Appetite 114 (2017) 23e27

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Appetite
journal homepage: www.elsevier.com/locate/appet

Appetite disorders in cancer patients: Impact on nutritional status and

quality of life
David E. Barajas Galindo a, *, Alfonso Vidal-Casariego a, Alicia Calleja-Ferna

ndez a,
Ana Herna
ndez-Moreno a, b, Begon ~ a Pintor de la Maza a, Manuela Pedraza-Lorenzo b,
María Asuncio


n Rodríguez-García b, Dalia María Avila-Turcios a
, Miran Alejo-Ramos a,
Rocío Villar-Taibo , Ana Urioste-Fondo , Isidoro Cano-Rodríguez a,
a a

María D. Ballesteros-Pomar a
a
n Clínica y Diet

Unidad de Nutricio
n de Endocrinología y Nutricio
etica, Seccio
n, Complejo Asistencial Universitario de Leo

n, Leo

n, Spain
b
Servicio de Oncología M

n, Spain
edica, Complejo Asistencial Universitario de Leo

a r t i c l e i n f o a b s t r a c t

Article history: Cancer patients are at high risk of malnutrition due to several symptoms such as lack of appetite. The aim
Received 28 July 2016 of this study was to determine the prevalence of different appetite disorders in cancer patients and their
Received in revised form influence on dietary intake, nutritional status, and quality of life. We conducted a cross-sectional study of
13 March 2017
cancer patients at risk of malnutrition. Nutritional status was studied using Subjective Global Assess-
Accepted 14 March 2017
ment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall, and patients
Available online 16 March 2017
were questioned about the presence of changes in appetite (none, anorexia, early satiety, or both).
Quality of life was measured using EORTC-QLQ-C30. Multivariate analysis was performed using linear
Keywords:
Cancer malnutrition
regression. 128 patients were evaluated. 61.7% experienced changes in appetite: 31% anorexia, 13.3% early
Anorexia satiety, and 17.2% both. Appetite disorders were more common in women and with the presence of
Satiety cachexia. The combination of anorexia and satiety resulted in a lower weight and BMI. However, there
Appetite were no significant effects on energy or macronutrient intake among different appetite alterations. Pa-
Quality of life tients with a combination of anorexia and early satiety had worse overall health perception, role func-
tion, and fatigue. Appetite disorders are highly prevalent among cancer patients at risk of malnutrition.
They have a significant impact on nutritional status and quality of life, especially when anorexia and early
satiety are combined.
© 2017 Elsevier Ltd. All rights reserved.

1. Introduction

Cancer represents a considerable burden of disease on the

Abbreviations: BMI, Body Mass Index; CCSG, Cachexia Cancer Study Group; CHO,
general population due to its high prevalence and consequences for
Carbohydrates; EORTC-QLQ-C30, European Organization for Research and Treat-
ment of Cancer Quality of Life Core Questionnaire; FFM, Fat free mass; FFMI, Fat free
morbidity, mortality and quality of life. Cancer causes nearly 30% of
mass index; GI, Gastrointestinal; HN, Head and Neck; QoL, Quality of life; SGA, all deaths in Spain and is the second most common cause of mor-
Subjective Global Assessment. tality (Calleja Ferna
ndez et al., 2015; Instituto Nacional de
* Corresponding author. Seccio
n de Endocrinología y Nutricio
n, Complejo Asis- Estadística Nota de Prensa An ~ o, 2011). Malnutrition is present at

n, Altos de Nava, SN, 24008, Leo
tencial Universitario de Leo
n, Spain.
the moment of cancer diagnosis in up to 40% of patients, and this
E-mail addresses: dabarajas@saludcastillayleon.es (D.E. Barajas Galindo), avcyo@
hotmail.com (A. Vidal-Casariego), calleja.alicia@gmail.com (A. Calleja-Ferna
ndez), rate rises to 80% in patients with advanced malignancies (Nelson &
ahmoreno@alumni.unav.es (A. Herna
ndez-Moreno), delamaza.begona@gmail.com Walsh, 2002). Malnutrition is also an important cause of morbidity
(B. Pintor de la Maza), mpedrazal@saludcastillayleon.es (M. Pedraza-Lorenzo), and responsible for 20% of deaths in cancer patients (Capra,
mrodriguezgarcia@saludcastillayleon.es (M.A. Rodríguez-García),


