New Solution: A Popular Antipsychotic Drug Is Now Being Used to Stimulate Appetite In Cancer Patients

The syndrome of cancer-related anorexia/cachexia is marked by a combination of anorexia, weight loss, and a decline in muscle mass and body fat. Alongside reduced energy intake, there can be an increase in resting energy expenditure, leading to elevated breakdown of muscle protein and fat. These changes are believed to be partially caused by an inflammatory response triggered by tumor-released cytokines.

The Psychosocial Burden of Anorexia

Patients and caregivers often find the loss of appetite and physical changes associated with cachexia to be distressing. Caregivers may mistakenly interpret the lack of eating as their own failure to provide sufficient care, which can be compounded by cultural and familial beliefs that equate sharing food and feeding with expressions of love and hope. So if you are a caregiver, don’t be too hard on yourself!

It is important to encourage a loved one to partake in social dining experiences with family members, emphasizing the pleasure of tasting food rather than focusing solely on caloric intake. In general, patients with anorexia/cachexia syndrome who are capable of eating should be advised to consume small, frequent meals that are calorie-dense (such as eggs or liquid nutritional supplements). Other strategies to enhance caloric intake include opting for easily prepared meals (such as microwaveable options) and resting before meals.

Near the end of life, issues regarding eating and feeding can become even more challenging. The following key points might help you or a loved one:

• Forcing a patient to eat is generally counterproductive and can potentially lead to increased complications such as aspiration, nausea, and vomiting. Moreover, efforts to coerce eating can result in reduced social interactions, increased distress for the patient, and a possible inclination to avoid interactions with family and caregivers.
• It’s important to know that providing additional calories through feeding tubes or intravenous routes does not typically improve outcomes for most patients with advanced cancer and cachexia. Don’t be afraid to question your doctor whether that tube is needed.
• Caregivers may find it more beneficial to listen to and support the patient in various other ways (such as giving a massage or applying lip moisturizer) rather than attempting to persuade them to eat more.

About the New Study

The researches evaluated 112 patients between November 2020 and June 2022 to receive olanzapine at 2.5 mg or placebo, once a day for 12 weeks together with chemotherapy.

Overall, 55% of patients had gastric, 35% had lung, and 10% had hepatopancreaticobiliary cancer; 84% of patients had stage IV disease. That means, the majority of patients had advanced disease.

At 12 weeks, weight gain > 5% was observed in 60% of patients in the olanzapine group vs 9% in the placebo group and improvement in appetite occurred in 43% in the olanzapine group vs 13% in the placebo group

Nutrition scores also improved in 43% vs 9% of patients and there was also improvement in quality of life on the Cancer Institute Quality of Life tool occurred in 70% vs 50% of patients

Why Does Cancer Cause Weight Loss?

• Decreased appetite: Cancer can affect the body’s normal metabolism and lead to a reduced appetite. Factors such as tumor-related chemicals, inflammation, and the release of certain substances by cancer cells can contribute to a loss of appetite.
• Altered metabolism: Cancer can disrupt the body’s metabolism, leading to changes in how nutrients are processed and utilized. The tumor itself may require a significant amount of energy, diverting nutrients away from normal bodily functions and resulting in weight loss. Increased energy expenditure: Some cancers can increase the body’s energy expenditure, causing it to burn calories at a faster rate. This can result in weight loss, even if a person’s calorie intake remains the same.
• Nutrient malabsorption: Certain types of cancer, particularly those affecting the digestive system, can impair the absorption of nutrients from food. This can lead to malnutrition and weight loss, as the body is not able to adequately absorb essential nutrients.
• Cancer treatment side effects: Treatments like chemotherapy, radiation therapy, and surgery can have side effects that contribute to weight loss. These treatments can affect the digestive system, cause nausea, vomiting, changes in taste, and impact a person’s ability to eat and tolerate food.
• Cachexia: Cancer-related cachexia is a severe form of weight loss characterized by muscle wasting, loss of body fat, and weakness. It is often associated with advanced stages of cancer and is thought to be caused by a combination of factors including inflammation, metabolic changes, and the release of certain substances by the tumor.

What can I do on my own to eat enough?

To eat enough and make sure that your body gets the nutrients it needs, you can:

• Eat 5 to 6 small meals a day, instead of 3 large meals.
• Eat healthy snacks in between meals whenever you feel hungry.
• Add butter, oil, nuts, gravy, powdered milk, protein powder, or cream to your foods to give them extra calories and protein.
• Drink fluids between meals instead of with your meals, so you don’t fill up on fluids.
• Eat foods that smell good, or add spices or condiments to your food.
• Eat with family or friends.
• Buy pre-cooked foods or cook food ahead of time and freeze it.
• Ask someone to cook or shop for you, if you are unable to cook or shop.
• Take a short walk about an hour before you eat to help you work up an appetite.
• Ask your doctor if you should take vitamins or work with a nutrition expert.
• If you have side effects from your treatments that are keeping you from eating, these tips might help:
• If you have a dry mouth, drink lots of fluids and avoid foods that are hard or dry (such as toast or crackers). You can eat moist foods, or suck on ice chips or sugar-free hard candy.
• If you have mouth sores, eat soft foods that you can chew and swallow easily. You can also cut up your food into small pieces or mash it in a blender. Try to avoid spicy or salty foods.
• If you have nausea, eat foods that are bland and dry, such as crackers, rice, and toast. Avoid foods that are spicy and greasy.
• If you have trouble having a bowel movement, try to drink more fluids. You can also eat foods with a lot of fiber, such as vegetables, fruits, beans, nuts, oatmeal, and some breads and cereals (figure 1).
• If you have diarrhea, try to drink a lot of fluids so your body doesn’t lose too much water. Try to avoid milk, greasy foods, and foods with a lot of fiber.

Questions to Ask Your Doctor

• Why don’t I feel like eating?
• Am I eligible to receive olanzapine?
• Are there other drugs that might help me gain weight?

Learn more about SurvivorNet's rigorous medical review process.

---