Cancer care · October 12, 2026
On chemotherapy, the women who lost their appetite cut about 320 calories a day more than those who didn't. The mix on their plates barely changed, and the symptom that went with it was taste
A Kyoto study followed 105 women through the first cycles of chemotherapy for ovarian, womb and cervical cancer, asking what they ate before and during treatment. Appetite loss meant less of everything rather than a worse diet, it tracked a change in taste more than nausea, and it went with a drop in how people felt about their lives. Their weight and blood tests didn't show it.
Ask anyone who has been through chemotherapy what got to them and food comes up early. Things taste of metal or of nothing, a favourite dish becomes hard to face, and meals shrink. Most research on this has looked at people whose cancer gets in the way of eating directly, in the mouth, throat or gut, or at people with advanced disease. Women treated for ovarian, womb (endometrial) and cervical cancer are a different group. Many have chemotherapy after surgery for a cancer caught fairly early, and nothing about the tumour stops them swallowing. A team from Kyoto University Hospital wanted to know what happens to their eating when appetite goes. Their paper came out in the journal Supportive Care in Cancer on 2 October 2026.
Between July 2022 and March 2026 they recruited 153 women starting their first chemotherapy for a newly diagnosed gynaecological cancer. Each filled in a validated Japanese diet questionnaire covering more than 50 foods and drinks, once before treatment began and again the day before the third cycle. 105 completed both, and almost all (94) were on a taxane drug, alone or with a platinum drug. Before the third cycle, the women answered one plain question from a standard cancer quality-of-life form: 'Have you lacked appetite?' over the past week. Forty-one of them, 39%, said at least 'a little'.
Those 41 had cut back much more. Compared with the women whose appetite was intact, their daily energy intake fell by a median of about 321 kcal more (95% CI 119 to 455), with protein down about 12 g a day more, fat about 8 g and carbohydrate about 26 g. Yet the balance between protein, fat and carbohydrate was the same in both groups. Of the food groups, red and processed meat fell most clearly, by about 6 g a day more; dairy and beans dipped too, though not clearly. Vegetables, fruit, fish, poultry, sweets, rice and other grains changed no differently between the groups. The authors point out that meat is the food most often reported as off-putting during cancer treatment.
The vitamins and minerals tell the same story in a useful way. In absolute amounts, 13 of the 16 micronutrients the team looked at fell more in the women with poor appetite, with iron, zinc, magnesium and vitamin B2 showing the biggest differences. But once the researchers counted nutrients per 1,000 kcal, every one of those differences disappeared. The women were not choosing worse food. They were eating less of the same food. For anyone cooking for someone on chemotherapy, that points towards smaller, energy-dense, appealing portions rather than a hunt for one missing vitamin.
Which side effect went with poor appetite? The team tested seven that plausibly affect eating: dry mouth, mouth sores, taste changes, nausea, constipation, diarrhoea and fatigue. Taken together, only taste changes were clearly linked. Nausea, which most people would guess first, was not, at least in this analysis. The authors wonder whether a vicious circle is involved, since zinc matters for taste and less food means less zinc. They are clear that this is a guess: nobody's zinc level was measured.
Appetite was also tied to how women were coping. As appetite loss worsened, their overall quality-of-life score fell, and the strongest links were with their ability to keep up their usual roles (work, home), their concentration and memory, their social life and their mood, more than with their physical functioning. A separate group of 127 patients at five Japanese hospitals, who filled in questionnaires through 15 weeks of treatment, showed quality of life dropping in the week after each dose and recovering the week after, with appetite loss among the strongest signals of those swings. The dip falls between clinic visits, when nobody is asking.
Now the cautions, several of which the authors raise themselves. This is an observational study in one hospital, and it cannot say what caused what. The diet questionnaire covered the previous month while the appetite question covered the previous week. Most appetite loss was mild. Women who were sicker were more likely to drop out, and 48 of the 153 did. The appetite-loss group had started chemotherapy sooner after surgery, so some of what looks like the effect of chemotherapy may be surgical recovery, although the main results held after adjusting for that. Among the 49 women who had no appetite loss at the start, the 16 who developed it ate less across the board, but only the drop in carbohydrate was statistically clear.
