Anorexia: an Eating Challenge in Palliative Care

Abstract

Anorexia is a common and complex symptom in patients with advanced cancer, characterized by partial or total decrease of food intake or desire to eat. Food aversion1 can be triggered by various metabolic and immunological disorders1-5, in addition to emotional complications that may contribute to the worsening of the nutritional status and the general condition of the patients6,7. The relationship between cancer anorexia and poor prognosis and survival is factual due to weight loss that impairs the immune system, muscle mass with loss of strength and balance that may be associated with cachexia syndrome2,4,5. Consequently, this can affect patients’ quality of life1,3, 6,5,8,9 and result in apathy, gradual disinterest in life and social isolation. According to the World Health Organization, one of the pillars for palliative care is the quality of life of patients with chronic, evolutionary and even terminal diseases, including cancer. Therefore, palliative care entails a set of practical assistance measures for advanced cancer patients who require special care for addressing serious, chronic, degenerative, progressive, and life-threatening illnesses10. It is an urgent humanitarian need worldwide due to a high level of late diagnosis, and poor survival rates. Furthermore, palliative care transcends traditional care models, bringing bioethics issues to the fore, including nutrition-related themes8 . Due to the multiple dimensions involved in caring for palliative patients -physical, social, psychological - a multidisciplinary approach is needed to provide proactive care, while ensuring previous management of several symptoms8,10. Thus, multidisciplinary teams should develop effective communication and patient-and family centered care, although it may become quite challenging on account of the complexity of advanced cancer. Similarly, dietitians as healthcare providers involved in this setting have a great responsibility to employ all the necessary skills to provide comprehensive assessment for palliative care patients8 . Despite the relevance of the issue, it is surprising that palliative patients are neglected by the healthcare providers, and that a gap in the literature exists on nutritional intervention to prevent or mitigate anorexia. Therefore, in an effort to deepen this issue, this article addresses the importance of debating the eating challenges of these patients and emphasizes the dietitian’s role in a multidisciplinary team.