A Systematic Review of the Evidence on Symptom Management of Cancer-Related Anorexia and Cachexia

Jean K. Brown

ONF 2002, 29(3), 517-532. DOI: 10.1188/02.ONF.517-532

Purpose/Objectives: To evaluate and synthesize the evidence regarding cancer-related anorexia and cachexia symptom management and make recommendations for future directions.

Data Sources: Cochrane Library, MEDUNE®, CANCERLIT®, CINAHL, Dissertation Abstracts, EBM Reviews—Best Evidence, EMBASE, and the Computer Retrieval of Information on Scientific Projects. Current overviews, clinical trials, systematic research reviews, and meta-analyses.

Data Synthesis: All studies focused on increasing food intake. Nonpharmacologic clinical trials increased caloric and protein intake but resulted in no improvement in nutritional status, weight, tumor response, survival, or quality of life. Weight, appetite, and well-being were improved with megestrol acetate, but nutritional status was not improved. Some exercise studies demonstrated improvements in nutrition-related outcomes, but these were not primary research outcomes.

Conclusions: Symptom management of anorexia and cachexia should focus on decreasing energy expenditure or minimizing factors creating a negative energy balance, as well as improving food intake. Increased measurement sensitivity also is needed.

Implications for Nursing: Improved nutritional assessment skills are needed with an emphasis on anticipated problems and current status.

Jump to a section


    Arnold, C.A., & Richter, M.P. (1989). The effect of oral nutritional supplements on head and neck cancer. International Journal of Radiation Oncology, Biology, and Physics, 16, 1595--1599.

    Azcona, C., Castro, L., Crespo, E., Jimenez, M., & Sierrasesumaga, L. (1996). Megestrol acetate therapy for anorexia and weight loss in children with malignant solid tumors. Alimentary Pharmacology and Therapeutics, 10, 577--586.

    Barsevick, A.M. (1999). Energy conservation and cancer treatment-related fatigue [Abstract]. Retrieved February 5, 2002 from the World Wide Web: http://www.nih.gov/ninr/research/dea/1999grants/pdf/cancer/cancer_abarsevick.pdf.

    Brown, J., Byers, T., Thompson, K., Eldridge, B., Doyle, C., & Williams, A.M. (2001). Nutrition during and after cancer treatment: A guide for informed choices by cancer survivors. CA: A Cancer Journal for Clinicians, 51, 153--187.

    Brown, J.K. (1991). Precancer factors and outcomes of weight loss in adults with lung cancer. Dissertation Abstracts International, 52, 2989B.

    Brown, J.K. (1993). Gender, age, usual weight, and tobacco use as predictors of weight loss in lung cancer. Oncology Nursing Forum, 20, 466--472.

    Brown, J.K., Knapp, T.R., & Radke, K.J. (1997). Sex, age, height, and weight as predictors of selected physiologic outcomes. Nursing Research, 46, 101--103.

    Brown, J.K., & Radke, K.J. (1998). Nutritional assessment, intervention, and evaluation of weight loss in patients with non-small cell lung cancer. Oncology Nursing Forum, 25, 547--553.

    Bruning, P.F., Egger, R.J., Gooskens, A.C., Hermus, R.J.J., Hulshof, K.F.A.M., Kistemaker, C., et al. (1985). Dietary intake, nutritional status, and well-being of cancer patients: A prospective study. European Journal of Cancer and Clinical Oncology, 21, 1449--1459.

    Center for Reviews and Dissemination Reviewers. (2000). A meta-analysis of intervention effectiveness for symptom management in oncology nursing research [Review]. Retrieved February 15, 2001 from Cochrane Library Database of Abstracts of Reviews of Effectiveness online database on the World Wide Web: http://www.update-software.com.

    Chute, C.G., Greenberg, E.R., Baron, J., Korson, R., Baker, J., & Yates, J. (1985). Presenting conditions of 1,539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont. Cancer, 56, 2107--2111.

    Cohn, S.H., Gartenhaus, W., Vartsky, D., Sawitsky, A., Zanzi, I., Vaswani, A., et al. (1981). Body composition and dietary intake in neoplastic disease. American Journal of Clinical Nutrition, 34, 1997--2004.

    Costa, G., Bewley, P., Aragon, M., & Siebold, J. (1981). Anorexia and weight loss in cancer patients. Cancer Treatment Reports, 65(Suppl. 5), 3--7.

    Costa, G., & Donaldson, S. (1980). The nutritional effects of cancer and its therapy. Nutrition and Cancer, 2, 22--29.

    Courneya, K.S. (1999). Exercise effects on quality of life in cancer patients [Abstract]. Retrieved February 28, 2002 from the World Wide Web: http://crisp.cit.nih.gov/.

    Courneya, K.S., & Friedenreich, C.M. (1999). Physical exercise and quality of life following cancer diagnosis: A literature review. Annals of Behavioral Medicine, 21, 171--179.

    Cunningham, R.S., & Bell, R. (2000). Nutrition in cancer: An overview. Seminars in Oncology Nursing, 16, 90--98.

