Weight changes, including both weight loss and weight gain, are commonly experienced during cancer treatment. While many individuals with cancer may lose weight, others may experience weight gain. Understanding the factors contributing to weight loss after chemotherapy and implementing appropriate management strategies are crucial for improving the quality of life and potentially the survival of cancer patients.
Causes of Weight Loss After Chemotherapy
Weight loss after chemotherapy can stem from a variety of factors, including:
- Poor appetite: Chemotherapy and radiation treatments can cause a host of side effects that make it difficult or unpleasant to eat, including nausea, taste changes, and mouth sores, among other things. Cancer itself can also decrease appetite or make you feel full quickly.
- Eating less: Due to the side effects of chemotherapy, patients often eat less than their bodies need, leading to weight loss.
- Diarrhea: Chemotherapy can disrupt the digestive system, leading to diarrhea and subsequent fluid and nutrient loss.
- Vomiting: Nausea and vomiting are common side effects of chemotherapy, further contributing to reduced food intake and weight loss.
- Dehydration: Diarrhea and vomiting can lead to dehydration, exacerbating weight loss.
- Increased energy expenditure: Some types of cancer can cause the body to use up more energy, even if you are not very active. You may lose weight even if you are eating well.
- Cachexia: In severe cases, weight loss can be a sign of cancer cachexia.
Impact of Weight Loss on Survival
A study published in Gynecologic Oncology in 2007 investigated the impact of weight change during primary chemotherapy on overall survival (OS) in advanced ovarian cancer patients. The retrospective data review included 792 patients who participated in a phase III randomized trial. The study found a significant relationship between median OS and weight change:
- >5% decrease in weight: 48.0 months
- 0-5% decrease in weight: 49.3 months
- 0-5% increase in weight: 61.1 months
- >5% increase in weight: 68.2 months
The study concluded that change of body weight during primary chemotherapy was a strong prognostic factor for overall survival. Loss of body weight during primary therapy is an indicator for poor OS; weight gain is an indicator for improved survival. The relative risk of death increased by 7% with each 5% decrease in body weight (HR=0.93, 0.88-0.99, p=0.013).
Managing Weight Loss After Chemotherapy
Managing weight loss after chemotherapy requires a multifaceted approach that addresses the underlying causes and focuses on optimizing nutritional intake. Some strategies include:
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- Treating the underlying cause: Managing chemo weight loss depends upon treating the underlying cause.
- Maintaining a normal weight: Try to maintain your normal weight.
- Eating well during chemotherapy: Focus on consuming a balanced diet that meets your nutritional needs.
- Consulting a registered dietitian: Your health care provider may recommend that you see a registered dietician who can help tailor a diet for your needs.
Dietary Recommendations
- Eat small meals frequently: Eat small meals spaced throughout the day.
- Focus on protein intake: It’s beneficial for cancer patients to increase the amount of protein they eat, since adequate protein intake is particularly important to avoid losing lean muscle mass when dropping weight.
- Stay hydrated: Staying hydrated is important for all cancer patients to help their bodies deal with the effects of treatment.
- Consider nutrition supplement drinks: Sip on nutrition supplement drinks between meals.
- Create a relaxing eating environment:
Lifestyle Modifications
- Stay physically active: Staying physically active is important for weight management regardless of whether weight loss or gain is desired because regular movement helps maintain lean muscle mass.
- Monitor weight regularly: If you are experiencing side effects or feel that you might be losing weight, you should weigh yourself. If you have lost 5 or more pounds in a week, you should notify your doctor or health care provider about your chemo weight loss.
- Keep a food diary: Since many patients already carry smartphones everywhere, apps such as MyFitnessPal can be used to keep an online food journal, tracking not only calorie intake and activity levels but also types of calories consumed.
Medical Interventions
- Appetite stimulants: If you are not able to keep your appetite up, talk with your doctor about appetite stimulants.
- Tube feeding (enteral nutrition) or IV nutrition (parenteral nutrition): If you continue to have trouble eating and are losing weight, your doctor or dietitian might suggest tube feeding or IV nutrition.
When to Contact Your Doctor
Seek emergency help and contact your doctor immediately if you experience:
- Sudden rapid or irregular heart beat
- Confusion
- Blue lips
- Rapid breathing
- Excessive sleepiness with difficulty arousing
Call your doctor or health care provider within 24 hours if you experience:
- You have lost 5 pounds or more within a week
- Signs of dehydration
- Dizziness
- Dark (concentrated) urine
- Dry mouth and skin
- Any side effects not relieved with prescribed recommendations.
Weight Gain After Chemotherapy
While weight loss is more commonly associated with chemotherapy, some individuals may experience weight gain. Weight gain after chemo may happen for a variety of reasons including:
- Less activity. People tend to exercise less while taking chemotherapy.
- Eating more. Some medications actually increase the appetite.
- Fluid retention (swelling or edema). Some chemotherapy weight gain is caused by fluid retention in your body.
- Increased fatty tissue. Some chemotherapy regimens may contain steroids. Steroids can cause fat deposits to develop (often between the shoulder blades). Some people also experience a round or full face. These side effects occur most often with long-term steroid use is expected and will go away once steroids are discontinued.
Managing Weight Gain After Chemotherapy
- Try to maintain your normal weight, if you are not overweight.
- If you notice weight gain after chemo, try to modify your diet to nutritious, low-calorie foods such as vegetables, fruits, low-fat cheeses, etc.
- Avoid concentrated sweets such as sugar, honey, and candy.
- Try to exercise, as tolerated, to maintain your optimal level of functioning. Discuss with your healthcare provider how you can create a specific exercise program to suit your needs. Make sure to exercise, under the supervision of your healthcare provider. Walking, swimming, or light aerobic activity may help you to lose the chemo weight, and promote the flow of oxygen in your lungs and blood (oxygenation).
- Participate in activities that take your mind off of food.
- It is not necessary to weigh yourself daily unless you have fluid retention.
- If you have fluid retention:
- Elevate your feet as often as possible.
- Do not stand for long periods of time.
- Avoid tight clothing (shoes, girdles, etc).
- Do not cross your legs.
- Reduce your salt intake. Avoid foods such as bouillon, potato chips, tomato juice, bacon, ham, canned soups, soy sauce, and table salt, for example.
- If your swelling is severe, consider wearing Jobst stockings or TED hose.
- Weigh yourself daily.
- Do not try any fad diets without discussing this with your health care provider. Some of these diets may pose risks to your health.
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