Eating-related distress in advanced cancer patients with cachexia and family members: a survey in palliative and supportive care settings

  • Koji AmanoEmail author
  • Tatsuya Morita
  • Saori Koshimoto
  • Teruaki Uno
  • Hirofumi Katayama
  • Ryohei Tatara
Original Article



Few studies have investigated nutrition impact symptoms and eating-related distress among advanced cancer patients and their families. This is a questionnaire survey to examine the severity of nutrition impact symptoms and the prevalence of eating-related distress among them in palliative and supportive care settings.


Questionnaires for patients and their families were preliminarily developed. We selected 16 common symptoms of advanced cancer, i.e., 9 symptoms of the ESAS-r and 7 of the PG-SGA. Each questionnaire concerning eating-related distress consisted of 12 items.


A total of 140 out of 147 patients responded (95.2%). They were classified into two groups: (1) non-cachexia/pre-cachexia (n = 57) and (2) cachexia/refractory cachexia (n = 83). The top 3 out of 16 symptoms in all patients were feeling of well-being, lack of appetite, and tiredness. Significant differences were observed in 8 symptoms between the two groups: tiredness (p = 0.007), drowsiness (p = 0.007), lack of appetite (p < 0.001), early satiety (p = 0.001), diarrhea (p = 0.025), abnormal taste (p = 0.02), difficulty swallowing (p = 0.002), and feeling of well-being (p = 0.003). Regarding eating-related distress in patients, significant differences were observed in all items, except for 2, between the two groups. Concerning eating-related distress in families, significant differences were observed in all items between the two groups.


Advanced cancer patients with cachexia have more severe nutrition impact symptoms than those without cachexia, and patients with cachexia and their families have greater eating-related distress than those without cachexia.


Advanced cancer patients Family members Cachexia Nutrition impact symptoms Eating-related distress 



We are very grateful to the nurses of the palliative care team in Osaka City General Hospital, Ms. Namiki Kitada, Ms. Hiromi Fumimoto, Ms. Sayuri Tojima, Ms. Emi Sato, Ms. Mihoko Nakamura, Ms. Yoko Mishina, Ms. Chika Shiraishi, and Ms. Mutsumi Yokoi, for their contribution to confirming the face validity of the questionnaires and collecting the data analyzed in the present study.

Compliance with ethical standards

The completion and return of the questionnaire was regarded as consent to participate in this study. The Institutional Review Board approved this study (No. 1804008).

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Koji Amano
    • 1
    Email author
  • Tatsuya Morita
    • 2
  • Saori Koshimoto
    • 3
    • 4
  • Teruaki Uno
    • 1
  • Hirofumi Katayama
    • 1
  • Ryohei Tatara
    • 1
  1. 1.Department of Palliative MedicineOsaka City General HospitalOsaka CityJapan
  2. 2.Palliative and Supportive Care DivisionSeirei Mikatahara General HospitalHamamatsu CityJapan
  3. 3.Section of Liaison Psychiatry and Palliative MedicineTokyo Medical and Dental UniversityTokyoJapan
  4. 4.Faculty of Human ScienceTokiwa UniversityMito CityJapan

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