Abstract
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.
TO UNDERSTAND the dilemmas encountered in end-of-life care and particularly the role of nutrition support, it is important to understand the philosophy behind both hospice care and palliative care. This article describes hospice and palliative care; nutrition support in the advanced cancer patient; and ethical issues in end-of-life care that may lead to an understanding of the role of nutrition in these patients.