To observe the anorexia, fatigue, wasting, debilitation—the cachexia—of the patient with advanced cancer is a disheartening experience for everyone. In patients who are able to enjoy eating, every opportunity to offer nourishment should be taken. Food is more than nutrition and plays a very important role in maintaining hope and offering some means of comfort to patients. Unfortunately, attempts at aggressive nutrition intervention often are not only frustrating but can also add to the patient's suffering. This article presents a review of hospice and palliative care philosophy and the ethical dilemmas that must be understood when dealing with patients who are near the end of life. The decision to feed these patients aggressively is also determined by understanding that a complex metabolic state accompanies advanced cancer and that the malnutrition seen in advanced cancer is not the same as simple starvation. When benefits of treatment reach their limits, pursuing those treatments can add to the patient's suffering.
From the New York Medical College and Palliative Care Institute, Calvary Hospital, Bronx, NY.
Grateful thanks to Maryann Santarsiero for her patience and help in putting this article together.
Corresponding author: James E. Cimino, MD, FACP, Palliative Care Institute, Calvary Hospital, 1740 Eastchester Rd, Bronx, NY 10461 (e-mail: firstname.lastname@example.org).