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About managing weight loss in cancer patients

Fruits and vegetables are recommended as part of a healthy eating lifestyle. Monitor photo

What you need to know:

  • It is important to take cues from the patient because too much pressure is going to result in somebody eating even less than she might have otherwise eaten and to resent those caregivers that force them to eat.

According to figures from the 2024 Global Cancer Report, about one in five people develop cancer in their lifetime. Almost every person has known a friend or relative who has or died of cancer. 

Between 50-80 percent of patients with cancer experience loss of weight, a condition termed as cancer cachexia. Cancer cachexia is when cancer affects appetite, making a patient fail to eat enough food and lose body weight, skeletal muscle, and fat. Cachexia can lead to fatigue, functional impairment, increased chemotherapy-related toxicity, poor quality of life, and reduced survival. This can be a life-threatening condition.

Research shows that cancer cachexia causes between 20-60 percent deaths in cancer patients and is one of the most challenging cancer conditions to manage both in a cancer centre and at home.

For the past two years, Pfizer has provided funding to the Uganda Cancer Institute to study and explore the impact of cancer cachexia on physical activity, performance, and functional measures and to recommend ways to improve the management of this condition and mitigate its devastating effects on women with advanced cervical cancer in Uganda.

Cancer cachexia can lead to significant functional impairment, physical distress, and poor quality of life in cancer patients and their families if it is not well assessed and managed. It can also impact cancer treatment, is linked to poor response to treatment and shortened survival.

Patients with cancer cachexia may have poor physical function and are at higher risk for disabilities, as well as facing difficulties with receiving and tolerating chemotherapy and often have poor quality of life and treatment outcomes.

Based on our most recent research and experience at the Uganda Cancer Institute, we recommend the following options for managing cancer patients with loss of appetite, body weight, muscle and fat (cachexia);

Nutritional interventions

● Seek advice from a nutritionist about providing patients and caregivers with practical and safe advice for feeding; education regarding high-protein, high-calorie, nutrient-dense food; and advice against fad diets and other unproven or extreme diets.

● Health workers should not routinely offer enteral tube feeding or parenteral nutrition to manage cachexia in patients with advanced cancer. A short-term trial of parenteral nutrition may be offered to a very select group of patients, such as patients who have a reversible bowel obstruction, short bowel syndrome, or other issues contributing to malabsorption, but otherwise are reasonably fit.

● Discontinuation of previously initiated tube feeding near the end of life is appropriate.

Pharmacologic Interventions

● Evidence remains insufficient to strongly endorse any drug to improve cancer cachexia outcomes; clinicians may choose not to offer medications for the treatment of cancer cachexia. There are currently no FDA-approved medications for the treatment of cancer cachexia.

● Medical workers may offer a short-term trial of a progesterone analog or a corticosteroid to patients experiencing loss of appetite and/or body weight. The choice of agent and duration of treatment should depend on treatment goals and assessment of risk versus benefit.

Outside the context of a clinical trial, no recommendation can be made for other interventions, such as exercise, or herbal medication for the management of cancer cachexia.

Tips for cancer patient caregivers

In many cancer cachexia patients, they just don't have an appetite. It's not a problem. It's not like they have pain, or it's not like they have nausea or vomiting. Now there are some patients who that bothers that they don't have an appetite, but many patients are not bothered by it. The family is oftentimes bothered tremendously by this particular situation.

Caregivers must not force cancer patients to eat more. It is not wise to do that. It is very important to try in a loving non-pressured way to communicate about it like, "Dad, is there anything you can think of that might taste good? Would you like a little bit of food y, b or x ?" Such kind of approach. And if Dad says, "No. I don't want anything," then try again a few hours later. More frequent offerings of small amounts of food are much more likely to be accepted than bringing in a full dinner plate.

It is important to take cues from the patient because too much pressure is going to result in somebody eating even less than she might have otherwise eaten and to resent those caregivers that force them to eat.

Innocent Atuhe, Cancer Cachexia Consultant and a Co-Investigator, Cachexia Study at the Uganda Cancer Institute