To Feed or Not to Feed: Is That the Right Question?

Mr. Smith was a 54-year-old man with ad-vanced non–small-cell lung cancer who had received two cycles of systemic chemotherapy for metastatic disease. He decided to not have any further chemotherapy. He had significant anorexia and cachexia, having lost 10 pounds in the last 2 months despite the use of meges-trol acetate. He emphasized that he was nei-ther hungry nor thirsty. At the clinic visit, it was evident that his family was quite dis-tressed by his situation and had been strongly encouraging the patient to eat. They asked his oncologist about a feeding tube. The situation in the office was clearly an emotional one. Nutrition at the end of life is an issue