Appetite Loss in Childhood Cancer

loss of appetite

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

A poor appetite or even loss of appetite is common with cancer and cancer treatment, and children with cancer may not feel hungry at all, eat less than usual, or feel full after eating only a little bit of food.

Ongoing appetite problems may result in your child losing weight, not getting the nutrients from food that his or her body needs, and loss of muscle mass and strength, all of which are serious complications.  The combination of weight loss and muscle mass loss is called cachexia, or wasting.

 

Causes

Loss of appetite in a child has many causes:

  • Advanced cancer
  • Ascites,  an accumulation of serous fluid in peritoneal cavity in the abdomen, may create a feeling of fullness even after eating only a tiny amount of food
  • Medications, including chemotherapy, immunotherapy, and sedatives that cause feelings of calmness or sleepiness
  • Radiation treatment or surgery to any part of the gastrointestinal organs, such as the stomach or intestines
  • Some cancers may cause the spleen to become enlarged. When a spleen grows in size, it can push on the stomach, creating a feeling of fullness.
  • Some types of cancer, including ovarian, pancreatic, and stomach cancers, may cause loss of appetite, by affecting a person’s metabolism, which is the process of the body breaking down food and turning it into energy.

Other side effects of cancer treatment, such as:

  • Changes in taste and smell
  • Constipation
  • Depression
  • Difficulty chewing
  • Difficulty swallowing
  • Dry mouth
  • Fatigue
  • Infections in the mouth
  • Mouth sores and mouth pain
  • Nausea and vomiting
  • Pain

 

Management/Treatment

The first step in treating appetite loss is to address the underlying cause where possible, such as when the lack of appetite is due to mouth sores, dry mouth, pain, or depression – treatment for these conditions could help improve your child’s appetite.

Treatments for appetite loss and associated weight loss may include medications that increase appetite and medications that help move food through the intestine, including:

  • Megestrol acetate (Megace) or medroxyprogesterone – forms of the progesterone hormone that can improve appetite and weight gain.
  • Steroid medications may increase your child’s appetite, improve their sense of well-being, and help with nausea, weakness, or pain. Due to steroids having serious side effects, they should only be used for a short time and under strict medical care.
  • Metoclopramide can prevent feeling full before eating enough food.
  • Dronabinol (Marinol), a cannabinoid made in the laboratory, may stimulate appetite.

 

Nutritional supplement drinks, medications that help food move through the intestine, and tube feeding (the use of a tube that passes through the nose into the stomach), can also be helpful when your child has no appetite or cannot eat.

Getting good nutrition and keeping a healthy weight are important parts of your child’s recovery and can help them cope better both physically and emotionally with the effects of cancer and cancer treatment.

 

Tips for proper nutrition when your child’s appetite is poor:

  • Feed your child 5 or 6 small meals a day instead of 3 large ones, and leave their favourite snacks foods nearby for them to pick on whenever they are hungry.
  • Determine which times of day they seem hungry, and make sure they eat at those times, and do not limit how much they eat.
  • Give them nutritious snacks that are high in calories and protein, such as dried fruits, nuts, yoghurt, cheese, eggs, milkshakes, ice cream, cereal, pudding, and granola bars.
  • Add calories and protein to various foods by adding cream, cheese, gravy, peanut butter, and nuts.
  • Give your child fluids between meals rather than with meals as drinking during a meal may make you them feel full too quickly.
  • Give your child nutritious or filling drinks, such as milk, nutritional milkshakes or smoothies.
  • If the smell or taste of food makes your child nauseous, rather let them try to eat food that is cold or at room temperature – this will decrease its odour and reduce its taste.
  • If your child says they are having trouble tasting the food, try adding spices and condiments to make them more appealing.
  • If your child has changes in taste, such as a metallic taste in their mouth, letting them suck on hard candy like mints or lemon drops before eating a meal can be helpful.
  • Ask your doctor about ways to relieve gastrointestinal symptoms, such as nausea, vomiting, and constipation or if your child is having any difficulty with managing pain.
  • Try light exercise, such as going for a 20-minute walk with your child about an hour before meals to stimulate their appetite. Consult your child’s health care team before starting any exercise program. Exercise also helps maintain muscle mass.
  • Find and meet with a registered dietitian for additional advice on meal planning.