The
cancer-related
cachexia/
anorexia syndrome is not well understood. It is related to several factors like metabolic changes,
tumor types, and disease extent and is frequently accompanied by decreased performance status. An important aspect of
anorexia is the psychosocial problem: the patient is unable to join the family for meals precisely when he or she most needs familial support. Several randomized studies have shown that
megestrol acetate, possibly in a dose-dependent fashion, can improve appetite and lead to
weight gain. This effect seems to be most prevalent in patients with
breast cancer and also occurs in the absence of a
tumor response. We have retrospectively analyzed 176 patients with
cancer types other than
breast cancer who received only
palliative treatment. The patients were treated with
megestrol acetate (160 mg tid) because they complained of
anorexia. After 10 days of treatment,
megestrol acetate was continued only in those patients whose appetite and/or general well-being improved. Fifty-seven patients (32%) experienced such an improvement and asked for continuation of
therapy. Many basic questions are still unanswered; nonetheless, from a practical clinical view it seems worthwhile to offer
anorectic patients a chance to improve, especially since side effects of
megestrol acetate are absent or mild, and the distinction between responders and nonresponders can be made by 10 days of treatment.