Arjun Gupta, MD, is an oncologist at the University of Minnesota in Minneapolis, Minnesota. His academic interests include gastrointestinal cancers, supportive care, and identifying and reducing the hidden side effects of cancer care. You can follow Dr. Gupta on Twitter. View Dr. Gupta’s disclosures.
Appetite loss among people with cancer is common. It may be related to the cancer itself, but it can also be caused by cancer treatments or by related symptoms such as mouth sores and nausea. Over time, loss of appetite can lead to weight loss and weakness. Sometimes it can be improved by treating other symptoms like nausea, by treating the cancer itself, or by using medications that increase appetite.
But for people who have advanced cancer when there may be no remaining effective cancer treatments, appetite loss is unlikely to improve even with interventions. Caregivers and loved ones may want to encourage or force the person with cancer to eat, even if they don’t feel like eating. But giving additional calories to people near the end of their life likely will not make them feel better or make them live longer. Although the patient may be concerned about their appetite loss, they are often more focused on getting help for other symptoms they may be experiencing, such as pain or shortness of breath.
Appetite loss and the desire of caregivers and loved ones to feed the person with advanced cancer can sometimes cause tension within the relationship during an especially emotional period of the cancer experience.
Here, learn more about the emotions that appetite loss can cause and how caregivers can best support their loved one who may be experiencing this side effect.
Appetite loss, cancer, and emotions
Across cultures, eating and the foods we eat are emotional issues. This extends to the acts of planning, preparing, and offering foods to those we love. Cooking and feeding others are often expressions of hope, care, and love. These are strong connections that are common among people.
When someone is at the end of life, offering food is a natural way for people to want to offer love and comfort for the person with cancer. For cancer caregivers, feeding someone offers the hope of control over a situation in which they otherwise have little control.
Caregivers may see appetite loss as their failure to provide good care. This may lead to feelings of helplessness, guilt, and rejection when the person they are caring for is unable to eat. Caregivers may believe that if they are unable to feed the person they are caring for, it will result in the person dying earlier. However, this is not true, and caregivers should not blame themselves if their loved one is unable to eat.
Focusing on food may lead to tension and conflict
When appetite loss happens, some caregivers may fixate on food and making the patient eat. This may even lead to force-feeding the person they are caring for or making elaborate feeding plans. The time leading up to each meal can become tense.
While this focus on food and feeding is well intentioned, attempts to feed someone with little or no appetite can make them feel worse. It may lead to nausea and vomiting. It can also lead to arguments between the person with cancer and their caregiver, which can create further conflict between them. In some cases, people with cancer may pretend to sleep through mealtimes to avoid eating or uncomfortable interactions. This is especially unfortunate because there may be limited time to spend together.
Loss of appetite is no one’s fault
In people with advanced cancer, especially at the end of life, appetite loss represents the effects of the cancer. Appetite loss is no one’s fault. Appetite loss does not mean that the person with cancer is not trying to eat. Similarly, it is not the caregiver’s fault if the person they are caring for does not have an appetite.
Appetite loss and weight loss toward the end of life represent a complex metabolic process that also causes muscle loss and weakness called cancer cachexia. Even if the person with cancer were to receive extra calories (through eating, tube feeding, or intravenous feeding), this course cannot be reversed. It is important for caregivers to know that this syndrome is part of the cancer process. It is not anyone’s fault, and it cannot be fixed with extra calories.
Supporting a loved one with appetite loss
Caregivers can support the person with cancer in loving, nonjudgmental ways.
If the person has a desire to eat, listen for favorite foods that they might mention and offer those.
Do not pressure or force them to eat. This can make appetite loss worse and add tension to your relationship.
Focus on the social aspects of the meal, such as eating for pleasure, eating for taste, or enjoying company at the dinner table.
Do not focus on how much food is eaten or how many calories are consumed.
For loved ones who do not want to eat, caregivers can consider alternative methods to show their love and care:
Providing lip balm
Giving a massage
It is important to talk to the health care team to receive guidance in coping with appetite loss. If appetite loss leads to conflict in the relationship with a loved one with cancer, ask the health care team for counseling support for both the person with cancer and the caregiver.