How long until appetite returns after chemo?

[nancy_east]

Hello all,

Hope everyone out there is feeling well and enjoying the colors of spring!

I am posting a question for my mother. I have only posted a couple of times so to briefly update you on her status, she has stage IV adenocarcinoma (nonsmoker) with previous mets to brain that have cleared with WBR and mets to various areas of bone and one lung mass. Two months ago, she completed 6 cycles of Alimta/Zometa/Cisplatin and is now currently on Avastin and Zometa every 3 weeks with 150 mg Tarceva daily.

My question is this: For those of you who may have had similar chemo regimens, how long did you nausea/inappetence last after your last chemo dose? My mother has never vomited through all this but feels "quesy" most of the day with absolutely no appetite at any time. She has to force herself to eat and it's never an enjoyable experience. I know the chemo won't just magically disappear from her body, but I guess I'm a little concerned that she is still feeling the same way she did when she received the last dose of the chemo, now 2 months ago. I'm starting to wonder if the Avastin or Tarceva are causing some of this. She has an appointment with her oncologist on Monday for her next dose of Zometa and Avastin so she is going to ask about all this then. But we are currently at the beach with her for a much needed vacation from all the stress, and it just kills me to watch her so miserable 24/7. She hides her discomfort well but she is a very stoic person and I know she is miserable beyond what she even expresses to her family.

Any advice or experience (and things you did to combat this) would be most appreciated, as always. Many thanks...

Nancy

[RandyW]

my first thought is that you should make sure Mom can eat anytime she wants to 24/7 and anything she wants Make sure she always has snacks available. We never had a lot of trouble with appetite so I cant offer too much there. Make sure Mom drinks plenty of fluid to avoid dehydration because a trip to the ER is not fun for IV fluids..

[recce101]

I'm starting to wonder if the Avastin or Tarceva are causing some of this.

Hi, Nancy. You may not hear this from the oncologist, but I can tell you from personal experience that the answer is YES. Here's my eating story in a nutshell:

During my 4 months on Taxol/Carboplatin/Avastin, the chemo did a real number on my digestive system from top to bottom. Taste became practically nonexistent (not BAD taste, just NO taste), the mouth and throat became irritated, and the only sensation from eating was the FEEL of the food going down. Anything with rough texture or defined edges (raw vegetables, bread crust, nuts, even some meats) was painful to swallow, and I existed mainly on Walmart's Ensure clone, Carnation Instant Breakfast powders mixed in milk, canned fruits, ice cream without chunks, milkshakes, and the like. Add to this the fact that my stomach wouldn't accept anywhere near the quantity that it previously did, so to maintain weight I needed to eat something like 5 small meals a day instead of 3 normal meals. Obviously a hassle for the family, so I maintained my own stash of tolerable snacks for that period.

Next was 8 months on Avastin alone. My eating slowly improved, but I emphasise SLOWLY, since a primary effect of Avastin is to retard the formation of new tissue (that's how it works against the cancer), and that translates into slow healing of previous irritation.

Next was 16 months on Tarceva alone. My healing returned to normal, and there was no longer any discomfort with swallowing, but heartburn increased significantly. I had to cut out foods that had never before caused a problem, such as tomatoes and anything with a tomato-based sauce (many of my favorites!). Although the foods with chunks and edges were no longer difficult to swallow, they DID frequently cause a problem when they hit the stomach, so small quantities chewed exceptionally well became the norm for those months. I also had some queasiness off and on with Tarceva, but never active nausea.

Eventually Tarceva became ineffective for my cancer, so I was taken off of it in preparation for a third-line treatment. Less than a week after stopping Tarceva, my heartburn disappeared completely, and the quantity of food my stomach would accept returned to normal. Yes, I gained a few pounds too, but that's okay. I'm happy to say that the new chemo (Alimta) hasn't caused any eating problems so far, and neither has the Carboplatin which was added last week (again, so far).

If your mother's reaction is similar to mine, I'm afraid she will continue to have some eating issues as long as she's on Tarceva (and to a lesser extent Avastin). I haven't had Zometa, so I can't comment on that. The best thing I can suggest is for her to keep meals small, supplement with between-meal snacks, eat slowly, chew well, and eliminate foods that don't agree. Don't pressure her to eat more or faster, and give her a hug from me. Aloha,

Ned

[dadstimeon]

Hi Nancy,

Eating is not one of my problems. Nothing stops me, I can eat in a coma. But seriously-- as mentioned by Randy it is important that Mon eats. Here is a link (if you have not already seen it) below that you might find helpful. Hope this helps. Rich

http://chemocare.com/eatingwell/

[nancy_east]

Ned, Randy, and Rich,

I cannot thank you enough for your thoughts and advice, but most of all your support. I had my mom read your posts and she too is always touched by your support (but isn't much of a computer person so always wants me to respond for her!) And Ned, I gave her that hug from you

Ned, she said she experiences many of the things you wrote about and it was reassuring just to know that she's not the "only one" with all these strange symptoms. She's going to ask her oncologist on Monday about possibly lowering her Tarceva dose to 100 mg and see if it helps a little.

Luckily, she gets a good chunk of calories in the morning with a smoothie she makes that has flax seed oil and cottage cheese (one of these holistic approaches we read about--I'm far from convinced it's doing much for the cancer but I'm thrilled that she drinks 800 calories first thing in the morning!)

Again, I can't thank you enough and please know that I keep everyone on these boards in my thoughts and prayers each and every day. You are such special people.

[RandyW]

Nancy could she want another at nite if she can handle one in the morning?? The more calories the better!!!