Key notes on symptom control issues in Palliative Care

Anorexia
Step one	Diagnose the cause and treat if possible	Small regular, high calorie snacks
Step two	Aperitif before meals	Low dose steroids or megestrol acetate
Step three	Ask for help

A loss of appetite is often a sign of advancing disease. This is a very common symptom and difficult to manage. Honest discussion with the carers about their desire to meet a basic human need and the patient’s inability to accept the offer of food need to be sensitively handled. The carer may feel rejected and hurt that their loved one is not trying and the patient may feel overwhelmed by the pressure exerted on them to eat. It is important to exclude treatable causes of anorexia such as a sore mouth, oral thrush, ill fitting or lost dentures. It may be appropriate to treat biochemical abnormalities such as hypercalcaemia in order to restore appetite.

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  Practical advice should be given to carers about providing regular, small, high calorie snacks rather than a single big meal.
  
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  Ensuring a meal is well presented on a small plate so it is not over facing may encourage a patient to eat.
  
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  Carers may be unaware that taste changes are common in advanced disease and need to be accommodated.
  
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  In addition, if supplement drinks appear too filling when taken from the carton they may be frozen and used like lollipops.
  
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  Simple strategies like giving an aperitif such as sherry before a meal may help some patients.
  
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  Low dose steroids (dexamethasone 4-6mg in a single daily dose) with appropriate GI protection may temporarily stimulate a patient’s appetite for a few weeks. If there is no improvement in appetite they should be stopped after a two week trial.
  
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  Megestrol acetate 80mg in the morning and at lunch-time may also temporarily stimulate the appetite for a few weeks or months and may have
  

some anticancer effect.

Dry Mouth