Journal Club

Fighting Over Food: Patient and Family Understanding of Cancer Cachexia

Joanne Reid

Hugh McKenna

Donna Fitzsimons

Tanya McCance

anorexia, diet, nutrition
ONF 2009, 36(4), 439-445. DOI: 10.1188/09.ONF.439-445

Purpose/Objectives: To investigate tensions over food that exist between patients with advanced cancer with cachexia and their families.

Research Approach: Heideggerian phenomenologic inquiry using unstructured interviews.

Setting: A regional cancer center in the United Kingdom.

Participants: 8 patients with advanced cancer living with cachexia and 8 family members.

Methodologic Approach: Singular unstructured interviews were recorded digitally, transcribed verbatim, and analyzed using thematic and interpretative phenomenologic analysis.

Main Research Variables: Cachexia and advanced cancer.

Findings: A fine line existed between offering food to a patient and forcing a patient to eat; often, conflict arose as a result. Contributors to that conflict focused on reduced dietary intake by the patient and the reaction to food refusal by the family, which frequently led to patients eating to please.

Conclusions: This study highlights the anxiety that surrounds eating and the distress it causes to patients and their families. This strain can escalate into arguments over food, causing negative repercussions for patients and their family members.

Interpretation: This is the first study to uncover tensions about eating as experienced by patients with advanced cancer and cachexia and their families. Nurses must consider this issue when designing and delivering effective care for this patient population.

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    References

    Consedine, N.S., Magai, C., Krivoshekova, Y.S., Ryzewicz, L., & Neugut, A.I. (2004). Fear, anxiety, worry, and breast cancer screening behavior: A critical review. Cancer Epidemiology Biomarkers and Prevention, 13(4), 501-510.
    Dewey, A., & Dean, T. (2008). Nurses' management of patients with advanced cancer and weight loss: Part 2. International Journal of Palliative Nursing, 14(3), 132-138.
    Fearon, K.C.H., Voss, A.C., & Hustead, D.S. (2006). Definition of cancer cachexia: Effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. American Journal of Clinical Nutrition, 83(6), 1345-1350.
    Freud, A. (1936). The ego and the mechanisms of defense. New York: International Universities Press.
    Hawkins, C. (2000). Anorexia and anxiety in advanced malignancy: The relative problem. Journal of Human Nutrition and Dietetics, 13(2), 113-117.
    Holden, C.M. (1991). Anorexia in the terminally ill cancer patient: The emotional impact on the patient and the family. Hospice Journal, 7(3), 73-84.
    Holmes, S. (1998). The challenge of providing nutritional support to the dying. International Journal of Palliative Nursing, 4(1), 26-31.
    Holmes, T.A. (2001). Conflict resolution. Retrieved May 22, 2009, from http://www.doctorholmes.net/conflictmanagement.html
    Hopkinson, J., & Corner, J. (2006). Helping patients with advanced cancer live with concerns about eating: A challenge for palliative care professionals. Journal of Pain and Symptom Management, 31(4), 293-305.
    Hughes, N., & Neal, R.D. (2000). Adults with terminal illness: A literature review of their needs and wishes for food. Journal of Advanced Nursing, 32(5), 1101-1107.
    Lawrence, C. (1984). The anorexia experience. London: Women's Press.
    Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Newberry Park, CA: Sage Publications.
    MacDonald, N., Easson, A.M., Mazurak, V.C., Dunn, G.P., & Baracos, V.E. (2003). Understanding and managing cancer cachexia. Journal of the American College of Surgeons, 197(1), 143-161.
    McClement, S.E., Degner, L.F., & Harlos, M.S. (2004). Family responses to declining intake and weight loss in a terminally ill relative. Part I: Fighting back. Journal of Palliative Care, 20(2), 93-101.
    Meares, C.J. (1997). Primary caregiver perceptions of intake cessation in patients who are terminally ill. Oncology Nursing Forum, 24(10), 1751-1757.
    Muscaritoli, M., Bossola, M., Aversa, Z., Bellantone, R., & Fanelli, F.P. (2006). Prevention and treatment of cancer cachexia: New insights into an old problem. European Journal of Cancer, 42(1), 31-41.
    Plutchik, R., & Kellerman, H. (1980). Emotion, theory, research, and experience. New York: Academic Press.
    Reid, J. (2007). An exploration of the experience of cachexia for patients with cancer and their significant others [Unpublished doctoral dissertation]. University of Ulster. Jordanstown.
    Reid, J., McKenna, H., Fitzsimons, D., & McCance, T. (2009). The experience of cancer cachexia: A qualitative study of advanced cancer patients and their family members. International Journal of Nursing Studies, 46(5), 606-616.
    Shragge, J.E., Wismer, W.V., Olson, K.L., & Baracos, V.E. (2007). Shifting to conscious control: Psychosocial and dietary management of anorexia by patients with advanced cancer. Palliative Medicine, 21(3), 227-233.
    Smith, J.A., Jarman, M., & Osborne, M. (1999). Doing interpretative phenomenological analysis. In M. Murray & K. Chamberlain (Eds.), Qualitative health psychology: Theories and methods (pp. 218-240). London: Sage.
    Stephany, T.M. (1991). Nutrition for the terminally ill. Home Healthcare Nurse, 9(3), 48-49.
    Strasser, F., Binswanger, J., Cerny, T., & Kesselring, A. (2007). Fighting a losing battle: Eating-related distress of men with advanced cancer and their female partners. A mixed-methods study. Palliative Medicine, 21(2), 129-137.
    Thorne, S. (1997). Phenomenological positivism and other problematic trends in health science research. Qualitative Health Research, 7(2), 287-293.
    Tisdale, M.J. (1997). Biology of cachexia. Journal of the National Cancer Institute, 89(23), 1763-1773.
    Tisdale, M.J. (2009). Mechanisms of cancer cachexia. Physiological Reviews, 89(2), 381-410.
    Van Manen, M. (2001). Researching lived experiences. Ontario, Canada: Transcontinental.
    Wiedenmann, B., Malfertheiner, P., Friess, H., Ritch, P., Arseneau, J., Mantovani, G., et al. (2008). A multicenter, phase II study of infliximab plus gemcitabine in pancreatic cancer cachexia. Journal of Supportive Oncology, 6(1), 18-25.
    Wigmore, S., Ross, J., Falconer, J.S., Plester, C., Tisdale, M., Carter, D., et al. (1996). The effect of polyunsaturated fatty acids on the progress of cachexia in patients with pancreatic cancer. Nutrition, 12(1, Suppl.), S27-S30.