Nutrition and Palliative Care

last authored: April 2012, David LaPierre
last reviewed:

 

 

Introduction

Eating patterns and nutritional needs change over the life cycle, including during the end of life.

Many times, family feels the need to feed dying patients. Food can create much conflict for family, staff, and patients.

It is important to answer fundamental questions of the goals of care, and to approach decisions within this framework. Different families have different

"Your mom or dad looks peaceful to me. I think we can assume they ARE peaceful, if they look peaceful, and that more interventions (whatever they are) may not be necessary"

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Biology of Nutrition at End-of-Life

Stopping eating and drinking is natural during the dying process.

Food may cause more discomfort than pleasure, and the atmosphere around eating is more important than what is injested.

 

Anorexia is a loss of appetite. It is mediated in part by cytokines, such IL-1, IL-6, and TNF-alpha, which suppress appetite and decrease gut motility, the latter There are many gut-associated neurons that respond.

 

Cachexia is an involuntary weight loss (>5% of baseline). Loss of muscle is greater than loss of fat. Systemic inflammation, as described above, increase basal metabolic rate. Tumour-produced factors, such as proeolysis-inducing factor and lipid-mobilizing factor, also can increase metabolism. Mediators of increased metabolism include:

This leads to increased nutrient expenditure, mediated by inefficient energy use, increased protein and fat breakdown, and decreased protein synthesis.

This can result in a vicious cycle of muscle breakdown and...

 

CACS is different from starvation, in which metabolic efficiency increases and fat breakdown is greatly increased. In contrast, CACS is characterized by decreased metabolic efficiency and greatly increased muscle breakdown.

 

There are multiple contributing factors to anorexia and cachexia, including:

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Options for Nutrition

Among patients undergoing non-surgical cancer treatments,

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IV Fluids

There is not clear right or wrong in regards to IV therapy.

An IV is anintervention. This may, or may not, be positive, depending on the perspective of the patient and family.

An IV might prolong the dying process and reduce delirium, but can contribute to pulmonary congestion, edema, and ascites.

IV fluids will NOT prevent dry mouth.

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Communicating with Family

What works is more important than what is 'right.'

It is important to understand the question behind the question.

 

 

Q: Why won't my mom eat?

The family may be wondering if anorexia will directly lead to decreased survival

The body's reaction to the presence of a tumour can directly reduce one's appetite.

Cancer, and cancer treatments, can indirectly impact appetitie

 

Q: Is my mom starving?

In starvation, the body seeks to conserve nutrients and energy, and people are hungry. In cancer, the body spends energy more rapidly, and they do not feel hunger.

 

Would medication help?

There are some medications that can be helpful for appetite stimulation, though maintenance of lean body mass does not seem to be helped. Some of the best studied include:

 

Does this mean he will die sooner?

Probably, but this is not your fault.

There is often a great deal of guilt on the part of families, that they are failing in their responsibilities. If I just cooked something they would like.

Don't fire the caregiver - change the job description. One way of involving family members is to participate in mouth care, or to use small amounts of flavorful foods (spaghetti sauce, chocolate pudding, etc).

 

 

If he dying because he's not eating?

He's not eating because he's dying.

 

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"We can always change our mind. If tomorrow we see this, or decide that, we can re-evaluate."

 

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Resources and References

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