Cancer patients battle to keep the pounds on

WASHINGTON -- Ric Haury is fighting both tonsil cancer and a second battle -- trying not to waste away, even as the radiation and chemotherapy needed to save him make it impossible to eat normally.

First a week of nausea. Then a throat too painfully swollen to swallow anything more solid than gravy-laden mashed potatoes. Then his appetite disappeared. Now his saliva has, too.

Haury is lucky -- so far he's lost only 15 pounds. But it's a constant battle.

About half of all cancer patients suffer serious weight loss and malnutrition, a wasting syndrome that makes surviving harder. But experts say there are ways to head it off and wish more patients were like Haury, armed with the help of a nutrition specialist almost from the moment of diagnosis.

"Unfortunately with the vast majority of patients, quite often nutrition is an afterthought," says David Grotto of the American Dietetic Association. "The key message is to be aggressive with nutrition before they develop a problem."

Wasting, also called cancer anorexia or cancer cachexia, is not just losing excess fat but vital muscle. Wasting makes therapy harder to tolerate, and studies suggest patients who lose more than 5 percent of their original weight have a worse prognosis than stable-weight patients.

Therapy often to blame

Tumors themselves can cause the wasting, particularly gastrointestinal cancers. But therapies often are to blame. Radiation and, to different degrees, different chemotherapy regimens can cause nausea, appetite suppression, mouth sores, difficulty swallowing, dry mouth or -- one of the most common problems -- strangely altered taste.

The taste problem often comes as a shock because doctors seldom warn about it, Bloch says. Some patients develop an aversion to a particular food: meat tastes rotten or bread like sawdust. But many get a metallic taste in their mouths so bad they simply can't bear to eat.

Add a sore or dry mouth that makes chewing difficult, and it's not unusual to go days with little food -- risking electrolyte imbalances that can make patients pass out.

Once wasting is diagnosed, doctors may try different medications to stimulate appetite. But the cancer society and dietitian group stress that nutritionists often can help prevent or minimize the side effects before someone's too sick.