Appetite Loss and Nausea in Elderly Cancer Patients

Experiencing hunger but feeling nauseous at the sight of food?

My mother is 81 years old and has been diagnosed with breast cancer for 10 years, continuously receiving treatment.
Due to concerns about infection during the pandemic, she interrupted her chemotherapy for the past year.
About 10 months ago, she received her first dose of the High-End vaccine, which had minimal side effects.
Four months ago, she received her second dose of the High-End vaccine, and a few days later, she experienced hoarseness and vocal cord weakness (as described by her, she has to exert a lot of effort to speak).
Prior to this, her appetite was quite normal, but after the second vaccine dose, her appetite significantly declined.
She feels hungry but experiences nausea when food is presented to her, making it difficult to swallow.
Her mobility and cardiopulmonary function have also been affected.

Could you please advise what might be the cause? Which specialty should we consult for diagnosing and improving my mother's appetite? Recently, she has been taking anxiety-relief coated tablets, and her nausea has worsened.

Niming, 50~59 year old female. Ask Date: 2022/08/20

Dr. Liang Yinpan reply Geriatrics

Dear Mr.
Jerryinilan,
You should first take your mother to see an otolaryngologist to examine whether the structures around her vocal cords and throat are normal.
Next, she should undergo an upper gastrointestinal endoscopy with a gastroenterologist to check for any abnormalities in the esophagus or stomach.
After that, it is important to have an oncologist assess whether there is a recurrence or metastasis of breast cancer.
If all these evaluations come back normal, you should schedule an appointment at a long COVID special clinic to investigate whether her symptoms are related to vaccine side effects.
Wishing your mother a speedy recovery.
Best regards,
Liang Yin-Pan, Department of Geriatrics, Changhua Hospital
August 22, 2022

Reply Date: 2022/08/20

More Info

Understanding appetite loss and nausea in elderly cancer patients is a complex issue that can arise from various factors, especially in someone like your mother, who has a long history of breast cancer and has recently received vaccinations.
Firstly, it's important to recognize that cancer itself and its treatments can significantly affect appetite and cause nausea. In your mother's case, she has been living with breast cancer for a decade, and while she has been receiving treatment, the interruption of chemotherapy due to the pandemic could have led to changes in her overall health status. Cancer can lead to metabolic changes in the body, which can affect how food is processed and how hunger signals are sent. Additionally, the psychological impact of living with cancer, including anxiety and depression, can also contribute to appetite loss.

The recent vaccinations she received may also play a role in her current symptoms. Vaccines can sometimes cause temporary side effects, including fatigue, malaise, and gastrointestinal symptoms like nausea. While the first dose of the vaccine had minimal side effects, the second dose seems to have triggered more significant reactions, including hoarseness and difficulty swallowing. This could be due to an inflammatory response affecting her vocal cords or throat, making it uncomfortable for her to eat.

Moreover, the medication she is currently taking, such as the "釋憂膜衣錠" (which translates to a calming or anxiety-relief medication), may also contribute to her nausea. Many medications can have gastrointestinal side effects, including nausea and changes in appetite. If the medication is causing her to feel more nauseous, it may be worth discussing with her healthcare provider to explore alternative treatments or adjustments to her current regimen.

Given her age and medical history, it is crucial to approach this situation holistically. Here are some steps you can take:
1. Consult a Healthcare Provider: It would be advisable to consult her oncologist or a geriatric specialist who can evaluate her overall health, including her cancer status, the effects of the vaccine, and her current medications. They can help determine if her symptoms are related to her cancer, the vaccine, or her medications.

2. Nutritional Support: A registered dietitian who specializes in oncology can provide tailored dietary advice to help manage her appetite loss and nausea. They can suggest small, frequent meals that are easier to digest and may help stimulate her appetite.

3. Symptom Management: If nausea is a significant issue, her doctor may prescribe anti-nausea medications that are safe for her to take, especially considering her cancer history.
4. Physical Activity: Encouraging gentle physical activity, if she is able, can help improve her appetite and overall well-being. Simple exercises or even short walks can stimulate hunger.

5. Psychological Support: Given the emotional toll of cancer and its treatment, psychological support through counseling or support groups can be beneficial. This can help address any anxiety or depression that may be contributing to her appetite loss.

6. Monitor Symptoms: Keep a diary of her symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for her healthcare team in diagnosing and managing her condition.

In conclusion, appetite loss and nausea in elderly cancer patients can stem from a combination of cancer-related factors, treatment side effects, and psychological issues. A multidisciplinary approach involving her oncologist, a dietitian, and possibly a mental health professional will provide the best chance for improving her quality of life and managing her symptoms effectively.

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