Ferguson, & Ried, 2001). Cachexia can be defined as a complex
dalisavilaturcios@yahoo.es (D.M. Avila-Turcios), mirian_alejo@hotmail.com
(M. Alejo-Ramos), rotaibo22@gmail.com (R. Villar-Taibo), anaurifon@gmail.com
syndrome in which inflammation leads to early satiety and
(A. Urioste-Fondo), isicano@picos.com (I. Cano-Rodríguez), mdballesteros@ anorexia, decreased body-fat, and fat-free body mass, and
telefonica.net (M.D. Ballesteros-Pomar).

http://dx.doi.org/10.1016/j.appet.2017.03.020
0195-6663/© 2017 Elsevier Ltd. All rights reserved.
24 D.E. Barajas Galindo et al. / Appetite 114 (2017) 23e27
weakness (Muscaritoli et al., 2010). With a prevalence ranging
70e80% in advanced phases of the disease, cancer cachexia is also
associated with poor response to chemotherapy, increased sus-
ceptibility to treatment-related adverse events, shorter survival,
and is also a cause of morbidity and deterioration of quality of life
(QoL) (Ross et al., 2004; Wigmore, Plester, Richardson, & Fearon,
1997).
Reduced food intake is a commonly found problem in patients
with cancer. It is related to several factors such as gastrointestinal
symptoms (e.g., vomiting, diarrhea), tumor location (e.g., esoph-
agus or oral cavity, causing dysphagia), toxicities related to treat-
ments (e.g., radiation-associated mucositis), altered perception of
tastes and odors, and reduction of appetite (Go
mez-Candela et al.,
2003). The foods most commonly affected by these changes are
high-protein foods (including meat) and high-fat foods (Mattes,
Arnold, & Boraas, 1987). Appetite disorders may be a common
problem among oncologic patients; some studies described a
prevalence of around 80% in patients with advanced tumors. The
causes of lack of appetite are diverse: the systemic inflammatory
response generated by the tumor can suppress appetite in the
central nervous system; both chemotherapy and radiotherapy (RT)
can reduce hunger as an adverse event; anatomic changes after
surgery can limit the intake of food (e.g., total gastrectomy);
nutrient deficiency (e.g., zinc) can be related to anorexia. Finally,
psychological symptoms like anxiety and depression, can be asso-
ciated with appetite suppression (O'Gorman, McMillan, & McArdle,
1998; Chiu, Hu, & Chen, 2000; Ogama et al., 2010; Kamiji, Troncon,
Suen, & de Oliveira, 2008; Ezeoke & Morley, 2015). Disturbances of
appetite can be manifested in different ways: a reduction in the
desire to consume food (anorexia), the early apparition of satiety, or
even a combination of both. The differentiation among the different
appetite alteration may be relevant due their potential effects on
nutritional intake and status, and the different treatments that can
be offered to patients (prokinetics for satiety, appetite stimulants
for anorexia).
The aim of this study is to determine the prevalence of each type
of appetite disorder in cancer patients, and to associate each one of
them with oral intake, and quality of life. We hypothesized that the
coexistence of both anorexia and early satiety may be associated
with a greater impact on intake, nutritional status, and quality of
life than each one of these symptoms independently.
1.1. Patients and methods
This cross-sectional study took place at the Complejo Asistencial
Universitario de Leo
n (Spain) between February 2013 and June
2014. Patients attending the outpatient clinic of the Clinical
Nutrition and Dietetics Unit were consecutively recruited if they
fulfilled the inclusion criteria: a diagnosis of solid or hematological
malignancy, age
18 yr, and at current risk of malnutrition
(Malnutrition Screening Tool score
2 points). Exclusion criteria
included previous dietary counseling, patients receiving any type of
artificial nutrition support (oral nutritional supplements, enteral
nutrition, parenteral nutrition), treatment with appetite stimulant
drugs (e.g., megestrol), or inability to perform either body
composition or dietary assessment.
Patients were asked about recent (1 month) changes in their
appetite: a reduction or lack of the sensation of hunger or in the
desire to consume food was classified as anorexia; a precocious
