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Anorexia is a symptom seen in the majority of patients with cancer or the acquired immunodeficiency syndrome (AIDS) who experience involuntary weight loss. It is frequently not seen as a symptom requiring management in the same proactive manner as pain, nausea, or constipation. Progressive inanition or wasting is a fundamental component of the complex phenomenon known as the anorexia/cachexia syndrome (ACS) of malignancy or AIDS. Weight loss can be seen in the full spectrum of patient care settings: as a presenting complaint, defining condition, treatment-related toxicity, or as a hallmark of impending death. Primary pharmacologic management of ACS includes use of orexigenic agents (appetite stimulants), anticatabolic agents (antimetabolic and anticytokine), and anabolic agents (primarily hormonal). In addition to these specific categories of pharmacologic intervention, broad aspects of symptom management need to be addressed and are complementary. The available literature evaluating pharmacologic management of ACS in both malignancy and AIDS is reviewed.

Timely and appropriate nutritional interventions for patients with cancer and/or human immunodeficiency virus (HIV) infection require adoption of routine nutritional screening and comprehensive evaluations into clinical practice. Traditionally, the clinical skills necessary for comprehensive nutritional evaluation have not been a part of medical education. Likewise, the importance of nutritional screening and assessment has not been fully appreciated. In the context of current health care, these skills are increasingly important in maintaining or improving patient care and improving clinical and economic outcomes. It is imperative that nutritional screening be routinely implemented in all clinical settings (eg, office practices, clinics, preadmission units, homecare) to offset the impact of decreased rates of hospital admission. Hospitals have traditionally been the setting for dietetic screening and intervention and nutritional support services. Therapy for patients with cancer or HIV infection is increasingly being managed primarily or entirely in an outpatient setting. When nutritional risk or deficit is identified on screening, it is important to carry out sequential reassessment after intervention. This article reviews the principles of nutritional screening and comprehensive assessment. It includes a detailed overview of an instrument that can be used for either nutritional screening or assessment in patients with either malignancy or HIV infection.

Nutritional care of cancer patients should always be considered supportive, whether the oncologic aim is cure or palliation. The goals of nutritional care are to support nutritional status, body composition, functional status, and quality of life. Proactive nutritional assessment and early intervention are the cornerstones of success. Failure to address nutrition is associated with longer hospital stays, increased risk of complication and death, and higher health care costs. Supportive nutritional intervention mandates standardized, cost-efficient assessment and aggressive symptom management. The latter includes nutrition-impact symptoms along the entire gastrointestinal tract, sensory changes, psychologic distress, pain, and anorexia. Components of pharmacologic and behavioral intervention are discussed in the context of supportive nutrition of the patient with cancer.