Feb 2003
Dear Readers: Here's the Article for this Month:
Name of article:
Eating-related disorders in patients with advanced cancer
Author(s): Florian Strasser
Reference: Support Care Cancer 2003; 11: 11-20
Abstract:
This work was presented at a workshop entitled: "To eat or not to eat, that is the question" held 24-25 October 2001 at the 4th San Salvatore Meeting on Palliative Care, Lugano and St. Gallen, Switzerland (Congress Chairman Hans Neuenschwander)
One of the first signs of cancer is weight loss associated with perceived changes in body image, fatigue, reduced performance status, anorexia and chronic nausea. These factors are among the main and most frequent causes of psyco-social distress and quality of life alterations for the advanced cancer patients and their families. The family’s reaction is to press the patient to eat more, with the idea that "if you do not eat, you’ll die." The patients suffer, on one hand due to the pressure of their families to eat more and, on the other hand, because they prefear to avoid social events as a consequence of anorexia and their altered body image.
Strasser gives practical advice for a " eating hygiene" to this population as well as educating the family to this purpose (eat a little, often and whenever one wants, if possible eat caloric food, in company, in relaxed surroundings, eat a lot of outside meals, maintain regular bowel functions).
The causes and mechanisms of anorexia/cachexia are indicated as primary (metabolic, neuroendocrine and anabolic) and secondary (impaired oral intake and/or impared GI absorption; significant loss of proteins; catabolic states like infections, chronic cardiac and/or renal failure, hyperthyroidism; loss of muscle mass).
The importance and the modality of the screening and basic assessment of anorexia/cachexia are indicated as a guide for considerations on the usefulness of potential therapies.
The aim of treating anorexia includes the control of specific symptoms (i.e. reduced food intake, sensation of anorexia, chronic nausea or asthenia) as well as changes in body image, nutritional status, body composition, and the improvement in performance status for an overall improvement of the quality of life.
Ethical considerations should be taken into account in the decision-making for the selection of treatments. The available therapeutical interventions for patients suffering from anorexia/cachexia and correlated symptoms include: 1. actions against the primary cause such as cancer, 2. management of aggravating factors (secondary anorexia/cachexia), 3. administration of an appropriate and patient proportionate nutritional support, 4. use of pharmacological treatments (steroids, progestins, prokinetics), 5. advice and sympathetic support.
The decision-making in selecting the treatment for eating-related disorders in patients with advanced cancer should be guided by the allocation of the priorities in respect to the presence of the associated physical, psycological and esistential problems as well as by the consideration of the natural course of the cancer and the effects of specific oncological therapies.
Why I chose this Article:
Strasser’s revision focuses on physical as well as psycho-social problems of the advanced cancer patients with eating-related disorders and at the same time takes into consideration their families’ issues. The Author leads us to consider how eating-related disorders in these patients do not receive the appropriate attention by the health care personnel notwithstanding the high frequency, the prognostic relevance, the physical suffering as well as the psycho-social implications that eating-related disorders represent.
Regards,
Carla Ripamonti, MD
Member of the Board of Directors, IAHPC