sensation of fullness when eating that impeded a complete intake
of a meal was classified as early satiety; the combination and the
absence of both symptoms was considered as well. Nutritional
status was evaluated using Subjective Global Assessment (SGA)
(Kondrup, 2003). Anthropometry included the measurement of
height and body weight, body mass index (BMI), grip strength
(Smedlay's Dynamo Meter™) and determination of fat-free mass
(FFM) and fat mass (FM) by a bioelectrical impedance (Tanita Body
Composition Analyzer TBF-300™). The Fat-Free Mass Index (FFMI)
was calculated by dividing the individual's FFM in kilograms by the
square of their height in meters. Usual weight was reported by the
patient. Body composition and grip strength evaluation were per-
formed by physicians specialized in Clinical Nutrition, with a wide
experience un nutritional assessment, Cachexia was defined by
CCSG (Cachexia Cancer Study Group) definition (Fearon, Voss, &
Hustead, 2006). Dietary assessment included a 24-h recall, which
was guided and subsequently analyzed by an expert dietician using
Dietsource 3.0™ (Novartis Medical Nutrition SA, 1997e2003).
These data were obtained and collected in a structured question-
naire in a single session, during their first attendance to the
nutrition clinic.
Quality of life was evaluated by the European Organization for
Research and Treatment of Cancer Quality of Life Core Question-
naire (EORTC QLQ-C30) (Bottomley et al., 2005). It was developed
for cancer patients enrolled in clinical trials and it is reliable in
multicultural contexts. It assesses several factors that contribute to
QoL, including physical ability, role, cognitive status, emotional and
social factors, as well as symptoms (e.g. fatigue, pain, dyspnoea and
insomnia).
1.2. Statistical analysis
Normally distributed quantitative variables were summarized
as means and standard deviations (SDs) and compared using Stu-
dent's t-test or ANOVA. Variables not matching a normal distribu-
tion were summarized as medians and interquartile ranges (IQRs),
and compared using the Mann-Whitney U test or Kruskal-Wallis
test. Categorical variables were summarized as percentages and
compared using the c2 test. Liner regression was used for multi-
variate analysis. For all tests p < 0.05 was considered significant.
This study was conducted according to the guidelines laid down
in the Declaration of Helsinki and all procedures involving human
patients were approved by the Ethics and Clinical Investigation
Committee of the hospital. Verbal informed consent was obtained
from all patients, in the presence of witnesses, according the
Spanish legislation and following the recommendations of the
Ethics Committee.
2. Results
The study included 128 consecutive patients, as any of them
presented any exclusion criteria; the characteristics of the sample
are given in Table 1. According to SGA, 24.8% of patients were well-
nourished (SGA-A), 28.0% were at risk of malnutrition or moder-
ately malnourished (SGA-B), and 47.2% were severely malnourished
(SGA-C). Patients ate 1856.1 (731.9) kcal and 73.8 (33.8) g of protein,
which represented 29.8 kcal/kg and 1.25 g/kg respectively. Protein
accounted for 17.0 (4.3) % of dietary energy. Carbohydrates
accounted for 46.6 (10.0) % of dietary energy and fat 35.5 (9.0) %,
with a daily intake of fiber of 16.2 (10.3) g. There were no significant
differences in energy [SGA-A 32.7 (12.6) kcal/kg, SGA-B 26.6 (11.1)
kcal/kg, SGA-C 29.6 (11.8) kcal/kg, p ¼ 0.097] or protein intake
[SGA-A 1.38 (0.51) g/kg, SGA-B 1.42 (2.66) g/kg, SGA-C 1.23 (0.54)
kcal/kg, p ¼ 0.097] according to nutritional status.
More than a half (61.8%) described changes in their appetite:
31.3% anorexia, 13.3% early satiety, 17.2% both. Appetite disorders
were significantly more common in women (anorexia 29.5%, early
satiety 22.7%, both 25.0%) than in men (anorexia 32.1%, early satiety
8.3%, both 13.1%; p ¼ 0.011), with the presence of cachexia
(cachexia vs no cachexia: anorexia 42.5% vs 24.4%, early satiety
15.0% vs 7.3%, both 22.5% vs 19.5%; p ¼ 0.046), and in patients who
 D.E. Barajas Galindo et al. / Appetite 114 (2017) 23e27 25