    DeWys, W.D., Begg, C., Lavin, P.T., Band, P.R., Bennett, J.M., Bertino, J.R., et al. (1980). Prognostic effect of weight loss prior to chemotherapy in cancer patients. American Journal of Medicine, 69, 491--497.

    Dodd, M.J. (1999). Exercise---An intervention for fatigue in cancer patients [Abstract]. Retrieved February 28, 2002 from the World Wide Web: http://crisp.cit.nih.gov/.

    Doerr, T.D., Marks, S.C., Shamsa, F.H., Mathog, R.H., & Prasad, A.S. (1998). Effects of zinc and nutritional status on clinical outcomes in head and neck cancer. Nutrition, 14, 489--495.

    Doerr, T.D., Prasad, A.S., Marks, S.C., Beck, F.W., Shamsa, F.H., Penny, H.S., et al. (1997). Zinc deficiency in head and neck cancer patients. Journal of the American College of Nutrition, 16, 418--422.

    Enig, B., Petersen, H.N., Smith, D.F., & Larsen, B. (1987). Food preferences, nutrient intake, and nutritional status in cancer patients. Acta Oncologica, 26, 301--305.

    Evans, W.K., Nixon, D.W., Daly, J.M., Ellenberg, S.S., Gardner, L., Wolfe, E., et al. (1987). A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small cell lung cancer. Journal of Clinical Oncology, 5, 113--124.

    Fietkau, R., Riepl, M., & Kettner, H. (1997). Supportive use of megestrol acetate in patients with head and neck cancer during radio(chemo)therapy. European Journal of Cancer, 33, 75--79.

    Gagnon, G., & Bruera, E. (1998). A review of the drug treatment of cachexia associated with cancer. Drugs, 55, 675--688.

    Goldberg, R.M., & Loprinzi, C.L. (1999). Cancer anorexia/cachexia. In C.F. von Gunten (Ed.), Palliative care and rehabilitation of cancer patients (pp. 31--41). Boston: Klewer Academic.

    Grant, M.M. (1988). Effects of a structured teaching program for cancer patients undergoing head and neck radiation therapy on anorexia, nutritional status, functional status, treatment response, and quality of life (Doctoral dissertation, University of California, San Francisco, 1988). Dissertation Abstracts International, 48, 3248B.

    Heymsfield, S.B., & McManus, C.B. (1985). Tissue components of weight loss in cancer patients: A new method of study and preliminary observations. Cancer, 55, 238--249.

    Hickman, D.M., Miller, R.A., Rombeau, J.L., Twomey, P.L., & Frey, C.F. (1980). Serum albumin and body weight as predictors of postoperative course in colorectal cancer. Journal of Parenteral and Enteral Nutrition, 4, 314--316.

    Klein, S., Kinney, J., Jeejeebhoy, K., Alpers, D., Hellerstein, M., Murray, M., et al. (1997). Nutrition support in clinical practice: Review of published data and recommendations for future research directions. American Journal of Clinical Nutrition, 66, 683--706.

    Kraemer, H.C., & Thiemann, S. (1989). A strategy to use soft data effectively in randomized controlled clinical trials. Journal of Consulting and Clinical Psychology, 57, 148--154.

    Lai, S.L., & Perng, R.P. (1998). Impact of nutritional status on the survival of lung cancer patients. Chinese Medical Journal, 61, 134--140.

    Larson, P.J., Lindsey, A.M., Dodd, M.J., Brecht, M.L., & Packer, A. (1993). Influence of age on problems experienced by patients with lung cancer undergoing radiation therapy. Oncology Nursing Forum, 20, 473--480.

    Lindsey, A.M. (1986a). Cancer cachexia. In V.K. Carrieri, A.M. Lindsey, & C.M. West (Eds.), Pathophysiological phenomena in nursing (pp. 122--136). Philadelphia: Saunders.

    Lindsey, A.M. (1986b). Cancer cachexia: Effects of the disease and its treatment. Seminars in Oncology Nursing, 2, 19--29.

    Lindsey, A.M., Larson, P.J., Dodd, M.J., Brecht, M.L., & Packer, A. (1994). Comorbidity, nutritional intake, social support, weight, and functional status over time in older cancer patients receiving radiotherapy. Cancer Nursing, 17, 113--124.

    Lindsey, A.M., & Piper, B.F. (1985). Anorexia and weight loss: Indicators of cachexia in small cell lung cancer. Nutrition and Cancer, 7, 65--76.

    Maltoni, M., Nanni, O., Scarpi, E., Rossi, D., Serra, P., & Amadon, D. (2001). High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: A systematic review of randomised clinical trials. Annals of Oncology, 12, 289--300.

    McCallum, P.D., & Polisena, C.G. (Eds.). (2000). The clinical guide to oncology nutrition. Chicago: American Dietetic Association.

    McCallum, P.D., & Polisena, C.G. (Producers). (2001). Patient-generated subjective global assessment video [Motion picture]. (Available from the American Dietetic Association, 216 West Jackson Boulevard, Chicago, IL 60606.)

