食欲下降 – 安健肿瘤治疗中心食欲下降
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Decreased Appetite A poor appetite or feeling full early, also known as early satiety, may be due to cancer treatment or the cancer itself. Early satiety can lead to drastic weight loss if not carefully managed. Appetite stimulants are often used to treat early satiety.
What is early satiety? Early satiety is the feeling of being full after you have only eaten a small amount, perhaps only a few bites. This condition may also be described as having a poor appetite.
What causes early satiety? Early satiety is a common side effect of chemotherapy, but may also be a complication of the cancer itself.
What are the treatments for poor appetite/early satiety? Early satiety may be treated with nutritional support or appetite stimulants.
Nutritional Support Since early satiety can compromise your ability to get adequate nutrition through food sources, you may benefit from treatment with nutritional support. All cancer patients should meet with a nutritionist or registered dietitian before and throughout their treatment to help maintain their health through appropriate alterations to their diet. Your nutritionist may recommend that you focus on eating higher calorie food, such as protein-rich food. For example, you may try including more of the following in your diet:
In some situations, you may require caloric supplementation beyond what you can get through altering your diet. Nutritional support is beneficial to patients both before and during treatment. Nutritional support may be administered into the veins through parenteral nutrition, or directly into the intestines with enteral nutrition. Both of these types of nutritional support appear to be most beneficial to patients undergoing stem cell transplantation. Other patients who can benefit from it are those with an intestinal obstruction below the level of the stomach and those suffering from radiation or severe chemotherapy induced intestinal damage causing impaired nutrient absorption. Total Parenteral Nutrition - Total parenteral nutrition refers to the intravenous (into your vein) delivery of a nutritionally adequate solution. Total parenteral nutrition is used for patients who cannot eat and may be beneficial in the perioperative setting for cancer patients with severe malnutrition; however, long-term use of total parenteral nutrition for patients undergoing chemotherapy is strongly discouraged, as it does not appear to offer any benefit. Patients undergoing stem cell transplantation appear to receive the greatest benefit from total parenteral nutrition. Enteral Nutrition - Enteral nutrition refers to the delivery of nutrients directly into the gastrointestinal tract and is used when a patient cannot ingest, chew, or swallow food, but can digest and absorb nutrients. Enteral nutrition appears to be beneficial for some patients undergoing stem cell transplantation. It is most useful for patients who cannot swallow (for example, conditions caused by treatment of head and neck cancers with chemotherapy and/or radiation therapy) or those who have obstructions due to cancer above the level of the stomach (for example, esophageal cancer).
Appetite Stimulants A variety of appetite stimulants may help you to maintain adequate calorie and nutrient intake from food sources. These include Marinol® (dronabinol), Megace® (megestrol acetate), and dexamethasone. Marinol: Marinol is part of a class of drugs called cannabinoids. Dronabinol, the active ingredient in Marinol, is produced in the laboratory and is a version of a naturally occurring substance in Cannabis sativa L. (marijuana). Dronabinol is known to be an appetite stimulant. Also, dronabinol is thought to directly block a receptor that is involved in chemotherapy-induced nausea and vomiting. Because of these two effects, dronabinol may be beneficial to patients receiving chemotherapy treatments. In 139 patients with anorexia and weight loss, dronabinol significantly increased appetite after 4 weeks. There was a total increase in appetite of 38 percent for patients receiving dronabinol compared with 8 percent for patients receiving a placebo. The patients receiving dronabinol also tended to have decreased nausea and improved body weight and mood. Dronabinol has also been proven to reduce chemotherapy-induced nausea and vomiting in cancer patients. Unlike marijuana, dronabinol provides standardized THC (tetrahydrocannabinol) concentrations and does not contain the other 400 uncharacterized substances found in smoked marijuana, such as carcinogens or fungal spore. It is not associated with the quick high of smoked marijuana. However, you should not drive, operate machinery, or engage in any hazardous activity until it is established that you can tolerate the drug and perform such tasks safely. Dronabinol is FDA-approved and is administered orally in capsule form. Some patients have increased anxiety from it, especially elderly people. Megace (Megestrol Acetate) - Megestrol acetate is a progesterone, or steroid hormone, that improves appetite in patients with advanced cancer. Megestrol acetate is FDA-approved for the palliative treatment of advanced breast and endometrial cancer. Several studies have established that megestrol acetate causes appetite stimulation and weight gain in cancer patients with anorexia. In a North Central Cancer Treatment Group trial, patients who received megestrol acetate experienced an increase in both appetite and nonfluid weight. Furthermore, 13 out of 15 placebo-controlled trials evaluating megestrol acetate demonstrated that it improves appetite in cancer patients. Megestrol acetate is associated with some side effects. Megestrol acetate suppresses some endocrine functions and presents a slightly increased risk for thrombophlebitis, an inflammation of veins that is often accompanied by blood clots. Patients receiving megestrol acetate who experience serious infection or trauma may require supplemental corticosteroids to reduce inflammation. Dexamethasone: Dexamethasone is a corticosteroid that is often prescribed for cancer-associated anorexia. Corticosteroids are substances produced by the adrenal gland, which serves important functions in the body, including regulating metabolism and reducing inflammation. In a randomized, placebo-controlled trial, dexamethasone was found to improve appetite in patients with advanced cancer. A study that compared several different drugs that stimulate appetite indicated that dexamethasone and megestrol acetate produced equivalent improvement in appetite. However, dexamethasone was associated with significantly worse side effects, such as myopathy, which is an abnormal condition of the skeletal muscle characterized by muscle weakness and other changes in the muscle tissue. It can also cause very high blood sugar, especially in diabetics so this needs to be followed carefully and treated if necessary. As a result, dexamethasone is not recommended for chronic use, but appears to be beneficial for some cancer patients with a poor prognosis, as serious side effects are unlikely to occur in the short term.
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