The patient's current care should be continued. Anorexia, weight loss, and cachexia reflect a final common pathway during the terminal phase of most disease processes. Assuming potentially reversible conditions (nausea, altered taste, medication side effects, bowel obstruction, dysphagia, psychological comorbidities) have been ruled out, disease-related cachexia is caused by an altered neurohormonal, inflammatory milieu that results in profound alterations in metabolism. These changes lead to a decreased appetite and increased catabolism, leading to progressive weight loss. Educating this patient and her family on the etiology and pathophysiology of cachexia is the primary intervention and may help them to better understand and accept the expected course of the disease.

Only 20% to 30% of patients who take pharmacologic agents, such as dronabinol and megestrol, for cachexia of advanced disease gain any weight at all. For those who do gain weight, there is no improvement in mortality, and the majority of studies of their use in cachexia associated with cancer show no improvement in the quality of life. The role of other agents for treatment of cachexia in advanced disease, including anabolic steroids, medical marijuana and its derivatives, melatonin, and NSAIDs, remains to be defined.

Cachexia cannot be significantly reversed by more aggressive or invasive methods of nutritional support, including enteral (or parenteral) nutrition, and these interventions in the context of cachexia of advanced disease do not improve morbidity or mortality. Additionally, interventions to provide artificial nutrition, such as use of a nasogastric or nasojejunal tube or placement of a percutaneous endoscopic gastrostomy tube, have some associated risk and a potential negative effect on the patient's quality of life.