Psychological aspects of anorexia: areas for study

Malignant disease: nutritional implications of disease and treatment

Protein-energy malnutrition (PEM) is common in cancer patients and may develop into the syndrome known as 'cancer cachexia'. This is characterised by complex disturbances in carbohydrate, lipid, protein, and electrolyte metabolism. The aetiology is equally complex, with host and therapeutic factors contributing to the reduced food intake and effects on host tissues. Anorexia is of prime importance, differing in its cause from one patient to another and often presenting a barrier to successful nutritional support. Further research is necessary to elucidate the interaction of central and peripheral factors that may be involved in the aetiology of anorexia. Because of the interplay of biochemical, physiological, and psychological consequences of cancer, the nutritional support of the patient presents a considerable challenge to the caring professions.

Psychological aspects of nutrition and cancer

Cancer and the various treatments employed to combat this disease have an impact on food intake that is psychologic in nature. These psychologic consequences include behavioral responses such as learned food aversions, changes in food preferences, and anticipatory nausea and vomiting. In a second cluster of psychologic consequences are the emotional responses of anxiety and depression. A third type of psychologic consequence is perceptual in nature and is most commonly represented by changes in palatability of foods. A fourth psychologic aspect of food intake and cancer includes attitudinal responses, wherein social, religious, cultural, and other values related to food may change as a consequence of the disease. Studies are needed in this area. Approaches to nutritional care that address the psychologic impact of cancer are described. As a means of maintaining adequate nutritional status, artificial feeding routes may create psychologic problems. In general, cancer and its treatment can exert a negative impact on quality of life. Finally, the ethics of feeding are discussed in terms of care giving versus alimentation.