Acute Medicine | Palliative care | Assessment and management of weight loss and loss of appetite

Assessment and management of weight loss and loss of appetite
Session overview
Description
This session gives a framework for assessing and managing loss of appetite (anorexia), weight loss and cachexia in patients near the end of their lives.

This session was reviewed by Alice Gray and Richard Kitchen and last updated in January 2021.

Learning objectives
By the end of this session you will be able to:

• differentiate between the terms anorexia and cachexia
• explain the link between anorexia and cachexia in advanced disease
• list some of the reversible factors underlying loss of appetite in disease
• recognise the psychosocial impact on both patient and carer of both loss of appetite, and involuntary weight loss/cachexia
• outline drug and non-drug approaches to the management of anorexia & cachexia

A reduced desire to eat, especially as a result of disease, is a common experience. The medical term for this is anorexia. Appetite loss occurs in over half of all cancer patients with weight loss becoming more common in the last weeks and months of life. This is also often true of patients with non-malignant conditions, such as dementia and end stage heart failure.

Food and eating have great social significance for patients and theirfamilies. Witnessing a prolonged loss of appetite and decreased oral intake can cause more psychological distress to close family members than to patients themselves.

Anorexia is closely linked with cachexia, the physical wasting with loss of weight and muscle mass caused by disease, particularly cancer.Cachexia is not the same as starvation. A healthy person's body can adjust to starvation by slowing down its use of nutrients, but incachectic patients, the body does not make this adjustment.

This session will discuss the association between anorexia and cachexia and other underlying causes for anorexia. It will also look at the management of anorexia and cachexia.