Prepared by Veronica A. Ward, Oncology Nurse Clinical Inquiry Specialist at Dana-Farber Cancer Institute's Phyllis F. Cantor Center. This presentation offers information for cancer patients on how to control appetite and weight loss -- whether you're looking to maintain weight or lose weight. Learn about common causes of weight loss, symptoms to watch out for and report, and how to maintain good nutrition during and after cancer treatment.

1. TAKE CONTROL OF YOUR APPETITE &
WEIGHT LOSS
Veronica A. Ward
Oncology Nurse Clinical Inquiry Specialist
DFCI Nursing Department –
Phyllis F. Cantor Center
July 12, 2012

2. WEIGHT LOSS PRIOR TO AND
DURING CANCER TREATMENT
Malnutrition – too little or too much
nutrients in the body
Common Causes of Malnutrition
 Anorexia - decreased appetite or
loss of desire to eat
 Cachexia - progressive loss of
appetite that causes a decrease in
energy levels leading to muscle loss
and weight loss

3. WHAT DOES WEIGHT LOSS AFFECT?
 Physical – Loss of Function
 Psychosocial / Well-Being - Mood
 Treatment Delays
 Quality of Life

4. INTERNAL CAUSES OF WEIGHT LOSS
 Cancer disease
 Digestion - delayed emptying of the stomach
 Weakened immune system
 Muscle and fat injury
 Stress / anxiety / depression / mood changes

5. OTHER CAUSES OF WEIGHT LOSS
 Lack of nutrients and vitamins in the body
 Treatment side effects
 Medications side effects

6. DIFFERENCES IN PATIENTS WITH CANCER
 Very subjective - Personal food choices and personal
experiences with the body

7. DIFFERENCES IN PATIENTS WITH CANCER
 A very different experience for cancer patients
“Some days I feel great, other days I am tired and have no
desire to eat”
“ I seem to have different taste buds and food tastes funny
to me and it‟s just not the same”
“ I feel like I have to shovel food down my throat to get
something in”
“ I dislike using the G tube and want „real‟ food”

8. WHAT TO REPORT
 Unintentional weight loss over a period
of 3 months
 Decreased desire to eat or decreased food intake (under
1500 calories/day)
 Fever
 Muscle and fat loss
 Decreased energy levels or fatigue
 Leg swelling
 Changes with smell - “Odors bother me.”

9. OTHER THINGS TO REPORT OR RECOGNIZE
Stomach:
 Diarrhea
 Constipation
 Lactose intolerance
 Belly swelling
 Difficulty eating rich or heavy foods
 Feeling of fullness after eating something or
“bloating”
 Decreased fluid intake
 Nausea and/or vomiting
 Stomach or belly pain

10. OTHER THINGS TO REPORT OR RECOGNIZE
Mouth:
 Mouth pain
 Dry mouth
 Mouth sores
 Taste changes - “Things taste funny”
Throat:
 Throat pain
 Problems swallowing or chewing

11. OTHER THINGS TO REPORT OR RECOGNIZE
Mental:
 Family and/or friends pressuring
me to eat
 Depression, sadness, increased
stress or anxiety
 Personal concerns about weight –
“I am very thin-looking”
 Lack of Appetite - “Just did not feel
like eating”

12. WHAT HELPS
 Lifestyle changes
 Change meal size and
frequency –
 Emotional support from family,
5-6 small meals/snacks
friends, co-workers, or
daily
therapists
 Nutritional shakes and
 Decrease stress, anxiety,
drinks
and/or sadness
 Consultation and
education with
nutritionists, nursing, &
medical staff

13. DECREASE STRESS
What are some of the things you enjoy
or love to do?
 Social activities or hobbies
 Sports or physical activities
 Entertainment
 Pursue relaxation techniques
 Travel
 Pamper, relax & re-energize!

14. FAMILY AND FRIENDS
Your family and social network is
your foundation!
 Provide help & positive support
 Listen, provide feedback, ask questions with your
loved-one
 Attend appointments and treatment visits
 “Home is where the heart is”

15. WORK
 Prioritize responsibilities and pace yourself
 Colleague and co-worker support
 Delegate as needed
 Have you had your break today?
 Employee Assistance Program (EAP)

16. NUTRITION DURING AND AFTER
CANCER TREATMENT
 2 Priorities During Treatment
 Prevent Weight Loss
 Maintain Muscle Mass
 Answer?
 Individualized nutrition plan based on
your likes, dislikes, lifestyle, symptoms
and concerns.
 A registered dietitian, social worker, and
nursing staff are key resources for
helping maximize your cancer
treatment.

17. HOW TO CHOOSE PROTEIN SOURCES
 For anorexia-cachexia syndrome: Protein is strongly
recommended for lean body muscle mass growth.
 For a healthy, survival diet: High calorie, high protein, low fat,
low carb diet but if have trouble eating, eat what you love!
 Use protein-rich nutritional shakes to supplement current diet in
tolerated amounts as a source of additional nutritional intake.
 Not all protein supplements provide adequate nutrients.
However, incorporating liquid protein supplementation is better
than not having any nutrients at all.
 Choose foods and recipes that are familiar to you, that also
smell and taste good to you
 Adjust temperature of foods to determine what works for you
and your belly
 Eat to live and thrive!

