If you or a loved one have mesothelioma, you probably already know about the associated trouble with food. Many mesothelioma patients have appetite issues, and/or trouble eating and keeping on weight, due to the side effects of the condition and its common treatments. However, it is crucial for mesothelioma patients to continue getting the nutrients, calories, and protein they need despite these issues. Not doing so can lead to drastically decreased quality of life, worse treatment outcomes, and an increased risk of complications, as well as more severe symptoms.
In this article, we’ll be taking a deep dive into appetite issues and weight loss for mesothelioma patients, exploring what causes these issues and what mesothelioma patients and their caretakers can do to address them.
What causes appetite issues and weight loss in mesothelioma patients?
There are several factors that can contribute to mesothelioma-related weight loss and appetite issues:
- Treatment Side Effects: Mesothelioma treatment—including chemotherapy, radiation, surgery, and immunotherapy—have common side effects that can make it difficult to eat or want to eat. These include nausea, mouth and throat soreness, and digestive upset, among others.
Many mesothelioma treatments also cause changes in how foods smell and taste. These taste changes vary widely among patients. Food may taste metallic, bland, soapy, extremely bitter, sweet, or salty, or just “off”. In addition, previously neutral or enjoyable food smells may become repulsive and off-putting.
- Mesothelioma Symptoms: Mesothelioma itself also has unique side effects that can affect patients’ ability to eat and keep on weight, including:
- Changes in metabolism: Mesothelioma causes metabolic changes (or, changes in how the body converts fuel into energy). Cancer cells take up far more energy than healthy cells, which can kick the metabolism into overdrive (or a “hypermetabolic” state). Since hypermetabolic mesothelioma patients burn far more calories than usual, they also need to consume far more calories to keep up. This can cause significant unintentional weight loss, even if a patient maintains their usual diet. In addition, these metabolic changes can also cause the body to burn the wrong tissues, burning healthy skeletal muscle tissue instead of fat. This can lead to an extreme condition called cachexia, or muscle wasting, causing severe weight loss and depletion of nutrients, as well as weakness, fatigue, and other serious side effects.
- Tumors and Excess Fluid: Mesothelioma tumors and excess fluid in the body (ascites) can cause feelings of extreme fullness and bloating, as well as digestive issues and pain. As tumors grow and as fluids increase, they may press down on or even block the digestive tract or bowels. This can cause the body to stop sending normal hunger signals, leaving mesothelioma patients feeling uninterested in food and uncomfortably full after just a few bites.
- Breathing Issues: Difficulty breathing is one of the most common symptoms of pleural mesothelioma. Those having trouble breathing often find it very difficult to eat or to focus on food.
- Stiff Tissues: Many people with mesothelioma experience stiffening of the tissues around the lungs and digestive tract. This can make it difficult for the stomach and intestines to expand properly in order to accommodate food, which can make it very difficult to eat or to feel hungry. Surgery and radiation can sometimes worsen this issue by causing scar tissue around the digestive area.
- Psychological and Emotional Symptoms: Dealing with the stress, fear, and uncertainty of mesothelioma can cause a range of psychological symptoms, including depression and anxiety. These issues can make it difficult for those with mesothelioma to want to eat, especially if eating is physically hard or painful.
What to do: Tips and Advice
If you are a mesothelioma patient struggling with appetite and weight loss, the first thing to do is to consult with your mesothelioma care team, and/or seek out an oncology nutritionist or dietician. Your care team and other medical professionals will know what’s best in your case.
In addition, the following suggestions may be helpful:
- Prioritize calories and protein. If you are struggling to eat and keep on weight, the most important thing to focus on is getting more calories and protein. While it’s always good to eat nutritiously and to get lots of fruits and veggies, it is even more important that you maintain a stable weight to keep up your strength, both for treatment and for quality of life.
To get more calories in your diet, try incorporating more:
- Butter, oils, and margarine
- Nuts, seeds, and nut butters
- Cream, full-fat milk, and full-fat yogurt
- Avocado, guacamole, and hummus
- Fruit canned in heavy syrup, or with ice cream or whipped cream
- Higher-calorie beverages (like fruit juice, soda, milkshakes, and smoothies)
- Cream sauces and high-calorie salad dressings
Those struggling to incorporate more protein can try:
- Protein-rich salads (i.e., tuna salad, chicken salad)
- Enriching milk by adding ¼ cup of powdered milk to 1 cup of whole milk.
- Eating more eggs, especially cheese scrambles and desserts made with eggs, like puddings and custards.
- Adding cheese—whether it’s melted on sandwiches, or grated onto soups, stews, salads, and pasta.
- Adding extra meat, poultry, fish, cheese, nuts, or beans (ideally pinto, navy, black, and/or kidney beans).
- Using protein powders and other supplements
- Eat 5-6 smaller meals a day at regular times. If you find it difficult to eat large meals or feel full very quickly, try several small meals throughout the day. If you yourself feeling hungry infrequently (or not at all), you might also want to set regular times for these mini-meals throughout the day—ideally including eating within an hour of waking up, and then every three hours or so.
- Experiment if food tastes strange or unappealing, address specific issues, and follow your cravings. It’s important to be flexible, accommodating, and experimental when developing a mesothelioma diet. Identify what tastes off or unappealing and avoid it. If something tastes good or is appetizing, stick with it. Have appealing snacks handy for when you do feel hungry. If food tastes metallic, try using plastic utensils to avoid transfer tastes. You may also want to use a baking soda-salt water rinse or alcohol-free mouthwash, which will clear the taste buds. If food tastes too salty, add sugar or apple juice; if it tastes too sweet, add salt or lemon juice. Experiment with new spices and with different flavors to see what tastes best.
- Consider nutrition drinks and supplements, as well as nausea meds and appetite stimulants: There are many nutritional shakes and supplements (i.e., Boost, Ensure, etc.) that can be incredibly helpful for mesothelioma patients. You may find drinking a shake much easier than eating a meal, and they often come fully loaded with all of the vitamins, minerals, and proteins you need.
If you struggle with nausea, ask your mesothelioma care team about anti-nausea meds, as well as prescription appetite stimulants like megestrol, medroxyprogesterone (Provera), corticosteroids, and medical cannabis.
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