Overview of anorexia, weight loss and cachexia in palliative care

Anorexia (lack of appetite), weight loss and cachexia (a syndrome of progressive weight loss and muscle wasting that is not reversible by normal nutrition) are among the most recognised symptoms in patients with an advanced life-limiting illness. These symptoms are often troubling for patients and their families and carers.

The loss of weight observed in most patients in the late stage of illness confirms advancing disease and heralds approaching death—however, ‘death by starvation’ or ‘not eating causes death’ are common misconceptions. Patients may not be eating because of the effect of the illness on their body as part of the dying process, rather than dying because they are not eating; see Nutrition and hydration in the last days of life for further information.

Preparing and eating food has social and emotional meaning for patients and their families and carers. It may have powerful cultural significance and is often an intimate part of the expression of love and caring. While measures to improve appetite may be effective earlier in a life-limiting illness, patients often lose interest in food as the illness progresses. Families and carers may interpret this as rejection or that they are failing in their duty. Give patients ‘permission’ not to eat, and families and carers ‘permission’ not to feed. Encourage families and carers to find other ways to express their love and care.