Rakusin Dori, O'Brien Kate, Murphy Michael
Psychiatry Department, The Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
Nutrition and Dietetics Services, The Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
J Eat Disord. 2021 Dec 24;9(1):166. doi: 10.1186/s40337-021-00522-5.
It is unusual for a de novo eating disorder to emerge in late adulthood. Across a number of years, a number of patients were identified who experienced severe and unexpected weight loss post curative management of an upper abdominal cancer (i.e., cancer survivors). Each of the patients was readmitted to the tertiary surgical hospital due to complications of severe malnutrition. Each presentation was initially considered to have a major physical health problem (such as cancer recurrence). Each required extensive investigations and multidisciplinary team involvement and were later conceptualised as a new-onset (in later adulthood) eating disorder that emerged post curative cancer treatment. The team wished to better understand this group and/or characterise and/or inform the scientific community of this phenomena if not already well described.
The review identified that the re-emergence of pre-existing eating disorders at the time of cancer treatment was described; however, there was no identification of similar new-onset in later adulthood cases of eating disorders in cancer survivors in the medical literature.
Once ethics and consent was obtained, then the clinical course of four complex individuals were reviewed, including the use of a multidisciplinary Delphi review process, to understand commonalities and then plot a common care pathway with potential intervention points.
Common factors identified among the four patients included the lack of a physical health (organic) cause to the weight loss and ongoing weight loss despite intense multidisciplinary care. All had abnormal attitudes and behaviours relating to food, nutritional rehabilitation and/or recovery. None returned to a healthy weight and/or healthy eating despite extensive team input. The presentations were ultimately conceptualised as having severe disordered eating behaviours and in at least three cases met criteria for a formal eating disorder. The cohort had similar psychosocial characteristics including low socioeconomic status and complex family dynamics. None had prior formal psychiatric care. The outcomes were poor; one patient died, another required admission to a specialist eating disorder admission with a subsequent relapsing remitting course, and the remaining two had complicated chronic courses.
Similar cases may be underreported. If identified earlier, there may be a role for intervention to prevent high morbidity and mortality and to support clinical teams managing similar complex patients.
成年晚期出现新发饮食失调的情况并不常见。多年来，我们识别出了一些患者，他们在上腹部癌症治愈性治疗后（即癌症幸存者）出现了严重且意外的体重减轻。每位患者均因严重营养不良的并发症再次入住三级外科医院。每次就诊最初都被认为存在重大身体健康问题（如癌症复发）。每位患者都需要进行广泛的检查并由多学科团队参与，后来被认定为治愈性癌症治疗后出现的新发（成年晚期）饮食失调。该团队希望更好地了解这一群体，和/或对这一现象进行特征描述，和/或向科学界通报这一尚未得到充分描述的现象。
该综述发现，已有文献描述了癌症治疗期间既往存在的饮食失调再次出现的情况；然而，医学文献中未发现癌症幸存者成年晚期出现类似新发饮食失调病例的报道。
在获得伦理批准和患者同意后，对四名复杂患者的临床病程进行了回顾，包括采用多学科德尔菲回顾流程，以了解共同特征，然后制定具有潜在干预点的共同护理路径。
在这四名患者中识别出的共同因素包括体重减轻不存在身体健康（器质性）原因，且尽管接受了强化多学科护理，体重仍持续下降。所有人在食物、营养康复和/或恢复方面都有异常态度和行为。尽管团队投入巨大，但无一例恢复到健康体重和/或健康饮食状态。这些表现最终被认定为具有严重的饮食行为紊乱，至少三例符合正式饮食失调的标准。该队列具有相似的社会心理特征，包括社会经济地位低和家庭关系复杂。没有人曾接受过正规的精神科护理。结局不佳；一名患者死亡，另一名患者需要入住专门的饮食失调病房，随后病情呈复发缓解过程，其余两名患者病程复杂且迁延不愈。
类似病例可能未得到充分报告。如果能更早识别，干预措施可能有助于预防高发病率和死亡率，并为管理类似复杂患者的临床团队提供支持。
