{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T02:46:31Z","timestamp":1782355591134,"version":"3.54.5"},"reference-count":46,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Loss of appetite is a common symptom in patients with advanced cancer, and may contribute to patient deterioration. There is a lack of information about this issue, particularly in patients with advanced cancer admitted to an acute palliative care unit. The aims of this study were to assess appetite loss in patients admitted to an APCU and to investigate whether changes following comprehensive palliative care treatment are associated with survival. Materials and Methods: A consecutive sample of 520 patients admitted to the APCU was assessed. Patient characteristics and Edmonton Symptom Assessment Scale (ESAS) were measured at admission (T0) and after one week of comprehensive palliative care treatment (T7). Results: Of 381 patients screened, 208 (54.6%) had a poor appetite rating (\u22654\/10). Following comprehensive palliative care (T7), the number of patients with poor appetite significantly decreased to 116 (30%) (p &lt; 0.0005). A multivariate regression analysis revealed that nausea (p = 0.002), weakness (p = 0.006), poor well-being (p = 0.017), and total ESAS score were correlated with poor appetite at T0. At T7, pain (p = 0.018), anxiety (p = 0.001), depression (p = 0.014), poor sleep (p = 0.047), drowsiness (p = 0.035), nausea (p = 0.018), weakness (p &lt; 0.0005), poor well-being (p &lt; 0.0005), and total ESAS score (p &lt; 0.0005) were correlated with poor appetite. Survival was associated with a low Karnofsky (OR = 3.217(1.310\u20135.124), p = 0.001) and the presence of poor appetite at T7 (OR = \u22127.772(\u221214.662\u2013\u2212882), p = 0.027). Conclusions: A large proportion of patients admitted to an APCU present moderate-to-severe poor appetite. Clinical improvement of poor appetite is associated with improved survival.<\/jats:p>","DOI":"10.3390\/nu17111882","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T09:22:41Z","timestamp":1748596961000},"page":"1882","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Poor Appetite and Survival in Patients Admitted to an Acute Palliative Care Unit for Comprehensive Palliative Care"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9859-6487","authenticated-orcid":false,"given":"Sebastiano","family":"Mercadante","sequence":"first","affiliation":[{"name":"Main Regional of Supportive\/Palliative Care, La Maddalena Cancer Center, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-5354","authenticated-orcid":false,"given":"Daniele","family":"Napolitano","sequence":"additional","affiliation":[{"name":"CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5581-4114","authenticated-orcid":false,"given":"Alessio","family":"Lo Cascio","sequence":"additional","affiliation":[{"name":"Direction of Health Professions, La Maddalena Cancer Center, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4988-4391","authenticated-orcid":false,"given":"Stefano","family":"Mancin","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-9535","authenticated-orcid":false,"given":"Alessandra","family":"Casuccio","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0167-5273(02)00234-6","article-title":"Cancer Anorexia: A Model for the Understanding and Treatment of Secondary Anorexia","volume":"85","author":"Laviano","year":"2002","journal-title":"Int. J. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rudzi\u0144ska, A., Piotrowicz, K., Perera, I., Gryglewska, B., and G\u0105sowski, J. (2023). Poor Appetite in Frail Older Persons\u2014A Systematic Review. Nutrients, 15.","DOI":"10.3390\/nu15132966"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e677","DOI":"10.1016\/j.jpainsymman.2023.01.010","article-title":"Characteristics of Untreated Cancer Patients Admitted to an Acute Supportive\/Palliative Care Unit","volume":"65","author":"Mercadante","year":"2023","journal-title":"J. Pain Symptom Manag."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"539","DOI":"10.3109\/0284186X.2013.823239","article-title":"Weight Loss, Appetite Loss and Food Intake in Cancer Patients with Cancer Cachexia: Three Peas in a Pod?-Analysis from a Multicenter Cross Sectional Study","volume":"53","author":"Solheim","year":"2014","journal-title":"Acta Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6061","DOI":"10.3390\/curroncol31100452","article-title":"Appetite Loss in Patients with Advanced Cancer Treated at an Acute Palliative Care Unit","volume":"31","author":"Helgesen","year":"2024","journal-title":"Curr. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100336","DOI":"10.1016\/j.ctarc.2021.100336","article-title":"Appetite Problem in Cancer Patients: Pathophysiology, Diagnosis, and Treatment","volume":"27","author":"Hariyanto","year":"2021","journal-title":"Cancer Treat. Res. Commun."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Madrigal, C., Soto-M\u00e9ndez, M.J., Hern\u00e1ndez-Ruiz, \u00c1., Ruiz-L\u00f3pez, M.D., Samaniego-Vaesken, M.d.L., Partearroyo, T., Varela-Moreiras, G., and Gil, \u00c1. (2022). Dietary Intake, Nutritional Adequacy, and Food Sources of Selected Antioxidant Minerals and Vitamins; and Their Relationship with Personal and Family Factors in Spanish Children Aged 1 to <10 Years: Results from the EsNuPI Study. Nutrients, 14.","DOI":"10.3390\/nu14194132"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1177\/0269216306070322","article-title":"The Management of Anorexia by Patients with Advanced Cancer: A Critical Review of the Literature","volume":"20","author":"Shragge","year":"2006","journal-title":"Palliat. