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Systematic Review of the Treatment of Cancer-Associated Anorexia and Weight Loss

From the Harry R. Horvitz Center for Palliative Medicine, the Taussig Cancer Center, and the Cleveland Clinic Foundation, Cleveland, OH

Address reprint requests to D. Walsh, MSc, FACP, FRCP (Edin), the Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, M-76 Cleveland, OH 44195; e-mail: walsht{at}ccf.org

PURPOSE: We systematically assessed the efficacy and safety of appetite stimulants in the management of cancer-related anorexia. Literature databases were searched for randomized controlled trials of appetite stimulants in the treatment of cancer anorexia.

MATERIALS AND METHODS: Studies were graded according to quality. Fifty-five studies met inclusion criteria.

RESULTS: Only two drugs have evidence to support their use for anorexia (progestins and corticosteroids). There is strong evidence against the use of hydrazine sulfate. The outcomes of these trials have been mixed and patient population heterogeneous.

CONCLUSION: The optimal dose, time to start, and duration of treatment for many appetite stimulants for cancer anorexia is still unknown. A more systematic approach to research methodology with universal outcome measure and prospective randomized studies are needed. Combination regimens are needed but this cannot at the present time be supported by the data presented.

The Harry R. Horvitz Center for Palliative Medicine is a WHO Demonstration Project in Palliative Medicine.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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