitter or metallic taste), which can affect the desire to eat.
When does anorexia occur?
The timing of anorexia varies widely and may occur mostly on treatment days or throughout treatment. Appetite usually returns to normal one to two weeks after treatment has ended. Sometimes, however, a decreased appetite may last for a longer period of time after the end of treatment.
How is anorexia managed?
The focus of managing anorexia is to treat the symptoms that are causing it. For example, controlling nausea and vomiting can improve appetite; treating mouth sores can make it more comfortable to eat; and taking pain medication 30 to 60 minutes before a meal may improve your desire to eat. In addition, changes in eating habits can help ensure adequate nutrition and avoid weight loss (Table 1). For example, if you have mouth sores or difficulty swallowing, choose soft foods and beverages that are high in calories and nutritional value. Several cookbooks are available for people with cancer and include recipes that are nutritional as well as easy to prepare (see "Cookbooks for people with cancer" at bottom of page). Your doctor or nurse may suggest that you see a dietitian or nutritionist to help you select foods that provide good nutrition and are easy to eat.
Physical activity can help stimulate your appetite and make you feel like eating more, and drugs that enhance appetite, such as megestrol acetate (Megace) and corticosteroids (dexamethasone), are also available. These drugs have side effects, however, so your doctor will help you decide whether an appetite enhancer is appropriate in your individual case.
Table 1. Eating habits to improve appetite and maintain nutrition
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Eat high-calorie, soft foods
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▪ Examples: casseroles, stews, macaroni and cheese, hearty and creamy soups,
eggs, pancakes, waffles, French toast, mashed potatoes, pasta dishes,
puddings and ice cream
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Drink high-calorie beverages
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▪ Examples: juices, milk, cocoa, malted milk, shakes, smoothies,
breakfast drinks and nutritional supplement beverages (i.e., Ensure, Boost)
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Keep high-calorie snacks readily available (have them nearby at home and take them with you when you do errands)
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▪ Examples: peanut butter, cheese, ice cream, puddings, nuts, trail
mix, breakfast bars, cereal, yogurt, cottage cheese and hard-boiled eggs
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Eat five to six small meals throughout the day rather than three large meals
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Eat when you have the most hunger
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▪ Schedule your “main” meal of the day for when your appetite is
best and you are able to eat the most.
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Plan meals, and vary your foods to enhance taste
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▪ Plan meals that include your favorite foods
▪ Increase the use of seasonings and vary the odors and
textures of foods
▪ Use acidic foods (such as lemon wedges, pickles and olives)
to stimulate taste buds
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Make mealtime pleasant
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▪ Create a pleasant setting for mealtimes and make them
relaxed and unhurried
▪ Have meals with family and friends and go to a restaurant for
a change of pace
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Eat high-calorie, nutritious foods first at mealtimes
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▪ Start with the protein (meat, chicken and fish), follow
with starches (potatoes, pasta), and end with
vegetables.
▪ Limit fluid intake during meals to sips to prevent beverages
from making you feel full.
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When should I talk to my doctor about anorexia?
Talk to your doctor about changes in your appetite and especially about other symptoms that may be related to difficulty while eating. Also tell your doctor if you have lost five pounds or more since the beginning of treatment. Anorexia should be addressed as early as possible because adequate nutrition is needed to help you tolerate treatment and heal.
Cookbooks for people with cancer
Additional Resources
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