UICC World Cancer Congress 2006

Objective: Anorexia is commonly reported in cancer and may be evident at diagnosis. Characteristics of appetite loss include anorexia, weight loss, early satiety, and taste and smell changes. We surveyed patients with anorexia to understand the experience of anorexia and help classify the symptom complex of anorexia.

Methods:Patients prospectively completed a 22 question questionnaire. It surveyed anorexia severity, diurnal variations, gastrointestinal (GI) symptoms, taste, smell changes, and possible relationship to cancer therapy, patient concerns about their anorexia.

Results:Ninety-five patients were surveyed (mean age: 63 M/F 46/49). Anorexia was present for months in 77% (severe in constipation (58%), early satiety (82%), nausea (59%), and vomiting (50%). Other GI symptoms occurred in 32-48%. Altered food preference occurred in 57% and taste changes in 68%. Taste changes were evenly divided between sweet (15%), salt (13%), bitter (6%), and sour (3%). Altered smell occurred in 40%. 28% were not concerned about anorexia. A numerical appetite scale was related to early satiety (p=0.03), constipation (p=0.04), and vomiting (p=0.02). A numeral appetite scale negatively correlated in univariate analysis with age (r=0.13), ECOG (r=0.12), weight loss (r=0.13), number of GI symptoms (r=0.17). ECOG score (p < 0.02), the severity of appetite loss (p < 0.01) were significant factors in the numerical rating of appetite loss in multivariate analysis.

Anorexia can present without cachexia. Severe anorexia is associated with the number of GI symptoms particularly early satiety. Anti-tumor therapy worsens anorexia in most. Anorexia is a complex of primary and secondary symptoms with prominent but variable manifestations depending upon severity.