Nutritional, Psychological, and Behavioral Therapies The management of cachexia in advanced cancer patients should first attempt to maximize oral intake by allowing the patient flexibility in type, quantity, and timing of meals.90 Professional teams of oncology physicians, nurses, and dietitians, along with patients and families, can diagnose specific needs and plan individualized treatment for improved nutritional health. Counseling, which any member of the health care team may provide, is an effective and inexpensive intervention and should be combined with other nutritional interventions.148 Nursing interventions to counteract cachexia should be aimed at minimizing the negative factors of nausea, vomiting, diarrhea, pain, fatigue, changes in taste, or food preferences that may influence appetite.149 Encouraging patient and family interaction and providing emotional and educational support may be helpful. When family members can provide the patient’s favorite foods, food intake usually improves and family bonds are strengthened. Communication among physicians and other health care professionals provides the patient with a multidisciplinary approach to care. The patient record will be an excellent resource to document a plan of care and patient responses to treatment.149 Psychological distress and psychiatric disorders are common among cancer patients and have a prevalence ranging from 10 to 79 percent of patients depending upon the group studied.10,150 These problems are also as common among the family members of people with cancer. The use of psychological and behavioral interventions in cancer is increasing and recent studies have suggested that some of these techniques may affect quality of life and, perhaps, survival rates.10,150 Evaluations of relaxation, hypnosis, and short-term group psychotherapy have suggested some benefit with regard to anorexia and fatigue, although the population most likely to benefit from these interventions has not yet been determined.10,150 Anorexia and cachexia may result in a secondary depression, or the depression may be a prime contributor to the anorexia and subsequent weight loss. Benzodiazepines can be helpful for persistent fear and anxiety and antidepressant drugs are increasingly used in depressed cancer patients. Assessment of the patient’s quality of life is also important and psychometric instruments relevant to this quality-of-life domain need to be designed and validated.91,150 Applicable References: 10. Higginson I, Bruera, E. Practical concepts for clinicians. In: Bruera E, Higginson I, eds. Cachexia-anorexia in cancer patients. Oxford, England: Oxford University Press;1996:185-189. 90. Fainsinger R. Pharmacological approach to cancer anorexia and cachexia. In: Bruera E, Higginson I, eds. Cachexia-anorexia in cancer patients. Oxford, England: Oxford University Press;1996:128-140. 91. Mantovani G, Maccio A, Massa E, et al. Managing cancer-related anorexia / cachexia. Drugs 2001;61:499-514. 148. Whitman MM. The starving patient: Supportive care for people with cancer. Clin J Oncol Nurs 2000;4:121-125. 149. Tait NS. Anorexia-cachexia syndrome. In: Groenwald SL, Goodman M, Frogge MH, Yarbro CH, eds. Cancer symptom management. Boston, MA: Jones and Bartlett Publishers;1996:171-185. 150. Higginson I, Winget C. Psychological impact of cancer cachexia on the patient and family. In: Bruera E, Higginson I, eds. Cachexia-anorexia in cancer patients. Oxford, England: Oxford University Press; 1996:172-183. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.