Current management of cancer-associated anorexia and weight loss

Loss of appetite and weight predict a poor prognosis for cancer patients. Although caloric supplementation might benefit subgroups of patients - specifically, perioperative, severely malnourished cancer patients, stem cell and bone marrow transplant patients, and head and neck cancer patients - its use remains controversial and is not recommended for the majority of patients with cancer-associated weight loss. Most patients with advanced cancer, anorexia, and/or weight loss do not appear to benefit from nutritional supplementation. Instead, discussions with patients and families about realistic eating goals and, at times, pharmacologic interventions with progestational agents or corticosteroids - both of which are aimed at palliating anorexia - provide clinical benefit. Other pharmacologic interventions such as eicosapentaenoic acid, thalidomide (Thalomid), adenosine triphosphate, and nonsteroidal anti-inflammatory agents focus on the fact that cancer-associated weight loss is an entity distinct from simple starvation. These interventions promise to replenish lean tissue but require further investigation before they can be recommended as standard clinical practice.