From: Case reports of new-onset eating disorders in older adult cancer survivors
Domain | Commonalities |
---|---|
Problem behaviours leading to re-admission due to complications of severe malnutrition. Diagnosis | Case 1 67yo woman, cancer survivor. She was non-adherent to community nutrition advice She was poorly adherence to parenteral nutrition plan and had a decreasing food repertoire There was a gradual, continued weight loss post discharge such that she was re-admitted 8 months post initial surgery Formal diagnosis of Anorexia Nervosa later made. Repeat admissions and presentations Case 2 69yo woman, cancer survivor. She warranted a prolonged admission for weight purposes post initial cancer surgery including TPN Thereafter, she was non-adherent to her community parenteral feeding plan and reported no desire to eat She suffered from subjective dry-retching and ongoing weight loss. She was readmitted 12 months post initial surgery Diagnosis of Atypical Anorexia Nervosa around that time. Unclear outcome due to disengagement Case 3 62yo man, cancer survivor. He had significant anxiety and somatic concerns post initial cancer treatment Many years later, he had severe, rapid weight loss due to subjective nausea and bodily complaints He was also then noted to have unusual and severely rigid eating patterns and behaviours Later diagnosis of Avoidant Restrictive Food Intake Disorder. He ultimately died of frailty Case 4 61yo man, cancer survivor. He was non-compliant post-operatively with both his parenteral feed schedule and diet plan Over the course of months he had limited insight into his continued weight loss, with likely death and near total food avoidance At the time of discharge, Atypical Anorexia Nervosa diagnosis was made with concerns for a poor prognosis |
Nutritional history before referral to psychiatry | All had excessive weight loss postoperatively (above expected post-operative weight loss) Most were unable to maintain adequate nutrition at time of initial surgical discharge |
Psychiatric factors (referral process, diagnosis, prognosis, outcome) | Perhaps understandably, all had a late referral to see psychiatry given complexity However, all patients were agreeable to psychiatric initial engagements Longitudinal (i.e., repeat) assessments and a multidisciplinary approach was needed for diagnosis None returned to either a healthy weight and/or healthy eating behaviours despite extensive team care |
Psycho-social factors | Pre-morbid (pre-cancer) mild maladaptive coping issues were identified Complex family dynamics (family position of mediator or carer) and generally lower socioeconomic standing were noted |
Key absent findings | None had a prior eating disorder diagnosis No other relevant psychiatric history/drug or alcohol concerns No concerns for clinical depression or psychotic illness at time of FED consideration No psychiatric medications at time of initial psychiatric referral |
Cancer/physical health | Major upper abdominal surgery resulting in removal of all cancer Most had chemotherapy and/or radiotherapy treatments before surgery to shrink the tumour All had no physical health findings that could explain the weight loss—i.e., no return of cancer, no strictures etc |