Table 1 3. Discussion
General characteristics of the patients.

N 128 Alterations in appetite are common among cancer patients and

Age in yrs
Sex (male/female)
Type of cancer
GI
Lung
HN
Others
Treatments
Chemotherapy
Radiotherapy
Surgery
sHeight in cm
Usual weight in kg
Current weight in kg
Weight loss as %
Fat mass as %
FFMI in kg/m2
Grip strength in kg
GI: Gastrointestinal; HN: head and neck cancer;; FFMI: Fat-free Mass Index. Quan-
titative data are presented as mean and standard deviation.
did not receive radiotherapy (RT vs no RT: anorexia 28.9% vs 32.2%,
early satiety 5.3% vs 16.7%, both 10.5% vs 20.0%; p ¼ 0.043). There
were no differences according to age, chemotherapy, previous
surgery, or type of tumor.
Changes in appetite were associated with malnutrition and
worse results in SGA and anthropometric parameters (Table 2). The
combination of anorexia and early satiety was associated with a
lower current weight and BMI, whilst early satiety and mixed
appetite disorders were associated with lower values of grip
strength (Table 2). There were significant reductions in total energy,
protein, and fat intake related to alterations of appetite, especially
with the presence of anorexia. Nevertheless, these changes did not
reach statistical significance when considered as kcal/kg of body
weight or gm of protein/kg of body weight (Table 3). With regard to
quality of life, appetite disorders altered the perception of global
health, physical function, role function, cognitive function, and
symptoms such as fatigue and anorexia (Table 4).
After adjusting for other factors (sex, age, cachexia, malnutri-
tion, and type of tumor), patients with a combination of anorexia
and early satiety had worse overall health perception and fatigue;
patients with anorexia and combined disorder had worse role
function; and patients without appetite changes had better cogni-
tive and emotional function (Table 5).
65.9 (9.4) may affect nutritional status and quality of life, according to the
84/44 results of this study. The most frequent change is anorexia, but an
n (%)
93 (72.6)
important number of patients reported other symptoms such as
16 (12.5) satiety and a combination of both. These last combined symptoms
12 (9.4) were related to worse nutritional status and quality of life. A
7 (5.5) complex relationship has been previously described among
n (%)
inflammation, appetite loss, and malnutrition, which was
11 (86,7)
38 (29.7) confirmed in this study (O'Gorman et al., 1998). Cachexia, an
64 (50) inflammation-related mode of malnutrition, was associated with
162.7 (8.9) alterations in appetite, but changes in appetite independently
72.5 (13.8) influenced quality of life. Patients with conserved appetite pre-
64.1 (12.8)
11.3 (9.7)
sented better emotional and cognitive functions, whereas anorexia
16.2 (8.8) and early satiety worsened global health.
18.6 (3.6) Research on the subject of changes in appetite is usually focused
28.1 (8.8) on anorexia. As far as we know, this is the first study that tried to
explore the clinical relevance of the different patterns of hunger
disturbances. The prevalence of anorexia ranged from 14% to 55% in
previous studies, similar to our results (Bozzetti, 2008; Trajkovic-
Vidakovic, de Graeff, Voest, & Teunissen, 2012). The prevalence of
early satiety varied widely throughout different studies, ranging
from 13% to 61% (Armes, Plant, Allbright, Silverstone, & Slevin,
1992). These wide ranges of prevalence may be explained by
several factors. First, differences in the characteristics of the
recruited patients, as symptoms may depend on gender, type of
tumor, the stage of disease, or the administered treatments. Second,
there is not a consensual definition of early satiety, which has been
described as “fill up quickly”, “abdominal fullness”, or “appetite still
good though easily full” across studies (DeWys, Costa, & Henkin,
1981; Grosvenor, Bulcavage, & Chlebowski, 1989; Theologides,
1976). Third, anorexia is better recognized by health caregivers
and patients than satiety. Early satiety is frequently omitted,
whereas anorexia together with pain, fatigue, dyspnea, and nausea
are commonly reported complaints (Thomas, Walsh, & Aktas,
2015). Also, lack of appetite is included in several structured
questionnaires that assess the existence of cachexia or the quality
of life of cancer patients, making it easier to diagnose by health
professionals (Del Fabbro et al., 2015). A limitation in the research
about changes in appetite associated to cancer is the absence of a
validated tool for their assessment. For the purpose of this study,
early satiety was defined as “a precocious sensation of fullness
when eating that impeded a complete intake of a meal”. The defi-
nition used seems to be accurate to discriminate satiety from
anorexia. The score in the appetite loss item from the EORTC-QLQ-
C30 was significantly higher in patients with anorexia and

Table 2
Nutritional status and anthropometric parameters according to appetite disorders.

