A poor appetite is one of the most common side effects in cancer patients and is also a major risk factor for malnutrition. Poor appetite may be caused by a variety of factors, such as physiological effects of the disease itself or treatments and medications. Altered sense of taste or smell, early satiety, nausea and vomiting, trouble swallowing, acid reflux, and depression also are known to contribute to poor appetite in cancer patients.
RDs play a key role in providing patients with strategies to improve appetite and optimize food intake. Proper food intake will ensure adequate consumption of calories and nutrients, which are necessary for healing, maintaining strength, and improving overall health outcomes.
It isn’t feasible for RDs to provide the same nutrition recommendations for every cancer patient. Poor appetite is a complex side effect with causes varying from person to person. All cancer patients react differently to treatment modalities and will have unique levels of success with appetite-promoting strategies. It’s important for RDs to think outside the box when educating and counseling patients with poor appetite about nutrition. Listed below are five strategies that I recommend in my own practice to encourage food intake in patients battling cancer.
1. Set an alarm. Small, frequent meals typically are recommended for cancer patients with a poor appetite. However, it can be difficult for them to remember to eat several times per day, especially if they aren’t feeling hungry. Fatigue and stress also can hinder patients’ ability to remember to eat. Setting an alarm for every few hours during the day is a great way to help them overcome this challenge. A smartphone or old-fashioned alarm clock will be required for individuals who want to use this strategy.
2. Encourage patients to perceive food as a necessary part of getting well. Just as their medications and treatments are required to help prevent hospital readmissions and facilitate the healing process, adequate food intake is needed for the same reasons. Cancer patients who eat enough are less likely to become malnourished and may feel better overall, as they’re getting the energy their bodies need. It can be difficult for cancer patients to become motivated to eat, especially when they don’t feel hungry. With the right nutrition counseling strategies, dietitians can help reframe patients’ thoughts about the importance of food to help motivate them to eat more.
3. Relax before meals. Eating in a calm, pleasant setting may be helpful for promoting appetite in cancer patients. Making sure their eating space is quiet, stress-free, and without distractions will help them focus on the food in front of them. When the eating environment is hectic, the meal can seem overwhelming and hinder their desire to eat. Stress also can mask feelings of hunger, which will likely reduce the patient’s appetite.
4. Keep easy-to-eat foods in convenient places. You wouldn’t normally recommend patients keep food at their bedside, but it may be warranted for those with cancer. In some cases, patients may be spending most of their time in bed or sitting in their favorite chair. Nonperishable foods, such as peanut butter crackers, small packages of nuts, and dried fruit can be left conveniently on a nightstand or side table. That way, when a hunger pang hits, the individual won’t have to worry about getting up and expending any energy to prepare a meal or snack.
5. Liquid supplements have gotten a bad reputation in recent years, but they can serve an important purpose for cancer patients with poor appetite. Of course, it would be beneficial for patients to prepare their own high-calorie shakes and smoothies, but not all patients have the time or resources to do so. I typically recommend liquid supplements as a meal replacement for cancer patients who can’t tolerate a full meal.
Dietitians can share these out-of-the-box strategies for improving appetite with their cancer patients and caregivers. Remember, the side effects cancer patients experience are highly variable and so are their reactions to treatment strategies. As the practitioner, it’s your role to help them navigate the trial and error process so they can discover what works best to improve their appetite.
— Brianna Tobritzhofer, MS, RD, LD, is the nutrition program manager for Open Arms of Minnesota, a nonprofit organization that cooks and delivers medically tailored meals to individuals living with life-threatening illnesses. She’s author of her blog, Fresh Fit Flourish, which is focused on nutrition, food, and lifestyle.