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Goodrose-Flores, C., Bonn, S.E., Klasson, C., Frankling, M.H., Lagerros, Y.T., and Bj\u00f6rkhem-Bergman, L. (2023). Appetite and Its Association with Mortality in Patients with Advanced Cancer-a Post-Hoc Analysis from the Palliative D-Study. BMC Palliat. Care, 22.","DOI":"10.1186\/s12904-023-01287-1"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Cotogni, P., and De Carli, L. (2025). Near-Death Quality of Life in Cancer Patients on Home Parenteral Nutrition. Nutrients, 17.","DOI":"10.3390\/nu17020271"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Deftereos, I., Yeung, J.M.C., Arslan, J., Carter, V.M., Isenring, E., and Kiss, N. (2021). on behalf of The NOURISH Point Prevalence Study Group Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study. Nutrients, 13.","DOI":"10.3390\/nu13103349"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1002\/jcsm.12156","article-title":"Cancer Anorexia: Hypothalamic Activity and Its Association with Inflammation and Appetite-Regulating Peptides in Lung Cancer","volume":"8","author":"Molfino","year":"2017","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.trecan.2022.01.004","article-title":"Emerging Signaling Mediators in the Anorexia-Cachexia Syndrome of Cancer","volume":"8","author":"Talbert","year":"2022","journal-title":"Trends Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1002\/jcsm.13186","article-title":"Association of Anorexia\/Appetite Loss with Malnutrition and Mortality in Older Populations: A Systematic Literature Review","volume":"14","author":"Fielding","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.2147\/JMDH.S394941","article-title":"Validation Study of the Revised Spirituality and Spiritual Care Rating Scale (SSCRS): A Cross-Sectional Survey in Poland","volume":"16","author":"Panczyk","year":"2023","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and Classification of Cancer Cachexia: An International Consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"508","DOI":"10.5732\/cjc.011.10267","article-title":"Metabolic Alterations in Cancer Cells and Therapeutic Implications","volume":"30","author":"Hammoudi","year":"2011","journal-title":"Chin. J. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Law, M.L. (2022). Cancer Cachexia: Pathophysiology and Association with Cancer-Related Pain. Front. Pain Res., 3.","DOI":"10.3389\/fpain.2022.971295"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13045-023-01454-0","article-title":"Cancer Cachexia: Molecular Mechanisms and Treatment Strategies","volume":"16","author":"Setiawan","year":"2023","journal-title":"J. Hematol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S87","DOI":"10.1016\/j.jada.2005.02.029","article-title":"Appetite: Measurement and Manipulation Misgivings","volume":"105","author":"Mattes","year":"2005","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.annonc.2022.04.007","article-title":"The Role of Patient-Reported Outcome Measures in the Continuum of Cancer Clinical Care: ESMO Clinical Practice Guideline","volume":"33","author":"Basch","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e70001","DOI":"10.1002\/rco2.70001","article-title":"Malnutrition Risk and the Psychological Burden of Anorexia and Cachexia in Patients With Advanced Cancer","volume":"8","author":"Dev","year":"2025","journal-title":"JCSM Commun."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kuipers, S.J., Cramm, J.M., and Nieboer, A.P. (2019). The Importance of Patient-Centered Care and Co-Creation of Care for Satisfaction with Care and Physical and Social Well-Being of Patients with Multi-Morbidity in the Primary Care Setting. BMC Health Serv. Res., 19.","DOI":"10.1186\/s12913-018-3818-y"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/ajsp.12386","article-title":"Is Personal Growth Initiative Associated with Later Life Satisfaction in Chinese College Students? A 15-Week Prospective Analysis","volume":"22","author":"Chang","year":"2019","journal-title":"Asian J. Social. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1089\/jpm.2011.0403","article-title":"Association between Patient-Reported Symptoms and Nurses\u2019 Clinical Impressions in Cancer Patients Admitted to an Acute Palliative Care Unit","volume":"15","author":"Rhondali","year":"2012","journal-title":"J. Palliat. Med."},{"key":"ref_26","first-page":"89","article-title":"Models of Integration of Oncology and Palliative Care","volume":"4","author":"Hui","year":"2015","journal-title":"Ann. Palliat. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.jpainsymman.2016.10.370","article-title":"The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments","volume":"53","author":"Hui","year":"2017","journal-title":"J. Pain Symptom Manag."},{"key":"ref_28","first-page":"277","article-title":"Visual Analogue Scales and Assessment of Quality of Life in Cancer","volume":"6","author":"Hauser","year":"2008","journal-title":"J. Support. