Brown, J.K. (2002). A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia. Oncology Nursing Forum, 29, 517–532.

To review the studies regarding cancer-related anorexia and cachexia symptom management and to make recommendations for future directions

A literature search was conducted using the Cochrane Library, MEDLINE, CancerLit, CINAHL, Embase, CRISP, EBM Reviews: Best Evidence, and dissertation abstracts.

All studies focused on increasing food intake. Studies evaluated included:

• Seven nonpharmacologic randomized controlled trials (RCTs) that examined the effects of nutritional counseling and/or commercial oral liquid supplements. Sample sizes ranged from 26 to 180 patients. Clinical trials were included if the major focus was increasing food intake, decreasing energy usage, or minimizing weight loss. 
• Four topical research reviews on pharmacologic and exercise interventions.
• Three overviews of the problem from 1998 to 2000.
• One meta-analysis on oncology nursing symptom-management interventions.
• Twenty-eight RCTs testing cancer symptom management interventions from published and unpublished studies from 1981 to 1990. Only one study focused on anorexia and cachexia.

Weight, appetite, and well-being were improved with progestational agents, with megestrol acetate having the most supporting evidence. All nonpharmacologic RCTs reported improved caloric intake resulting from nutritional counseling and oral liquid supplements. The meta-analysis concluded that insufficient evidence existed at the time to recommend any of the nursing interventions.

Patients with cancer should be screened at diagnosis and reevaluated at regular intervals for current and potential nutritional problems. If nutritional screening identifies an at-risk patient, a comprehensive nutritional assessment should be completed. A valid screening tool is needed.