Unveiling Disordered Eating in AYA Patients Undergoing Cancer Treatment

The prevalence of eating disorders in the United States is alarming, affecting nearly 1 in 10 Americans during their lifetime. This condition has the highest mortality rate among all mental illnesses, particularly affecting the adolescent and young adult (AYA) population from ages 15 to 25.¹ 

These statistics are concerning, and they become even more acute when considering the unique challenges faced by AYA oncology patients. These challenges stem from changes in nutritional needs and body transformation, which emphasize the need for increased awareness, intervention, and management of these potential co-occurring diagnoses.²

Diagnosing eating disorders in AYA patients with cancer poses significant difficulties, primarily due to the side effects of standard cancer treatments.³ Chemotherapy, radiation, and immunotherapy often cause side effects, including appetite suppression, changes in taste and smell, nausea, vomiting, gastrointestinal issues, diarrhea, and pain.³ 

These side effects can disrupt a person’s relationship with food, making it challenging for caregivers or healthcare professionals on the oncology team to identify early signs of disordered eating.

Complex Relationships 

Based on diagnosis and subsequent treatment, a patient may experience a sense of disconnection from their own body, feeling as though their body has let them down. In addition, chemotherapy and radiation can cause disruptions to the body’s normal functions and lead to uncomfortable side effects.⁴ 

Decreased appetite, changes in taste and smell, and gastrointestinal pain may contribute to reduced food intake, making meals anxiety-producing and uncomfortable. Weight loss or decreased nutritional intake during cancer treatment may trigger fears regarding food, impacting self-esteem and body image. In the context of a cancer diagnosis, where the patient may feel a great deal of uncertainty, food intake may become a way to regain a sense of control. 

Eating disorders are generally not about food. They frequently stem from a person wanting control when other aspects of their lives feel out of control.⁵ A cancer diagnosis could serve as a significant trigger, where decisions about the patient’s body are out of their control.

Impact of Disordered Eating

Oncology clinicians need to recognize the profound effects that eating disorders can have on this vulnerable population, as cancer treatment can compound underlying disordered eating patterns or serve as a trigger for potential disordered eating behavior. Early detection can lead to improved outcomes, and will help support these patients in having a healthier relationship with food and their bodies.² Early identification of disturbances in feeding or eating patterns increases the likelihood of a patient fully recovering and requiring less intensive therapeutic or medical intervention.  

Recognizing a Problem 

Existing screening methodologies do not consider nutritional changes or deficiencies experienced during cancer treatment. To address potential signs and symptoms of disordered eating, healthcare professionals should be aware of the following⁶: 

• Changes in eating habits, such as calorie restriction or binge eating 
• Preoccupation with body weight or appearance 
• Vomiting or laxative abuse 
• Calorie counting 
• Frequent discussion about dieting or exercise 
• Avoidance of food 

How Healthcare Providers Can Help 

Screening Healthcare providers can assist in the screening process by using a validated screening tool if they suspect their patient may be exhibiting disordered eating patterns.⁷

Education Social workers and oncology nurses can provide education on eating disorders to patients, families, and other members of the patient’s oncology team.⁷

Referrals If an eating disorder is suspected, oncology professionals can refer patients to appropriate counseling services. Connecting patients with specialized therapists or treatment programs has the potential to provide life-saving interventions and help a patient begin a path of recovery.⁴

Oncology healthcare professionals have a unique opportunity to make a difference in the lives of AYA patients with cancer who are struggling with disordered eating during their cancer treatment. If you suspect that a patient may be experiencing disordered eating behaviors, consider consulting the following resources for additional insights and guidance:

• National Association of Anorexia Nervosa and Associated Disorders (ANAD)
• National Eating Disorders Association (NEDA) Helplines contact information
• Eating Disorders Resource Center (EDRC)

Recognizing signs and symptoms of an eating disorder, providing appropriate screening, opening dialogue, and offering referrals to comprehensive treatment are all ways that a patient’s oncology care team can support this vulnerable population.