Loss of Appetite, Nausea and Vomiting in Oncology

Disturbances in the working of the sentient and “I” organizations in the metabolism

Nausea, vomiting and loss of appetite occur when the unconscious immersion of the “I”-organization and the sentient organization (soul body) in the digestive organization is disturbed. This leads to a pathological “awakening” in this area, with unpleasant and stressful perceptions rising from within, such as persistent nausea. This often happens in the course of a tumor disease or during its treatment with radiation and/or chemotherapy (1, 2).            

Any lack of “anchoring” of the “I”-organization and the soul body in the metabolism—thus in the body at all—can have diverse causes and can also differ in degree. Symptoms range from mild loss of appetite to severe nausea. In cases of pronounced nausea, the now dominant pathological internal perception leads to a loss of adequate reference to the external environment, or even to a loss of orientation in space. This is comparable to seasickness, which is not caused externally by high waves, but by imbalanced internal perception. Strengthening the patient’s awareness of space through gentle stimulation of the sensory organs can restore the missing connection to the environment and thus alleviate nausea. This is where non-medicinal therapeutic methods such as eurythmy therapy, sculpture, painting therapy and others are employed.

Physical, mental/emotional, and spiritual causes, and associated therapeutic approaches

The patient initially feels a loss of appetite and aversion to food, which can increase to nausea. The normally unconscious inner processes of digestion “awaken” and in extreme cases this can lead to reverse peristalsis, with vomiting.

Mechanical causes must be identified and, if necessary, eliminated

A stomach exit stenosis or (sub)ileus situation due to tumor-related obstruction or pronounced constipation as a physical cause must always be excluded or treated accordingly.

Strengthen the weakened life organization (etheric body)

A functioning digestion, with the ability to transform food substance, presupposes a strong life organization, which in turn is the basis for “inner appetite”. Tumor cachexia as an expression of a weakened etheric body is almost always accompanied by loss of appetite and latent nausea.

The liver, as the central organ of perception and synthesis of the metabolism, is particularly closely connected with all life processes in the organism. If its activity is weakened during extensive liver metastasis, nausea and loss of appetite are often the result.

Stabilize the sensory organization and reintroduce it into the metabolism to counter sensory hypersensitivity, pain and anxiety.

As mentioned at the beginning, all phenomena of perception, secretion and movement in the digestive tract are connected with the unconscious activity of the soul body in the physical body. In the conscious life of the soul, the soul body forms the basis for feelings and emotions. Both are closely linked, as can be seen from the connection between ulcer disease and psychological stress or the like. Thus, a feeling of nausea can be strongly influenced not only by physical causes, such as opiate treatment, but also by the way in which the person deals with their disease.

Altered sense of smell and taste: This can happen in two directions. When the soul body withdraws from its activity in the digestive system and turns too far outwards in perception, this can manifest as olfactory hypersensitivity—the smell of food alone then causes nausea. On the other hand, 20–50% of patients have a reduced, altered or missing sense of taste due to the illness or treatment, which results in loss of appetite.

Pain: Pain also reduces appetite. Here, too, the soul body “awakens” pathologically from its unconscious organic activity to consciousness. The soul body’s cramping, grasping gesture then has a debilitating effect on the etheric organization, which is usually already weakened. Treatment with painkillers containing an opiate, which is often indicated in this situation, can solve this too strong intervention of the soul body, but prevents the soul body’s physiological activity in the digestive tract: at the beginning of opiate therapy there is often agonizing nausea, which can improve after (mostly) sudden vomiting. This form of nausea can be alleviated by giving lemon juice—as acid draws the soul body into the digestive organization. In the further course of the treatment, a persistent tendency to constipation almost always appears in the foreground, due to a delay in intestinal passage and a reduction in intestinal, biliary and pancreatic secretion. This can also lead to inappetence and nausea.

Chemotherapy: Many chemotherapies cause nausea, either immediately or delayed for up to a week (e.g., cisplatin). The psychological stress associated with this can already manifest before chemotherapy in the form of anticipatory nausea.

Fears, emotional stress: Nausea and vomiting can be triggered by an overwhelming abundance of new impressions, information and changed living conditions at the time of diagnosis or in the course of a tumor disease. Also fears—including the fear of death—divert the activity of the soul body and can induce or intensify nausea.

Warmth processes and outlook on life—the significance of the “I”-organization.

The “I”-organization plays a decisive role in completely breaking down everything foreign in food (pancreatic enzymes) and reconstructing individual body substance. It is connected with all warming processes during digestion and its activity is invoked by warming substances administered internally, as well as by external applications, such as ginger compresses.

The “I”-organization is linked to human consciousness, where it is deeply involved with the will to live and with individual life goals. The “appetite for life” can be severely impaired in cancer patients experiencing a life-threatening situation and can affect their physical appetite. Here it is of decisive importance to provide psycho-oncological support to enable the person to develop a new perspective on life.

Case history

A 62-year-old female patient suffers from an inoperable sarcoma, but her general condition is still very good. She is told by the surgeons that nothing more can be done for her and that chemotherapy is not an option. Because of pain, the patient, who is still fit and healthy on the palliative care ward, is prescribed a pain pump with opiates, neuroleptics and corticosteroids, which she takes home with her. This makes her feel sedated and severely restricted in general, and she also suffers from severe and persistent nausea. She is then admitted to another palliative ward in order to switch the pain pump back to oral medication, which is successful. Only the nausea, for which no organic cause can be found, is torturous and cannot be alleviated even by the strongest antiemetics. The patient is visibly desperate and dissatisfied, the ward team stressed and helpless. Finally, the prognosis and its general perspective are discussed during ward rounds. Doctors emphasize that the disease is incurable, but her general condition is still good and the tumor has recently been rather stable. Instead of her waiting at home to die, she could also plan her life, meet up with friends and travel, do everything important to her—the final phase is still a long way off. The patient appears to feel relieved, meets with friends in the cafeteria for cake the same afternoon and soon is able to be released home without any nausea.

1 Debus M. Medikamentöse Begleitbehandlung bei onkologischen Erkrankungen. Der Merkurstab 2009;62(4):320-325.

2 Girke M. Internal medicine. Foundations and therapeutic concepts of Anthroposophic Medicine. 1st ed. Berlin: Salumed; 2016.


Research news

Art therapy & anxiety: In her doctoral thesis published 2020, Annemarie Abbing investigated the effectiveness of art therapy in the treatment of anxiety. Outcomes of a randomised controlled trial (n=59) showed preliminary evidence of the effectiveness of art therapy: Three months of anthroposophic art therapy led to a significant reduction in the severity of anxiety symptoms in the women compared to waiting list treatment. The therapy also improved quality of life and various aspects of self-regulation. The second part of this PhD research focused on case report methodology and the development of tools for research within this field. The doctoral thesis is available at 
https://scholarlypublications.universiteitleiden.nl/handle/1887/83276.


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