Symptom: Appetite, Loss of

Initial Grading Reminder

CTCAE grading of loss of appetite:

Grade 1 (Mild): Loss of appetite without alteration in eating habits
Grade 2 (Moderate): Oral intake decreased without significant weight loss, dehydration or malnutrition
Grade 3 (Severe): Inadequate oral caloric or fluid intake; tube feeding, TPN, or hospitalization indicated

Assessment and Grading


Does this patient have any existing issues with appetite caused by the cancer state, other clinical issues, or an eating disorder?

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you experienced any taste changes? Are you trying to eat 3 large meals or eating small amounts throughout the day (snack-size)? Are you doing any light exercise, stretching, walking, etc? Are you avoiding foods with strong aromas?

Grade the symptom

Ask the patient:

Are you still able to eat your normal foods? Have you lost weight? Are you very weak or faint?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you feeling faint/dizzy, passing out, having trouble thinking? Are you in intense pain? Do you have any abdominal (belly) pain? Are you overly sleepy? Do you have any yellowing of the skin/eyes?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with moderate or worse anorexia should be seen.

    For any red-flag symptoms, the patient should be seen immediately.

    Patients who are passing out or who have intense abdominal pain should go to the ED (they should be driven).

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of the loss of appetite?