Cancer patients battle to keep the pounds on

Tuesday, April 9th 2002, 12:00 am

By: News On 6

WASHINGTON (AP) _ Ric Haury is fighting both tonsil cancer and a second battle _ trying not to waste away, even as the radiation and chemotherapy needed to save him make it impossible to eat normally.

First a week of nausea. Then a throat too painfully swollen to swallow anything more solid than gravy-laden mashed potatoes. Then his appetite disappeared. Now his saliva has, too.

Haury is lucky _ so far he's lost only 15 pounds. But it's a constant battle.

About half of all cancer patients suffer serious weight loss and malnutrition, a wasting syndrome that makes surviving harder. But experts say there are ways to head it off and wish more patients were like Haury, armed with the help of a nutrition specialist almost from the moment of diagnosis.

``Unfortunately with the vast majority of patients, quite often nutrition is an afterthought,'' says David Grotto of the American Dietetic Association. ``The key message is to be aggressive with nutrition before they develop a problem.''

Wasting, also called cancer anorexia or cancer cachexia, is not just losing excess fat but vital muscle. Wasting makes therapy harder to tolerate, and studies suggest patients who lose more than 5 percent of their original weight have a worse prognosis than stable-weight patients.

Tumors themselves can cause the wasting, particularly gastrointestinal cancers. But therapies often are to blame. Radiation and, to different degrees, different chemotherapy regimens can cause nausea, appetite suppression, mouth sores, difficulty swallowing, dry mouth or _ one of the most common problems _ strangely altered taste.

Nausea is the best-known side effect, although for many patients it is periodic, striking for a few days and then abating until the next treatment, says Abby Bloch, an American Cancer Society nutrition consultant.

And anti-nausea medications developed in the last decade bring relief to many patients. But some of the most potent are very expensive and not covered by all insurance plans, so clinics may not give them until a patient complains, Bloch says. That's ``unfortunate because these medications have made enormous differences for individuals who are able to use them.''

The taste problem, however, often comes as a shock because doctors seldom warn about it, Bloch says. Some patients develop an aversion to a particular food: meat tastes rotten or bread like sawdust. But many get a metallic taste in their mouths so bad they simply can't bear to eat.

Add a sore or dry mouth that makes chewing difficult, and it's not unusual to go days with very little food _ risking electrolyte imbalances that can make patients pass out even before much weight loss is apparent.

Once wasting is diagnosed, doctors may try different medications to stimulate appetite. But the cancer society and dietitian group stress that nutritionists often can help prevent or minimize the side effects before someone's too sick.

Help ranges from little tips _ suck lemon wedges or lemon drops and keep hydrated to cut that metallic taste; choose crackers, sherbet or rice when nauseated _ to customized care that may include special high-calorie liquid foods.

But access to nutritionists can be a problem. Some hospitals, like the Cleveland Clinic where Haury sought care, routinely include a cancer nutritionist as part of the treatment team. For patients who seek nutrition help on their own, insurance typically doesn't pay for it, or for those special liquid meals. A registered dietitian charges $65 to $150 an hour.

Yet it's cheaper to keep a patient from needing tube-feeding, which insurance does cover, laments Haury's wife, Beverly.

The Stow, Ohio, man is responding well to cancer treatment. Now his challenge is packing at least 2,200 calories a day into an all-liquid diet to keep strong.

Menus evolve as treatment progresses, a Cleveland Clinic nutritionist helped the couple learn. Crackers helped nausea, but as radiation inflamed Haury's throat, gravy helped foods slide down. Now that he eats no solids and has no appetite, Mrs. Haury is scouting creative recipes for extra-fat, extra-protein milkshakes tasty enough that her husband will force down at least 20 sips a half-hour.

``That is a struggle,'' she says. ``He has a strong will, but you have to be creative.''