Overview

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.

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.

Early satiety is a common side effect of chemotherapy, but may also be a complication of the cancer itself.

Early satiety may be treated with nutritional support or appetite stimulants.

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 dietician prior to 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 foods, such as protein-rich foods. For example, you may try including more of the following in your diet.

• Protein drinks (powdered protein supplement mixed with fruit, milk and/or yogurt)

• Milk

• Dairy products

• Eggs

• Meat

• Sauces or gravies

• Oil

In some situations, you may require caloric supplementation beyond what you can get through altering your diet. Nutritional support is beneficial to patients both prior to 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.

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 patients undergoing stem cell transplantation.

Appetite stimulants may help you to maintain adequate calorie and nutrient intake from food sources. These include Marinol®, megestrol acetate (Megace®) 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). Marinol® is known to be an appetite stimulant. Also, Marinol® is thought to directly block a receptor that is involved in chemotherapy-induced nausea and vomiting. Because of these two effects, Marinol® may be beneficial to patients receiving chemotherapy treatments.

In 139 patients with anorexia and weight loss, Marinol® significantly increased appetite after 4 weeks. There was a total increase in appetite of 38% for patients receiving Marinol® compared to 8% for patients receiving placebo. The patients receiving Marinol® also tended to have decreased nausea and improved body weight and mood.^[1] Marinol® has also been proven to reduce chemotherapy-induced nausea and vomiting in cancer patients.^[2]

Unlike marijuana, Marinol® provides standardized THC 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. Marinol® is FDA-approved, and is administered orally in capsule form.

Megestrol Acetate (Megace®): Megace® is a progesterone, or steroid hormone, that improves appetite in patients with advanced cancer. Megace® is FDA-approved for the palliative treatment of advanced breast and endometrial cancer.

Several studies have established that Megace® causes appetite stimulation and weight gain in cancer patients with anorexia. In a North Central Cancer Treatment Group trial, patients who received Megace® experienced an increase in both appetite and non-fluid weight.^[3] Furthermore, 13 out of 15 placebo-controlled trials evaluating Megace® demonstrated that it improves appetite in cancer patients.

Megace® is associated with some side effects. Megace® 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 Megace® 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 serve 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.^[4] A study that compared several different drugs that stimulate appetite indicated that dexamethasone and Megace® produced equivalent improvement in appetite.³ However, dexamethasone was associated with significantly worse side effects, such as myopathy, which is an abnormal condition of skeletal muscle characterized by muscle weakness and other changes in the muscle tissue. 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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