From the Guidelines
Loss of appetite in T cell lymphoma patients is primarily caused by the cancer itself, treatment side effects, and associated complications, and management should focus on a multidisciplinary approach including pharmacological and non-pharmacological interventions to improve quality of life and treatment tolerance. The cancer can release cytokines that disrupt normal hunger signals, while treatments like chemotherapy and radiation can cause nausea, taste changes, and mouth sores 1.
Causes of Loss of Appetite
- The cancer itself, through the release of cytokines that disrupt normal hunger signals
- Treatment side effects, such as nausea, taste changes, and mouth sores from chemotherapy and radiation
- Associated complications, including oral thrush and pain
Management of Loss of Appetite
- Pharmacological approaches:
- Medications such as megestrol acetate (Megace) 400-800 mg daily or dexamethasone 2-4 mg daily to stimulate appetite 1
- Antiemetics like ondansetron 8 mg every 8 hours or prochlorperazine 5-10 mg every 6 hours to control nausea
- Medical cannabis or dronabinol 2.5 mg twice daily may benefit some patients, although evidence is limited and inconsistent 1
- Non-pharmacological approaches:
- Nutritional support, including small, frequent, nutrient-dense meals, oral nutritional supplements, and in severe cases, enteral or parenteral nutrition 1
- Treating underlying causes such as oral thrush with fluconazole 100-200 mg daily or pain with appropriate analgesics
- A multidisciplinary approach involving oncologists, dietitians, and palliative care specialists provides the best outcomes, as addressing appetite loss improves quality of life, treatment tolerance, and potentially survival outcomes for these patients 1.
Key Recommendations
- Nutritional assessment of all cancer patients should begin with tumor diagnosis and be repeated at every visit to initiate nutritional intervention early, before the general status is severely compromised and chances to restore a normal condition are few 1
- Supplemental parenteral nutrition (PN) is recommended in patients if inadequate food and enteral intake (<60% of estimated energy expenditure) is anticipated for more than 10 days 1
- PN is not recommended if oral/enteral nutrient intake is adequate 1
From the Research
Causes of Loss of Appetite in T Cell Lymphoma
- Loss of appetite in patients with T cell lymphoma can be caused by various factors, including the effects of active malignancy, systemic inflammation, and cumulative treatment burden 2.
- Cachexia and malnutrition are known secondary syndromes in many cancer patients, which can lead to loss of appetite 2.
- The development of anorexia in cancer patients is a complex process that involves many cytokines, receptors, chemical mediators/substances, hormones, and peptides 3.
- Growth and differentiation factor-15 (GDF-15) and toll-like receptor (TLR-4) have recently been found to be implicated in the pathogenesis of anorexia in cancer patients 3.
Management of Loss of Appetite in T Cell Lymphoma
- Several drugs with different mechanisms of action have been studied to help improve appetite in cancer patients, including anamorelin, mirtazapine, thalidomide, and eicosapentaenoic acid (EPA) 3.
- New repurposed agents such as olanzapine, anamorelin, and cannabis may also palliate loss of appetite in cancer patients 4.
- Malnutrition screening and dietetic referrals are important in managing loss of appetite in cancer patients, but there is often a lack of screening and referrals prior to treatment 2.
- The use of serotonin antagonists such as granisetron, tropisetron, and ondansetron may help control nausea and vomiting, which can contribute to loss of appetite, during high-dose chemotherapy and autologous stem cell transplantation 5.
Diagnosis of Loss of Appetite in T Cell Lymphoma
- Several questionnaires can be used to diagnose appetite problems in cancer patients, including the Functional Assessment of Anorexia Cachexia Therapy (FAACT), Visual Analog Scale (VAS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ30) 3.
- Nutritional status, including malnutrition and cachexia, can be assessed using tools such as the modified Glasgow Prognostic Score (mGPS) and Global Leadership Initiative on Malnutrition (GLIM) consensus 2.