The Key Role of Nonpharmacologic Management of Cachexia in Persons With Advanced Illness: A Teachable Moment

A man in his 80s with advanced colon cancer and malignant ascites presented to the oncology clinic to discuss next steps. He reported weight loss (approximately 15 kg in 2 months), and his daughter commented on his limited appetite, weakness, and that he was “just bones.” Recent computed tomography staging scans had demonstrated progression of the cancer. On examination, temporal wasting and an indwelling peritoneal catheter were noted.

The oncologist discussed the lack of further meaningful chemotherapy or clinical trial options. The daughter requested that something be done for appetite and weight loss. The patient expressed food aversion. The oncologist prescribed a 2-week supply of megestrol acetate solution for anorexia and/or cachexia. The co-pay was $57. Three days later, the daughter called the oncologist and was distressed because her father was now weaker and bedbound. The patient enrolled in home hospice and died the next day. The daughter expressed guilt that she was unable to nourish her father during his last days.