Indeed, we contend that the risks of treating a patient who has had a previous episode of thrombophlebitis far outweigh the benefits of appetite stimulation. Another potential risk is adrenal insufficiency with abrupt drug withdrawal. Further, male patients have reported impotence and female patients have reported menstrual bleeding with drug withdrawal. Patients should be informed of this adverse event profile prior to the initiation of therapy.
Corticosteroids are among the earliest medications used in symptom palliation. Their benefits in palliating cancer-associated loss of appetite were first demonstrated at the Mayo Clinic in the early s In the first randomized, double-blinded, controlled trial for treating cancer-associated anorexia, patients with advanced gastrointestinal malignancy deemed unsuitable for systemic chemotherapy were randomized to escalating doses of dexamethasone versus placebo.
Spurred by these results, numerous other studies evaluating corticosteroids for their orexigenic effects have since been completed. The results were similar and favorable in showing that corticosteroids boost appetite. The dose can be small and in the range of dexamethasone 1 milligram twice per day or even less.
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Short-term steroid usage improves appetite and, by some studies, it also improves sense of wellbeing in patients with advanced cancer 36 - At least one study has compared dexamethasone and megestrol acetate head-to-head. Though both drugs were similar with regard to efficacy for appetite enhancement, dexamethasone had higher discontinuation rates from toxicity The health risks of long-term steroid usage are well recognized and include metabolic changes, higher fracture rates, cataracts, gastrointestinal discomfort, and changes in mood or behavior.
Weighing the risk and benefits of steroid use in patients with cancer, their use is best reserved for patients who have a short life expectancy in the range of only weeks. If a patient has a longer life expectancy and has no contraindications to megestrol acetate, the latter is the preferred agent for appetite stimulation.
Although it was hoped that this agent would be of great value in not only boosting appetite but also augmenting functional lean tissue, the latter was not the case. However, anamorelin did demonstrate its ability to palliative anorexia in lung cancer patients with advanced disease. This agent is not yet clinically available, but these results should be noted as this agent continues to be developed for clinical use.
- What is Therapeutic Food? - Action Against Hunger.
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- What is Therapeutic Food?.
- A hunger for hunger: a review of palliative therapies for cancer-associated anorexia.!
In popular media, many advocate for the use of cannabis in the treatment of cancer-related symptoms. In a small phase II study of deltatetrahydrocannabinol THC , 13 out of 18 patients with cancer-related anorexia reported improvement in their appetite during the course of a 28 day study Quality of life was also measured and unaffected by the cannabis derivatives. In comparison to megestrol acetate, THC Dronabinol is inferior for appetite improvement and weight gain Further, it adds no benefit when used in combination with megestrol acetate.
Importantly, little research has been undertaken with marijuana itself which has a more complex chemical composition. Previous studies in relatively healthy individuals suggest marijuana does have orexigenic effects. For now, although marijuana derivatives do not appear to have a strong indication for appetite stimulation in advanced cancer patients, clearly more research is needed in the study of marijuana itself.
Appetite is an expression of complex neuroendocrine and neuronal physiology involving the peripheral nervous system and the brain. As a first example, mirtazapine is a widely used antidepressant known to antagonize post-synaptic 5-HT2 and 5-HT3 receptors. A pilot study assessed the effect of the drug on numerous cancer related symptoms, and though not statistically significant, mirtazapine did result in a trend toward improved appetite at 7 weeks It also resulted in improved weight and mood symptoms.
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To our knowledge, no large controlled trials have evaluated the effect of mirtazapine in patients with cancer-associated anorexia and weight loss. Another centrally-acting agent evaluated in cancer-associated anorexia is olanzapine, which is an atypical antipsychotic that acts through multiple neurotransmitters including serotonin and dopamine. Its use is commonly associated with weight gain in other populations, and it has the added benefit of being a potent antiemetic Used in combination with megestrol acetate, olanzapine resulted in greater improvement in weight and appetite compared to megestrol acetate alone Though promising, these results are from a single institution study and have yet to be replicated.
Cyproheptadine is a first generation antihistamine that is also a serotonergic antagonist known to be associated with weight gain in both healthy and unhealthy populations 50 , Unfortunately, a controlled trial of the drug in weight-losing cancer patients did not result in amelioration of weight loss One tumor-specific situation where patients may benefit from cyproheptadine is metastatic carcinoid tumors with associated loss of appetite Although the previous trial was conducted with goal of demonstrating that cyproheptadine conferred antineoplastic effects, these investigators observed weight gain in a significant portion of the patients.
This weight gain was thought to be mediated by peripheral rather than central action of the drug and was interpreted as evidence of appetite stimulation. In summary, loss of appetite is a distressing symptom that occurs in the majority of patients with advanced cancer. Healthcare providers should be aware of this symptom, its implications, and its challenges from the standpoint of quality of life and survival.
Though there are some palliative treatments available for stimulating appetite, their ability to improve quality of life and survival is limited. RUTFs also have excellent shelf lives, meaning…they can last up to 5 years? With no water, heating or preparation required, RUTFs avoid all of the major inconveniences of therapeutic milk-based products which are the original treatment in inpatient care of severe acute malnutrition.
The lack of required preparation contributes to making RUTFs a cost-efficient treatment.
RUTFs are also cost-efficient because they are highly effective. All these benefits enable parents to treat their children at home, meaning that families can save time and money on travel to health clinics. This is especially helpful to families who live in remote areas and cannot afford travel to distant health centres.
Action Against Hunger integrates the use of RUTFs with community-based management , ensuring that children can get the care they need from their home village. The benefits of RUTFs, combined with the efficiency of the community care model, have allowed us to scale up operations and reach more children. European Journal of Immunology. Biopsychology 6th ed.
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