— Improving the remaining quality of life is at the heart of proper nutrition in order to support energy and stamina levels
She’s almost 70 and has struggled to control high cholesterol levels and pre-diabetes for much of her adult life, resisting tempting treats like strawberry shortcake and French fries. But now her appetite is gone, and stage four ovarian cancer is gnawing away at her insides.
She only wants ice cream, preferably chocolate with a cascade of caramel sauce. Her daughter is adamant she shouldn’t have it. “Mom, you know it’s bad for you,” she says. But her mother is dying, and the doctor says it’s essential for her to eat.
Chemotherapy and radiation treatments, particularly to the mouth and other areas involved in the digestive process, can cause tissue injury and irritation and affect eating ability.
The goal of nutritional support for individuals in palliative care (when potentially curative treatments have been deemed unsuccessful and have been stopped) is to improve the remaining quality of life. Proper nutrition impacts energy and stamina levels.
According to Courtney Pelitera RD, a registered dietician with Top Nutrition Coaching, cachexia, wasting of the body and loss of muscle and fat are frequently seen towards the end of life. This can lead to impaired mobility, unplanned hospitalizations and increased symptoms.
Chemotherapy and radiation treatments, particularly to the mouth and other areas involved in the digestive process, can cause tissue injury and irritation and affect eating ability. Because the gut is not functioning normally and people may be less physically active, several symptoms are often seen in people undergoing cancer treatment, living with cancer or at the end of life, says Pelitera.
These changes impact appetite and ability to tolerate certain types of foods or liquids and may include:
- Appetite loss, anorexia
- Taste and smell changes
- Diarrhea, constipation, nausea, indigestion and heartburn
- Inflammation of oral mucosa and mouth sores, dry mouth
- Difficulty chewing or swallowing (dysphagia), choking episodes
The Emotional Aspects of Food Refusal and Appetite Loss
According to Pelitera, “Sharing a meal is one of the most common ways to socialize. In most cultures, people use food to celebrate milestones and special occasions. It is also sometimes used for comfort and to cheer people up. When someone is ill, visitors will often bring casseroles or sweets.”
“Because hunger cues are gone, people at the end of life are not uncomfortable if they are not eating or drinking.”
However, it can be very upsetting when someone you care about is uninterested in eating or refusing previously enjoyed foods. It is painful to see someone lose weight and become weaker, even though it is the disease process and not only the decreased food intake that is causing it.
The inclination to push food and prepare elaborate meals to try and entice the person to eat is counter-productive. The ill person may feel guilty, as if they are letting you down, and might try to eat even though it can cause them physical discomfort. As Pelitera explains, “Because hunger cues are gone, people at the end of life are not uncomfortable if they are not eating or drinking.”
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