R63.0/R63.4/R64 + (Z51.1)
DESCRIPTION
Anorexia/cachexia syndrome is a complex metabolic process found in many end-stage illnesses. It is characterised by loss of appetite, weight loss and muscle wasting, and cannot be fully reversed by conventional nutritional support. It may impact significantly on the quality of life of patients, leading to increased anxiety and distress for both patients as well as family.
GENERAL MEASURES
Reduced food and fluid intake is expected at the end of life, and treatment of anorexia and weight loss may not be appropriate if these symptoms are not having a direct impact on quality of life. This should be explained to caregivers and family.
Management of anorexia and weight loss includes identification and, if appropriate, treatment of possible underlying cause(s). It may include the use of pharmacological and non-pharmacological treatment approaches.
Identify reversible problems that may contribute to or exacerbate anorexia/ cachexia including:
- Pain, nausea, heartburn, dyspnoea, gastritis, depression, constipation anxiety dysphagia, medication and fatigue
- Oral problems e.g. dry mouth, ulcers, candidiasis, etc.
- Odours e.g. fungating lesions, cooking smells, incontinence etc.
- Delayed gastric emptying due to local disease, autonomic neuropathy with early satiety and vomiting of undigested foods
If appropriate, moderate exercise must be encouraged, along with pacing of activities and good sleep hygiene.
Nutritional advice includes eating small amounts of enjoyable food frequently.
MEDICINE TREATMENT
If the anorexia and/ cachexia contributes significantly to decreased quality of life and the patient has a short life expectancy.
- Corticosteroids (intermediate-acting) e.g.:
- Prednisone, oral, 0.5 mg/kg (e.g. 20–30 mg) daily.
- The effect may be rapid but usually decreases after 3–4 weeks.
- If there is no benefit after 1 week, stop the treatment.
If symptoms of reflux or gastritis: see Gastro-oesophageal reflux disease.
If gastroparesis is present, see Diabetic neuropathies.