Normal appetite Anorexia Early satiety Anorexia and early satiety One factor ANOVA p

SGA n (%)
SGA-A 26 (54.2%) 0 (0%)* 3 (17.6%)*# 2 (9.1%)*# <0.001
SGA-B 6 (12.5%) 19 (50.0%)* 5 (29.5%)*# 5 (22.7%)*#
SGA-C 16 (33.3%) 19 (50.0%)* 9 (52.9%)*# 15 (68.2%)*#
Current weight in kg 68.1 (15.8) 63.6 (10.4) 61.4 (10.7) 58.1 (10.4)* 0.014
Weight loss as % (6 months) 8.2 (11.0) 13.6 (8.6) 11.2 (8.7) 14.1 (7.4) 0.027
BMI in kg/m2 25.3 (4.6) 23.9 (3.7) 24.0 (3.6) 22.2 (3.4)* 0.031
Fat mass as % 17.3 (8.6) 16.7 (10.2) 13.9 (5.6) 14.4 (7.9) 0.461
FFMI in kg/m2 19.1 (2.5) 18.8 (5.2) 18.9 (2.7) 16.8 (2.1) 0.107
Grip strength in kg 30.9 (10.0) 28.2 (8.3) 24.0 (6.4)* 25.0 (6.7)* 0.009

SGA: Subjective Global Assessment; BMI: Body Mass Index; FFMI: Fat-free Mass Index.
*p < 0.05 for the comparison with normal appetite. #p < 0.05 for the comparison with anorexia.
Quantitative data are presented as mean and standard deviation.
26 D.E. Barajas Galindo et al. / Appetite 114 (2017) 23e27

Table 3
Dietary intake according to appetite disorders.

Normal appetite Anorexia Early satiety Anorexia and early satiety One factor ANOVA p

Energy in kcal 2133.1 (776.4) 1642.5 (641.9)* 1806.4 (653.4) 1666.1 (682.4) 0.006
Energy in kcal/kg 32.7 (13.6) 26.6 (11.4) 30.2 (12.1) 29.0 (11.4) 0.147
CHO in g 232.9 (76.5) 194.2 (82.1) 198.9 (64.1) 209.2 (111.2) 0.157
CHO as % 45.3 (9.8) 47.6 (9.5) 44.9 (9.9) 49.2 (11.0) 0.343
Protein in g 91.3 (35.3) 67.7 (29.8)* 79.5 (34.5) 66.4 (27.3)* 0.002
Protein in g/kg 1.40 (0.60) 1.10 (0.55) 1.31 (0.56) 1.16 (0.47) 0.074
Total fat in g 87.5 (44.9) 63.7 (31.3)* 76.9 (41.5) 62.2 (27.9) 0.012
Total fat as % 36.1 (8.5) 34.6 (9.0) 37.6 (10.0) 34.3 (9.5) 0.576
Fibre in g 18.7 (11.1) 13.8 (8.1) 15.6 (10.9) 15.4 (11.3) 0.100

CHO: Carbohydrates.
*p < 0.05 for the comparison with normal appetite.
Quantitative data are presented as mean and standard deviation.

Table 4
Effects of appetite disorders on the quality of life in cancer patients. Univariate model.

Normal appetite Anorexia Early satiety Anorexia and early satiety P

Global health 75.0 (33.4) 54.2 (43.8)* 70.9 (27.1) 33.3 (54.2)* <0.001
Physical function 96.7 (15.0) 86.7 (21.7) 86.70 (13.4) 73.3 (50.0)* 0.015
#
Role function 100 (16.7) 83.3 (33.3) 100.0 (4.2) 66.7 (75.0)* 0.03
Emotional function 83.3 (25.0) 75.0 (27.1) 70.9 (39.6) 66.7 (20.9)* 0.001
Cognitive function 100.0 (33.3) 100.0 (33.3) 91.7 (37.5) 83.3 (45.9)* 0.027
Social function 100.0 (20.9) 91.7 (16.7) 100.0 (16.7) 83.3 (50.0) 0.08
Fatigue 5.6 (22.2) 33.3 (33.4)* 22.2 (19.5) 44.4 (44.5)* <0.001
Nausea and vomiting 0.0 (16.7) 0.0 (33.3) 0.0 (4.2) 0.0 (4.2) 0.242
Pain 8.4 (16.7) 16.7 (41.7) 0.0 (33.3) 33.3 (41.7) 0.372
Dyspnoea 0.0 (0.0) 0.0 (0.0) 0.5 (33.3) 0.0 (33.3) 0.105
Insomnia 16.7 (33.3) 33.3 (66.7) 33.3 (41.7) 33.3 (50.1) 0.131
Anorexia 0.0 (0.0) 50.0 (66.7)* # 0.0 (8.3) 66.7 (66.7)* #
<0.001
Constipation 0.0 (0.0) 0.0 (33.3) 0.0 (8.3) 0.0 (33.3) 0.464
Diarrhea 0.0 (0.0) 0.0 (33.3) 0.0 (41.7) 0.0 (33.3) 0.607

Quantitative data are presented as median and interquartile range. The punctuation of each dimension of quality of life ranges between 0 and 100 points. For function, the
higher punctuation, the better function. For symptoms, the higher the punctuation, the more severe the symptoms. *p < 0.05 for the comparison with normal appetite.
#p < 0.05 for the comparison with early satiety.

