Coping with Appetite Changes

So much of food’s appeal is wrapped up in the senses—sight, aroma and taste converge to make people hungry. One of the many injustices of some cancer treatments is that chemotherapy alters the senses to destroy appetite, which can weaken the body’s ability to fight disease. Some patients find the aroma of cooking so unappetizing they need to leave the kitchen. For others, fear of nausea can trigger anxiety over the sight of food. Chemotherapy can give food a metallic taste. Patients who aren’t hungry in the first place can find themselves eating less if food doesn’t taste good.

“Food is medicine. You have to eat to improve your chances of the treatment working,” says Gerald P. Miletello, MD, an oncologist at the Baton Rouge Clinic and co-author of Eating Well Through Cancer: Easy Recipes and Recommendations During & After Treatment. “Patients and their families become obsessed with the fact that patients lose their appetites. It becomes a bone of contention between the patient and their caregiver. The constant nagging to eat makes one want to eat less.”

A 2008 Swedish study found that of 518 patients, 75 percent self-reported taste and smell changes that were closely related to other chemotherapy side effects. Many chemotherapeutic agents can cause changes in taste. The reasons for these negative effects are unclear, but one possibility is that chemotherapy damages the cells in taste buds. Drugs or radiation to the head and neck can also stop saliva secretion, causing dry mouth, which also can make food less appealing. Worse, chemotherapy-induced changes in taste and smell can linger for weeks, with one small study showing recovery taking up to three months.

Because people undergoing chemotherapy are seldom driven by hunger, Miletello and Leni Javier, a registered dietitian at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, offer these suggestions to maintain good nutrition during and after treatment:

> Eat small amounts of food on a schedule throughout the day.

> Try sucking on a thin slice of lemon or mint hard candy prior to eating to stimulate taste buds (not recommended for patients with mouth sores or sore throat).

> Eat more at breakfast because the chance of being hungry is greatest at this time of the day.

> If the aromas of cooking are bothersome, get help with food preparation and get out of the kitchen, or eat cold, non-fragrant foods, such as chicken salad, cheese or yogurt.

> Make the dining experience as pleasant as possible.

> Create distractions by turning on the TV, reading a newspaper or eating with friends who can provide good conversation.

> To get rid of food’s metallic taste, use plastic utensils. If red meats taste bitter, eat chicken or other types of protein, or use marinades to enhance flavor.

> Consult with a registered clinical dietitian for a nutritional assessment and intervention during cancer therapy and for recovery.

One key to tolerating chemotherapy is maintaining enough reserves to deal with side effects. Weight is one measure of those reserves, says Joel Picus, MD, a medical oncologist at the Siteman Cancer Center. When patients lose weight, they lose muscle mass, and weakened bodies lack energy to do much.

“If you are going to hike Mount Everest or run a marathon, you wouldn’t want to be weak and undernourished,” Picus says. “It’s not just weight, but also strength and ability to exercise.”