Recognizing eating disorders in patients with cancer

I have recently had two patients with cancer who have eating disorders. I have to say, this is really the first time that this has come up for me. So, when I saw this audio story on eating disorders, I paid attention: "Patient Voices: Eating Disorders;" The New York Times. A quick Medline search does not reveal much, aside from a case report and accompanying editorial.

I think, really, that even for our patients who may have eating disorders, we become so accustomed to our cancer patients losing weight that we might not notice. And certainly if they don't reveal to me that they have an eating disorder, how am I to know if they are so thin from the cancer or from the anorexia nervosa or bulimia? I think the other important factor is that we rarely see those at highest risk for eating disorders — young women. But I have heard lately in the lay press that more men and more older women are being diagnosed with eating disorders, so perhaps this will be a growing problem.

It is important for clinicians because, beyond the direct risks the eating disorder places on the patient, we also have to worry about postoperative wound healing and fatigue and vomiting from chemotherapy, among other things, which may all be negatively affected by eating disorders. I also wonder if a stressful event, like being diagnosed with cancer and having to go through its rigorous treatments, might cause a flair in a previously dormant eating condition — one could imagine that the patient might feel like their eating and exercising is the one part of their life they can still exert control over. A troubling thought.