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/j.pain.0000000000002669","article-title":"Maddalena Opioid Switching Score in Patients with Cancer Pain","volume":"164","author":"Mercadante","year":"2023","journal-title":"Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1136\/spcare-2022-004088","article-title":"Acute Palliative Care Units: Characteristics, Activities and Outcomes-Scoping Review","volume":"13","author":"Mercadante","year":"2023","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1016\/j.jpainsymman.2024.10.010","article-title":"Should an Acute Palliative Care Unit Be Mandatory for Cancer Centers and Tertiary Care Hospitals?","volume":"69","author":"Mercadante","year":"2025","journal-title":"J. Pain Symptom Manag."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/S1470-2045(03)01247-6","article-title":"Cancer Anorexia: Clinical Implications, Pathogenesis, and Therapeutic Strategies","volume":"4","author":"Laviano","year":"2003","journal-title":"Lancet Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4037","DOI":"10.1016\/j.clnu.2021.02.016","article-title":"Cancer-Associated Anorexia: Validity and Performance Overtime of Different Appetite Tools among Patients at Their First Cancer Diagnosis","volume":"40","author":"Molfino","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"151711","DOI":"10.1016\/j.soncn.2024.151711","article-title":"Assessment of Nursing Workload and Complexity Associated with Oncology Clinical Trials: A Scoping Review","volume":"40","author":"Bozzetti","year":"2024","journal-title":"Semin. Oncol. Nurs."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1080\/03007995.2017.1315332","article-title":"Delirium Assessed by Memorial Delirium Assessment Scale in Advanced Cancer Patients Admitted to an Acute Palliative\/Supportive Care Unit","volume":"33","author":"Mercadante","year":"2017","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/082585979100700202","article-title":"The Edmonton Symptom Assessment System (ESAS): A Simple Method for the Assessment of Palliative Care Patients","volume":"7","author":"Bruera","year":"1991","journal-title":"J. Palliat. Care"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Mercadante, S., Bellavia, G.M., Fusco, F., Adamoli, L., Scibilia, C., Lo Cascio, A., and Casuccio, A. (2024). Malnutrition Is Associated with Fatigue and Anxiety in Advanced Cancer Patients Admitted to Home Palliative Care. Am. J. Hosp. Palliat. Care.","DOI":"10.1177\/10499091241278924"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.jpainsymman.2008.03.008","article-title":"The Association of Physical and Psychological Symptom Burden with Time to Death Among Palliative Cancer Outpatients","volume":"37","author":"Cheung","year":"2009","journal-title":"J. Pain Symptom Manag."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1002\/jcsm.12756","article-title":"Diagnostic Criteria for Cancer Cachexia: Reduced Food Intake and Inflammation Predict Weight Loss and Survival in an International, Multi-Cohort Analysis","volume":"12","author":"Martin","year":"2021","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"4376","DOI":"10.1200\/JCO.2009.27.1916","article-title":"Prognostic Factors in Patients with Advanced Cancer: Use of the Patient-Generated Subjective Global Assessment in Survival Prediction","volume":"28","author":"Martin","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"151751","DOI":"10.1016\/j.soncn.2024.151751","article-title":"Psychometric Characteristics of the Quality of Oncology Nursing Care Scale (QONCS): A Validation Study","volume":"40","author":"Marcomini","year":"2024","journal-title":"Semin. Oncol. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Castro-Espin, C., and Agudo, A. (2022). The Role of Diet in Prognosis among Cancer Survivors: A Systematic Review and Meta-Analysis of Dietary Patterns and Diet Interventions. Nutrients, 14.","DOI":"10.3390\/nu14020348"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Yamamoto, E., Kato, T., Yaku, H., Morimoto, T., Inuzuka, Y., Tamaki, Y., Ozasa, N., Yoshikawa, Y., Kitai, T., and Taniguchi, R. (2022). Appetite Loss at Discharge from Acute Decompensated Heart Failure: Observation from KCHF Registry. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0267327"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1093\/eurheartj\/ehw008","article-title":"Intestinal Congestion and Right Ventricular Dysfunction: A Link with Appetite Loss, Inflammation, and Cachexia in Chronic Heart Failure","volume":"37","author":"Valentova","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.3390\/nu5041316","article-title":"Undernutrition in Patients with COPD and Its Treatment","volume":"5","author":"Itoh","year":"2013","journal-title":"Nutrients"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Lo Cascio, A., Bozzetti, M., Napolitano, D., Dabbene, M., Lunetto, L., Latina, R., Mancin, S., Sguanci, M., and Piredda, M. (2025). Catheter-Related Late Complications in Cancer Patients During and After the COVID-19 Pandemic: A Retrospective Study. Cancers, 17.","DOI":"10.3390\/cancers17071182"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/11\/1882\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:44:07Z","timestamp":1760031847000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/11\/1882"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["nu17111882"],"URL":"https:\/\/doi.org\/10.3390\/nu17111882","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]}}}