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Psychological Aspects of Anorexia in Cancer Patients¹

Department of Psychiatry, Montefiore Hospital and Medical Center, Albert Einstein College of Medicine, Bronx, New York 10461 [J. C. B. H., J. R.], and Department of Psychiatry, State University of New York at Buffalo School of Medicine, Buffalo, New York 14214 [M. P.]

Transient anorexia occurs in cancer patients secondary to psychological distress. Discomfort, pain, and lack of a sense of well-being contribute to a general dysphoric affective state, although the clinical signs of significant depression consonant with anorexia on the basis of depression are rarely seen in cancer and were not found in a controlled study. The anorexia-cachexia syndrome of advanced cancer derives from causes other than psychological, compounded at times by the side effects of surgery, chemotherapy, and radiation therapy.

Management of nutrition in cancer can be improved by judicious use of psychopharmacological drugs to diminish the nausea, vomiting, and anorexia of radiation or chemotherapy. Some drugs appear to have a specific appetite-stimulating effect and should be further investigated (cyproheptadine and ⁹-tetrahydrocanabinol). Behavioral techniques used in cases of anorexia nervosa seem to have little relevance in adults with cancer, although self-hypnosis appears useful in children. Creation of as pleasant an ambiance as possible around meals, with encouragement to eat, concern for the patient's food preferences, and attention to the most pleasant social setting for the serving of meals is desirable. The value of eating with a family member, friend, or fellow patient and, if desired, of serving wine, which may stimulate both appetite and social interaction, should not be overlooked.

¹ Presented at the Conference on Nutrition and Cancer Therapy, November 29 to December 1, 1976, Key Biscayne, Fla.

² Presenter.