    McCarthy, D., & Weihofen, D. (1999). The effect of nutritional supplements on food intake in patients undergoing radiotherapy. Oncology Nursing Forum, 26, 897--900.

    McMahon, K., & Brown, J.K. (2000). Nutritional screening and assessment. Seminars in Oncology Nursing, 16, 106--112.

    Mock, V., Pickett, M., Ropka, M., Poniatowski, B., & Drake, D. (2001, May). Fatigue in patients with cancer: An exercise intervention---Report of the FIRE® Project. Symposium conducted at the meeting of the Oncology Nursing Society 26th Annual Congress, San Diego, CA.

    Moloney, M., Moriarty, M., & Daly, L. (1983). Controlled studies of nutritional intake in patients with malignant disease undergoing treatment. Human Nutrition: Applied Nutrition, 37, 30--35.

    Morley, J.E., & Levine, A.S. (1985). The pharmacology of eating behavior. Annual Review of Pharmacology and Toxicology, 25, 127--146.

    Morrison, S.D. (1989). Cancer cachexia. Cancer Growth Progress, 3, 176--213.

    Ottery, F.D. (1994). Rethinking nutritional support of the cancer patient: The new field of nutritional oncology. Seminars in Oncology, 21, 770--778.

    Ottery, F.D. (1995a). Integrating nutrition into cancer and AIDS care: An audiotape companion monograph. Princeton, NJ: Bristol-Myers Squibb.

    Ottery, F.D. (1995b). Supportive nutrition to prevent cachexia and improve quality of life. Seminars in Oncology, 22(Suppl. 3), 98--111.

    Ovesen, L., & Allingstrup, L. (1992). Different quantities of two commercial liquid diets consumed by weight-losing cancer patients. Journal of Parenteral and Enteral Nutrition, 16, 275--278.

    Ovesen, L., Allingstrup, L., Hannibal, J., Mortensen, E.L., & Hansen, O.P. (1993). Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: A prospective, randomized study. Journal of Clinical Oncology, 11, 2043--2049.

    Ovesen, L., Hannibal, J., & Mortensen, E.L. (1993). The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast, and ovary. Nutrition and Cancer, 19, 159--167.

    Padilla, G.V., Grant, M.M., Ferrell, B., & Presant, C.A. (1995). Quality of life---Cancer. In B. Spilker (Ed.), Quality of life and pharacoeconomics in clinical trials (2nd ed., pp. 301--308). New York: Raven Press.

    Ripamonti, C., Zecca, E., Brunelli, C., Fulfaro, F., Villa, S., Balzarini, K.A., et al. (1998). A randomized controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation. Cancer, 82, 1938--1945.

    Robinson, G., Goldstein, M., & Levine, G.M. (1987). Impact of nutritional status on DRG length of stay. Journal of Parenteral and Enteral Nutrition, 11, 49--51.

    Ropka, M.E., & Spencer-Cisek, P. (2001). PRISM: Priority symptom management project. Phase I---Assessment. Oncology Nursing Forum, 28, 1585--1594.

    Sarna, L., Lindsey, A.M., Dean, H., Brecht, M.L., & McCorkle, R. (1993). Nutritional intake, weight change, symptom distress, and functional status over time in adults with lung cancer. Oncology Nursing Forum, 20, 481--489.

    Seltzer, M.H., Bastidas, J.A., Cooper, D.M., Engler, P., Slocum, B., & Fletcher, H.S. (1979). Instant nutritional assessment. Journal of Parenteral and Enteral Nutrition, 3, 157--159.

    Seltzer, M.H., Slocum, B.A., Cataldi-Betcher, E.L., Fileti, C., & Gerson, N. (1982). Instant nutritional assessment: Absolute weight loss and surgical mortality. Journal of Parenteral and Enteral Nutrition, 6, 218--221.

    Shils, M.E., Olson, J.A., Shike, M., & Ross, A.C. (1999). Modern nutrition in health and disease (9th ed.). Baltimore: Williams and Wilkins.

    Smith, M.C., Holcombe, J.K., & Stullenbarger, E. (1994). A meta-analysis of intervention effectiveness for symptom management in oncology nursing research. Oncology Nursing Forum, 21, 1201--1208.

    Somers, E. (1995). Food and mood. New York: Henry Holt.

    Spitzer, W.O., Dobson, A.J., Hall, J., Chesterman, D., Levi, J., Shepherd, R., et al. (1981). Measuring the quality of life of cancer patients. A concise QL-index for use by physicians. Journal of Chronic Diseases, 34, 585--597.

    Stanley, K.E. (1980). Prognostic factors for survival in patients with inoperable lung cancer. Journal of the National Cancer Institute, 65, 25--32.

    Theologides, A., Ehlert, J., & Kennedy, B.J. (1976). The calorie intake of patients with advanced cancer. Minnesota Medicine, 59, 526--529.

    Walsh, T.D., Bowman, K.B., & Jackson, G.P. (1983). Dietary intake of advanced cancer patients. Human Nutrition: Applied Nutrition, 37, 41--45.