Coping with Cancer-Related Weight Changes and Muscle Loss

Most people with cancer experience weight changes, muscle loss and fatigue (extreme tiredness) at some point during their illness. Treating and managing these symptoms can help you feel better and allow you to continue with more of your usual activities. This may also help you keep your strength up, which can help you finish your full course of treatment.

Why do weight and muscle loss happen?

One cause is the cancer itself. For example, in an effort to fight the cancer, the body produces substances called cytokines. These substances can lead to weight loss, muscle loss, and a decrease in appetite. Another common cause is the treatments for cancer. Radiation and chemotherapy often cause a decrease in appetite. They can also lead to side effects such as nausea, vomiting, and mouth sores, which can affect your ability to eat normally, further contributing to weight and muscle loss. Fatigue is also a factor, since the decreases in exercise and other physical activities that happen when you’re not feeling well can also contribute to muscle loss.

How are weight changes and muscle loss treated?

To help manage these symptoms, your oncologist may prescribe medicines such as megestrol acetate (Megace), anti-nausea medications, and steroid medications. These drugs can increase appetite for some people and may help to prevent weight and muscle loss, but they do not build up lost muscle tissue. A lot of research is underway to better help patients with these problems. There are two promising treatments that are currently in clinical trials. One trial involves ghrelin, a hormone that affects appetite and stimulates the release of growth hormone to build strength. Another study involves SARMs (selective androgen receptor modulators), drugs that encourage the body to build new muscle tissue. An example is the drug Enobosarm (GTx-024), which is currently being tested in patients with non-small cell lung cancer. Learn more about these and other related clinical trials at www.clinicaltrials.gov.

Keep in mind that appetite and energy levels may be affected by other treatable conditions, such as pain, anxiety or depression. Talk with your doctor if you are experiencing any of these concerns.

What can I do to help maintain my weight and build strength?

Along with taking any medicines your doctor prescribes, there are many things you can do to help your body stay strong. Good, balanced nutrition and proper hydration are very important:

• Eat a balanced diet, and be sure to include protein to protect lean body mass. Beef, pork, poultry, tofu and soy nuts are excellent sources of protein. So are dairy products – try some Greek yogurt, which is higher in protein than regular yogurt.

• Increase the number of calories you eat. Choose nutritious foods that you enjoy. If appetite is a problem, try eating smaller, more frequent meals; make milkshakes, smoothies, and purees, which may be easier to digest; and add milk or protein powder to your foods.

• Drink plenty of liquids throughout the day. Water is best, but you can also get fluids from soups, popsicles, sports drinks, and even Pedialyte.

Physical exercise also plays a key role in building new muscle and decreasing fatigue. It has also been shown to improve mood, outlook, and self-image:

• Start off slowly. If you are very weak or tired, start with 3 or 4 minutes of walking at a time and build up from there. You can also try some upper body exercises while sitting in a chair – moving your arms up and down and front to back can help maintain flexibility. Making a fist and lifting your arms up and down in front of you can increase strength.

• Pay attention to your breathing. Rounded shoulders restrict chest movement, but good posture helps your breathing and reduces fatigue. Focus on maximizing your breath during activities: for example, when climbing stairs, breathe out with each step so you won’t be as tired when you reach the top.

• Keep a diary. Note the type of exercises or other physical activities you do and how they affect your mood and energy level. Seeing the positive benefits may encourage you to keep moving.

Nutritionists and physical or occupational therapists can advise you on other ways to maintain your weight and build strength as you cope with cancer. Ask your oncologist for a referral if these professionals are not already part of your health care team.