Table 5
Multivariate analysis of the effects of appetite disorders on the quality of life.

Normal appetite Anorexia Early satiety Anorexia and early satiety

Global health e e e 30.3 (54.1 to 6.5)

p ¼ 0.014
Physical function e e e e
Role function e 28.6 (50.1 to 7.1) e 41.4 (65.0 to 17.8)
p ¼ 0.01 p ¼ 0.001
Emotional function 24.6 (8.1e41.1) e e e
p ¼ 0.004
Cognitive function 20.8 (1.6e40.1) e e e
p ¼ 0.034
Social function e e e e
Fatigue e e e 24.1 (3.0 45.2)
p ¼ 0.026
Anorexia e 36.3 (11.1e61.5) e 46.8 (19.2e74.5)
p ¼ 0.006 p ¼ 0.001

Data are presented as the coefficient B (confidence interval 95%). No significant associations are presented as “e”.

combined anorexia-satiety than in patients with early satiety only.
In addition to this, early satiety and the combination of anorexia
plus satiety was associated with lower grip strength and higher
fatigue scores, whereas isolated anorexia was not, suggesting a
specific functional effect of this symptom.
When nutritional intake was compared within the spectrum of
appetite disturbances, significant differences in total energy and
macronutrient intake were found. Nevertheless, these differences
remained not significant when the results were adjusted by body
weight. A tendency to lower protein and energy intake was
observed, and maybe a greater sample size would be necessary to
reach statistical significance. Previous studies have observed a
moderate correlation between oral intake and poor appetite
(Solheim et al., 2013). On the other hand, a selection bias could be
responsible for this data, as only patients at risk of malnutrition
(with a poorer nutritional intake than patients with normal nutri-
tional status) were included in the study. Another limitation is the
method used to assess intake, as 24 h recall provides less accurate
information than other methods. This study was performed during
real clinical practice, and all patients received nutritional treatment
after the evaluation, so a prospective method for dietary assess-
ment was not an option. The 24 h recall is an easy and quick,
 D.E. Barajas Galindo et al. / Appetite 114 (2017) 23e27
validated tool frequently used in clinical setting, although its results
can be biased by short term changes in intake and the limited
amount of disposable data. Finally, changes in usual diet could not
be described due to the cross-sectional design of the study. Each
alteration of appetite was associated with significant differences in
the prevalence and severity of malnutrition, therefore patients with
a mixed disorder presented a worse nutritional status. This result
was possibly caused by a greater deterioration in oral intake which
could not be detected without a longitudinal follow up. We
designed a cross-sectional study due to its exploratory aim, since
we wanted to test the hypothesis that the different alteration of
appetite could be related to different nutritional and QoL outcomes.
It is important to distinguish between anorexia and early satiety
when considering pharmacological treatment. Prokinetics such as
metoclopramide alleviate the abdominal discomfort that usually
accompanies early satiety, and favors gastric empting (Bruera et al.,
2000; Shivshanker, Bennett, & Haynie, 1983). However, there are no
studies that analyze the changes on dietary intake that these drugs
could induce. Treatment of cancer associated anorexia has been
widely studied. Megestrol acetate improves appetite and body
weight in cancer patients, but may increase mortality due to its
relationship with thromboembolic disease (Ruiz Garcia, Lo
pez-Briz,
Carbonell Sanchis, Gonzalvez Perales, & Bort-Marti, 2013). The
cannabinoid dronabinol was less effective than megestrol for the
treatment of anorexia, and did not show an additive effect when
used in combination (Jatoi, 2002). Anamorelin is an oral agonist for
the receptor of ghrelin, an orexigenic hormone, which has shown
promising results in preliminary trials (Garcia et al., 2015). How-
ever, its safety in cancer patients has to be perfectly established as
ghrelin is a potent stimulant of growth hormone secretion.
In conclusion, appetite disorders are highly prevalent among
cancer patients at risk of malnutrition and have a definitive impact
on nutritional status and quality of life. The worst scenario is rep-
resented by the coexistence of anorexia and early satiety. The cor-
rect identification of each kind of appetite alteration could allow a
specific treatment to alleviate these symptoms.
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