Treating ACS
The first thing you should do is discuss the problem with your nurse or physician. They will help you develop a plan of care to address the contributing factors. The approach will usually be multidimensional, focusing on symptom management, nutritional support, medications, social services, and spiritual support. It’s important to remember that approaches to treating anorexia and cachexia in advanced diseases don’t always work.Symptom Management
If there are symptoms of illness that are contributing to decreased appetite and weight loss, those should be addressed first. Pain, nausea, fatigue, and depression are the most common anorexia-inducing symptoms and they are usually easy to treat. If symptoms are a side effect of medication, your physician may want to stop the medication (if it’s not necessary) or try a different one.
Nutritional Support
There are two schools of thought regarding eating towards the end of life: One believes the ill person should only be eating nutritiously dense foods and the other believes the ill person should eat whatever he wants. Many people will hover right in the middle, offering nutritious foods and snacks but allowing indulgences from time to time. This is probably the most prudent approach. If your loved one is loosing weight and has no interest in eating meals but loves chocolate pudding, I say give him chocolate pudding!
Some really tasty and highly nutritious supplements are on the market. (Ensure and Boost are probably the most popular.) Adding supplements to your loved one's diet can increase his overall calorie intake and help make up for any nutritional deficiencies.
Artificial nutrition in the form of tube feedings is a controversial treatment for ACS. As noted above, once a patient is cachexic nutritional supplementation, including tube feeding, does not reverse it. Tube feedings can also have unpleasant or dangerous side effects and often increase a dying patient’s discomfort. You can read more about artificial nutrition in my article Artifical Nutrition and Hydration.
Medications
Several medications may help patients with ACS increase their appetite and gain weight. Common ones include megestrol (Megace), steroids like dexamethasone (Decadron), cannabinoids (Marijuana), and Metoclopramide (Reglan). Ask your loved ones physician if any of these medications could help. Physicians will usually try one or more of these medications for a time and discontinue them if they are ineffective. It’s important to note here that the smoked form of marijuana is still illegal.
Psychosocial and Spiritual Support
Anxiety, depression, family stressors, and other emotional and spiritual factors may contribute to ACS. Decreased appetite can also lead to a patient feeling isolated from loved on'es as meals are times for socialization. A medical social worker (MSW), chaplain, or psychotherapist may be able to help your loved one work through such feelings.
What Can You Do to Help?
With so many factors that can contribute to a diminished appetite, you might find yourself feeling defeated already. While it's important to keep in mind that your efforts at increasing an appetite may not work, it's equally as important to not give up hope. Read "7 Ways to Whet an Appetite" for tips and tricks to stimulating a decreased appetite. Working together with your healthcare provider will prove the most effective way at rescuing a fading appetite.
Sources:
Ferrell BR, Coyle N. Textbook of Palliative Nursing, 2nd Edition. Oxford Press, 2006.
Kinzbrunner BM, Weinreb NJ, Policzer JS. 20 Common Problems: End of Life Care. McGraw-Hill, 2002.
