Loss of appetite in palliative care

Loss of appetite should be differentiated from swallowing problems. If the patient is hungry but is unable to swallow food or drink, it’s important to explore ways to make swallowing easier or consider alternative ways to deliver nutrition. If there’s nothing preventing the patient from eating but they have no desire to do so, loss of appetite is the problem.

Loss of appetite is a common occurrence in advanced illness. It’s also one of the symptoms of cachexia, also known as “wasting syndrome”. Loss of appetite may be partly due to changes in, or a loss of, the sense of taste. In addition, various problems in the mouth affect the appetite. Having a sore or dry mouth makes it difficult to chew and swallow, which in turn makes eating seem unappealing.

Sometimes feeling depressed may lead to a loss of appetite, and vice versa. Not having an appetite may interfere with the patient’s social life and time spent with friends, as well as make the patient’s loved ones very concerned.

Loss of appetite is treated by treating the cause, if possible. If loss of appetite is caused by feeling full or experiencing nausea, anti-nausea medicine may be prescribed. The medicine helps food move through the stomach faster and therefore eases the feeling of fullness. Treatment for loss of appetite also includes good mouth care (see “Self-management”).

If the patient is bothered by the loss of appetite, some medicines, such as corticosteroids, may be used to increase appetite temporarily.

As the illness progresses and the patient’s appetite decreases, it’s common for the patient to eat and drink less than before. If the patient is still in moderate condition and has a life expectancy measured in months, they may benefit from nutrition counselling. As the illness progresses and the patient’s overall condition becomes weaker, the body’s metabolism changes and the body is unable to absorb nutrients as usual. This means that the body can’t make use of the nutrition it receives as it would in the case of a healthy person, and the patient loses weight despite nutrition care. The patient is allowed to eat according to their preferences for as long as they feel able and willing to do so. The role of mealtimes as social events and as sources of enjoyment becomes increasingly important. The care staff are able to provide guidance and tips (see “Self-management”).

As death approaches, the feeling of hunger disappears, and loss of appetite is usually no longer an issue. Once a dying patient no longer has the strength to eat, good mouth care is provided and the mouth is kept moist to relieve the feeling of thirst.

Loss of appetite may make both the patient and their loved ones worried, since it concerns one of the basic needs in life. Eating is an activity with many functions and a great deal of significance. Mealtimes are not just for satiating hunger or fulfilling the body’s nutritional needs; they’re also profoundly tied to social interaction, customs and habits, and time spent together with family and friends.

Preparing and serving food are ways to express love and caring. Sometimes hoping for the patient’s appetite to recover is connected to hoping that the illness itself will get better. Those close to the patient may interpret the loss of appetite and reduced intake of food as something causing the patient to starve. However, forcing the patient to eat will not improve their prognosis. Loss of appetite may even lead the patient to experience anxiety, as they worry that not eating the food they are served will make their loved ones feel bad.

Even if the patient’s appetite can’t be increased, it may be possible to make mealtimes more enjoyable for them. The foods served to the patient should be selected following the patient’s preferences. The patient usually finds it easier to have small, frequent portions. Soft and liquid foods are recommended especially if the patient has an esophageal narrowing (stricture). Additionally, if the patient finds them palatable, there are nutritional supplement products available in pharmacies without a prescription. Sometimes liquids are easier to swallow after being thickened. Thickening agents in powder form are available in pharmacies. Some patients prefer foods that are cold or at room temperature. It’s good to make sure that the food is presented nicely, and to avoid strong smells and extremely spicy foods. Some people may find an apéritif (a small drink before a meal) helpful in increasing appetite.

Appetite may also be improved with good mouth care, since a healthy mouth is better able to taste food. If the patient’s sense of taste is altered, it’s okay to explore new taste sensations and preferences with an open mind. If the patient’s sense of taste weakens, tastes such as vinegar may become preferable.

When a person is dying and is no longer able or willing eat, their wishes should be respected. Instead of food, they can be assisted in moistening the mouth – for example, by offering liquids or ice chips, or by applying oil or lip balm.