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Appetite Loss and Breast Cancer Treatment

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Breast cancer not only affects the breast tissue, but it also takes a toll on the entire body. Cancer and its treatment disturb the equilibrium of the body, both at a physical as well as mental level. Apart from the direct impact of the treatment on the body, the most commonly observed side effects include loss of appetite, decreased calorie intake, weight loss, and skeletal muscle wasting, which are together termed as cancer cachexia.

How Does Breast Cancer Treatment Affect Appetite?

Breast cancer treatment modalities like chemotherapy and radiation therapy can result in certain side effects, which either reduce the appetite directly or affect the ability to eat. They can result in nausea, vomiting and mouth sores. There may be some effect on the sense of taste or smell which indirectly results in a loss of appetite. These side effects occur because the chemotherapy drugs and radiation therapy kills a few normal cells along with the destruction of cancer cells. When the cells lining the gastrointestinal epithelium are destroyed, the patient may develop nausea and vomiting. Similarly destruction of taste buds, or of the cells lining the olfactory tract may impair the sense of taste and smell. Apart from these side effects, the fear associated with cancer treatment may result in depression which may, in turn, suppress the appetite of the patient.

Loss of Appetite and Weight Loss May Affect Treatment

Cancer treatment produces effects which lead to loss of appetite and subsequent weight loss. This, in turn, can limit the dose of medicines or radiation which can be safely administered to the patient, and even have an impact on the duration for which the treatment can be continued without harming the patient further. This is actually a vicious cycle.

Why Is It Essential to Maintain a Healthy Diet during Cancer Treatment?

If the patient stops taking regular healthy meals, it may lead to a decrease in the muscle mass. It can also further compromise the already weakened immune system and make the fight against cancer more difficult. A poor nutrition, along with the nausea and vomiting associated with the treatment, can lead to the development of electrolyte imbalance. This makes the patient feel weaker.

Treatment to Stimulate the Appetite in Breast Cancer Patients

There are several medicines prescribed to stimulate the appetite in patients receiving treatment for breast cancer. The most commonly prescribed medicines include:

  • Steroids: Steroids may stimulate the appetite in many patients and may even result in weight gain. However, their use is limited because of the number of side effects they produce on the metabolism. They are also associated with certain infectious and psychiatric effects.
  • Prokinetic agents like metoclopramide: These medicines are useful in reducing chronic nausea associated with breast cancer treatment. However, extrapyramidal symptoms produced by these medicines limit their long term use. Moreover, they do not help in any way in improving the patient’s appetite.
  • Progesterones like Megestrol acetate: Scientific research has proven that treating breast cancer with high dose of megestrol acetate (Megace) can lead to weight gain in 75% patients and treating with megestrol for 6 weeks can lead to weight gain in almost all the patients. This can improve the patient’s resistance and improve her quality of life. However, in certain patients, the medicine has been associated with water retention and increased risk of thromboembolism.
  • Ghrelin: Ghrelin is the only known circulating appetite stimulating hormone produced in the stomach and affecting the hypothalamus to influence feeding. The levels of plasma ghrelin are inversely proportional to body weight and fat mass. Endogenous production of the hormone increases as a response to weight loss and decreases when the body is gaining weight. Studies have shown that ghrelin can be an effective treatment in dealing with cancer anorexia associated with breast cancer.
  • Dronabinol (Marinol) drug  may be recommended for treating loss of appetite and weight loss. It is a marijuana derivative.

Simple Life Style Changes to Deal with Appetite Loss

Though appetite may be reduced as a side effect of cancer treatment, it can be managed by following the basics of a healthy diet. They include:

  • Regular consumption of at least 15 calories per pound of the body weight per day.
  • Taking protein rich foods to enhance repair of damaged tissue and for a better immune system to fight the diseases. Protein consumption in grams per day should be about 0.5 to 0.6 times the body weight.
  • Having lots of green vegetables and foods rich in fiber. Caloric intake from fat should be restricted below 30%.

As it is not easy to meet the above nutritional requirements in view of the patient’s reduced appetite, certain steps are recommended by dietitians around the world to simplify the process. Some of these steps include:

  • Consuming small frequent meals at regular intervals instead of three large meals. They prevent the patient from feeling too full and are easier to digest.
  • Having energy rich snacks ready at hand, to have them whenever hunger strikes. Yogurt, granola bars, dry fruits, yogurt and peanut butter crackers are some snacks that can provide instant energy.
  • Drinking calorie rich liquids like soups, juices and milk when there is hunger, but do not feel like eating food. However, it’s better to avoid drinks which provide empty calories like soda, alcohol, etc. Also, drinking too much liquid just before or during a meal should be restricted to avoid fullness.
  • Eating out with friends can be helpful in diverting the attention from food.
  • Having a bedtime snack to get those extra calories is a good habit.
  • Switching over to a fruit milkshake is a good choice if there is some aversion to raw fruits.
  • Rinsing mouth with lemon water, ginger ale, or baking soda dissolved in water, before eating food can help in clearing the taste buds.
  • A dietitian can suggest ways of getting the required calories even when there is no desire to eat.
  • Eating spicy, salty or rough foods should be avoided in case of mouth sores. Eating cold and frozen foods can be soothing for mouth sores, but not often.
  • Doing simple exercises every day may improve appetite.

There should never be an hesitation in consulting a doctor. With proper guidance and treatment, a speedy recovery is very much possible.

  • References
    • 1. Aisner J, Parnes H et al. “Appetite Stimulation and Weight Gain with Megestrol Acetate.” (1990). Print.
    • 2. ”Appetite Changes.” BreastCancer.org – Breast Cancer Treatment Information and Pictures. Web. 17 Sept. 2011. <http://www.breastcancer.org/treatment/side_effects/appetite.jsp>.
    • 3. ”Eating Hints – National Cancer Institute.” Comprehensive Cancer Information – National Cancer Institute. Web. 17 Sept. 2011. <http://www.cancer.gov/cancertopics/coping/eatinghints/page4>.
    • 4. Neary, N. M. “Ghrelin Increases Energy Intake in Cancer Patients with Impaired Appetite: Acute, Randomized, Placebo-Controlled Trial.” Journal of Clinical Endocrinology & Metabolism 89.6 (2004): 2832-836. Web. 17 Sept. 2011.
    • 5. Turkington, Carol, and Karen J. Krag. The Encyclopedia of Breast Cancer. New York: Facts On File, 2005. 12. Print.

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