18. PROTEIN-RICH FOOD SOURCES

19. READY-TO-DRINK PROTEIN SHAKES
EAS AdvantEdge*
Muscle Milk Light* Carb Control
 Lactose-free
 Sugar-free
 Gluten-free
 Flavors:
 Sugar-free Chocolate
 Flavors: Fudge,
Chocolate, Strawberry
Vanilla Crème, Cream, French
Banana, Vanilla, Dark
Strawberry, & Chocolate, &
Café Latte Café Caramel
 20 grams  17 grams
protein, low carb. protein, low carb,
& low fat & low fat
* DO NOT ENDORSE SPECIFIC PRODUCTS
 160 calories – THESE ARE EXAMPLES
approx.

20. CLINICAL RESEARCH: ORAL SUPPLEMENTS
Adams, L.A., Shepard, N., Caruso, R.A., Norling, M.J., Belansky, H., &
Cunningham, R.S. (2009). Putting Evidence Into Practice: Evidence-
based interventions to prevent and manage anorexia. Clinical Journal of
Oncology Nursing, 13, 95–102. doi: 10.1188/09.CJON.95-102
American Dietetic Association. (2007). ADA oncology evidence-based
nutrition practice guideline. Updated October 2007. U.S.A.: American
Dietetic Association. Taken on August 2, 2011, from:
http://www.adaevidencelibrary.com/topic.cfm?cat=3250
Baldwin, C., Spiro, A., Ahern, R., & Emery, P.W. (2012). Oral nutritional
interventions in malnourished patients with cancer: A systematic review
and meta-analysis. Journal of the National Cancer Institute, 104 (5), 371-
85.
Baldwin, C., Spiro, A., McGough, C., Norman, A.R., Gillbanks, A., Thomas,
K., Cunningham, D., O‟Brien, M., & Andreyev, H.J. (2011). Simple
nutritional intervention in patients with advanced cancers of the
gastrointestinal tract, non-small cell lung cancers or mesothelioma and
weight loss receiving chemotherapy: A randomised controlled trial.
Journal of Human Nutrition and Dietetics, 24 (5), 431-440. doi:
10.1111/j.1365-277X.2011.01189.x.

21. MONITORING
 Weight & Body Mass Index (BMI)
 Nutrition Screening Tool
 Symptom Management: Symptom review
 Treatment: Review of medications and side effects
 Lab Tests:
 Pre-albumin - to assess protein-calorie malnutrition
 Albumin – to assess general health status
 C-reactive protein – to check for systemic inflammation
 Activities and Functional Ability
 CT scan – lumbar spine
 Frequency of monitoring will vary based on severity
of appetite changes and weight loss

22. DFCI PILOT STUDY ON ANOREXIA
 Date: TBD
 Study: Pre-treatment education and
nutritional supplementation
intervention
 By: DFCI Cantor Center for Nursing
Research & Patient Care Services &
DFCI Nutrition Department
 Education & Pre-treatment menu
planning: Dietary plan tailored to the
individual with personal, social and
cultural needs in mind

23. DFCI PILOT STUDY ON ANOREXIA
 Monitoring, Support & Guidance:
Registered Nutritionists, Therapists,
Social Worker, Nursing & Medical Staff
 Goals:
(1) Patient self-report about weight loss
(2) To prevent protein malnutrition and
potential muscle-wasting

24. RESOURCES: ONCOLOGY WEB SITES FOR
INDIVIDUALS WITH WEIGHT LOSS
 American Cancer Society
 http://www.cancer.org/Healthy/EatHealthyGetActive/index
 USDA
 Food-A-Pedia, Food Tracker, & Weight Manager
 https://www.choosemyplate.gov/SuperTracker/default.aspx
 Oncology Nursing Society
 Book: Nutrition and Cancer: Practical Tips and Tasty Recipes for
Survivors ($16.95 from ONS)
 National Cancer Institute
 http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/
Patient/page1

25. RESOURCES: COOKBOOKS ON CANCER NUTRITION
 “Eating Well Through Cancer” by
Holly Clegg and Gerald Miletello,
M.D.
 “Nutrition and Cancer: Practical
Tips and Tasty Recipes for
Survivors” by Oncology Nursing
Society
 “The Cancer-Fighting Kitchen:
Nourishing, Big-Flavor Recipes
for Cancer Treatment and
Recovery” by Rebecca Katz and
Mat Edelson
* DO NOT ENDORSE SPECIFIC PRODUCTS – THESE ARE
EXAMPLES

26. LIFESTYLE CONSIDERATIONS:
“YOU HAVE CONTROL!”
Personal exploration
 Food
 Exercise or physical activity
 Your changing body
 Family, friend and/or partner support
“When I let go of what I am, I become what I might be.”
–Lao Tzu

27. DISCUSSION AND QUESTIONS
Questions? Veronica Ward, DNP, OCN, ANP-BC
e-mail: vward1@partners.org