One of the most well-described nutritional problems in patients with cancer is anorexia, which is the loss of the desire to eat. Underlying causes of this common symptom include psychological factors (stress, anxiety, depression), tumor factors (altered metabolism, pain, early satiety, motility problems, swallowing difficulty) and treatment factors (fatigue, nausea, chemosensory alterations, mucositis, or inflammation of the lining of structures such as the mouth and throat).
Loss of appetite can contribute to cachexia — a profound metabolic derangement with a heterogeneous clinical presentation that results in loss of lean body mass. A recent international consensus defined cachexia as a “multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterized by a negative protein and energy balance, driven by a variable combination of reduced food intake and abnormal metabolism.” Cachexia often progresses through stages from precachexia to refractory cachexia.
The diagnostic criterion for cachexia, established by international consensus, is weight loss > 5% (or > 2% in individuals already showing depletion of body weight or skeletal muscle mass). Moreover, the wasting of skeletal muscle can occur even before overall weight loss becomes apparent, and despite the ingestion of adequate calories, tumor-related factors can interfere with maintenance of fat and muscle. Although a secondary disorder, cachexia is often the proximal cause of death in patients with cancer.
“Weight loss shortens survival,” says Dixon, who emphasizes very early intervention for patients experiencing anorexia who are unable to ingest enough food. “These patients never feel hungry, so they need to eat by the clock or even ‘graze,’ eating small amounts of food all day,” explains Dixon.
But cachexia, she warns, can’t be reversed with calories alone. “Patients with more advanced cancers have deranged metabolisms. Their tumors can be a source of cytokines and signals that raise metabolism and suppress appetite. These patients often use fuel inappropriately. Instead of using fat for energy, tumors can create a situation in which the body uses lean tissue. You might be able to slow the process, but you can’t undo it, even with total parenteral nutrition. Medical therapies have been abysmal failures in these patients.”
This is why Dixon is a big advocate of screening, planning, and prevention. In some patients, this means a long-term feeding tube, usually a percutaneous endoscopic gastrostomy (PEG), for the administration of enteral feedings, should that become necessary. “Many patients are afraid of getting a PEG before they start treatment. Some will decide against the PEG, not realizing that the effects of radiation are cumulative. They make it through treatment, and they think they will start to feel better. However, many will hit their lowest point and become unable to eat weeks or even months after their treatment ends. If they have a PEG, they can start to use it at that point and continue for up to 6 months after treatment. For head and neck cancer patients with feeding tubes, consultation with a speech and language specialist is vital to develop a plan to preserve swallowing function.”
What about the patient who just doesn’t find any food appetizing? In this situation, Rebecca Katz turns to the oldest medicine known to man: warm, nourishing broth. She spent years developing the perfect recipe for “magic mineral broth,” which she calls the “ultimate culinary alchemy.” Magic mineral broth goes down easy, and patients find it very soothing. “It’s something that friends and families can make for the patient with cancer who is not feeling well; it’s like giving the body an internal spa treatment,” says Katz.
Magic mineral broth is a science-based, nutrient-dense concoction that can relieve many of the side effects of cancer treatment, such as nausea, vomiting, fatigue, and dehydration. It’s easy to swallow for patients with dysphagia. “A bowl of soup is appealing to almost anyone,” says Katz.
Recipe for Magic Mineral Broth
6 unpeeled carrots, cut into thirds
2 unpeeled yellow onions, cut into chunks
1 leek, white and green parts, cut into thirds
1 bunch celery, including the heart, cut into thirds
4 unpeeled red potatoes, quartered
2 unpeeled Japanese or regular sweet potatoes, quartered
1 unpeeled garnet yam, quartered
5 unpeeled cloves of garlic, halved
One-half bunch of fresh flat-leaf parsley
One 8-inch strip of kombu (a type of dried seaweed)
12 black peppercorns
4 whole allspice or juniper berries
2 bay leaves
8 quarts cold filtered water
1 teaspoon sea salt
Rinse the vegetables well, including the kombu. In a 12-quart (or larger) stockpot, combine all ingredients except salt. Fill the pot with water to 2 inches below the rim, cover, and bring to a boil. Remove the lid; reduce heat to low; and simmer, uncovered, for at least 2 hours. Add more water if needed to keep vegetables covered. Simmer until the full richness of the vegetables can be tasted. Strain through a large, coarse mesh sieve. Add salt to taste. Let cool to room temperature before refrigerating or freezing.
(Adapted from The Cancer-Fighting Kitchen. Courtesy of Rebecca Katz)
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- Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489-495. Abstract
- Suzuki H, Asakawa A, Amitani H, Nakamura N, Inui A. Cancer cachexia — pathophysiology and management. J Gastroenterol. 2013;48:574-594. Abstract