One finding stands out. By the usual hospital yardsticks, the women with poor appetite looked fine: as many lost more than 5% of their weight (27% against 22%, not a real difference), and their albumin and a standard nutrition index from blood tests did not differ. Only 8 of the 105 women had seen anyone for nutrition advice. Our reading: appetite loss in this setting is easy to miss if you go by the scale and the lab report, and worth asking about directly. Mention a change in taste or appetite to the oncology team, even a mild one; a cancer dietitian has practical ways around both.
Prospective observational study at Kyoto University Hospital, Japan: 105 women having first-line chemotherapy for ovarian, endometrial or cervical cancer, diet measured before treatment and before the third cycle, plus a separate five-hospital cohort of 127 patients for quality of life
39%
Women who reported at least a little appetite loss in the week before their third chemotherapy cycle (41 of 105)
−321 kcal
Extra fall in daily energy intake in the appetite-loss group compared with the others: difference in median changes, 95% CI −455 to −119
−12 g
Extra fall in daily protein intake in the appetite-loss group (95% CI −16.7 to −4.9). Fat −8.3 g and carbohydrate −25.6 g; the share of energy from each did not change
13 of 16 → 0
Micronutrients that fell more in the appetite-loss group in absolute amounts, and the number still different once counted per 1,000 kcal
Taste
The only one of seven side effects clearly linked to appetite loss (β 8.7, 95% CI 1.3 to 16.1). Nausea, fatigue, mouth sores, dry mouth, constipation and diarrhoea were not
8 of 105
Women who had any cancer-related nutrition counselling between starting treatment and the third cycle
Figures are from the open-access paper in Supportive Care in Cancer (doi 10.1007/s00520-026-11276-8, published online 2 October 2026, CC BY 4.0), read in full on PubMed Central: methods, results, Tables 1 to 3, figure legends, discussion, funding and competing interests. The supplementary file was not read, so group medians for intake, the full micronutrient table and the details of the second cohort are not given here. Recruitment: 153 women at Kyoto University Hospital, July 2022 to March 2026, newly diagnosed and starting first-line chemotherapy; recurrent disease, concurrent radiotherapy and another active cancer excluded; 48 dropped out or had incomplete data, leaving 105. Diet: brief self-administered diet history questionnaire (BDHQ, previous month), reports under 500 or over 3,500 kcal a day excluded. Appetite: EORTC QLQ-C30 item 13 (previous week); any answer above 'not at all' counted as appetite loss. Cancer types: ovary 43, endometrium 45, cervix 14, other 3. Taxane with or without platinum: 94. Chemotherapy after surgery: 90; before surgery: 15. Median age 53 in the appetite-loss group and 58 in the other (p = 0.06). Days from surgery to chemotherapy: median 34 against 40 (p = 0.03). The −321 kcal is the paper's −320.8, a difference between the two groups' median changes with a bootstrap 95% CI. Red and processed meat: −6.1 g a day (95% CI −13.4 to −0.6); dairy −3.8 g (−28.7 to 0.0) and legumes −6.2 g (−21.5 to 0.0) did not reach significance. Micronutrients: false-discovery-rate adjusted; Hedges' g −0.68 to −0.76 for iron, zinc, magnesium and vitamin B2, −0.47 to −0.58 for the other nine. Taste: multiple linear regression of the appetite-loss score on seven PRO-CTCAE symptom scores, adjusted for age and BMI. Quality of life (Spearman correlations of changes with change in appetite loss): global −0.31, role −0.49, cognitive −0.42, social −0.35, emotional −0.28, physical −0.16 (not significant). Weight loss above 5%: 26.8% against 21.9% (p = 0.56). Nutrition counselling: 12.2% against 4.7% (p = 0.26). Sensitivity: in 49 women without appetite loss at baseline, 16 (32.7%) developed it; their intake fell more but only carbohydrate reached p < 0.05. Results for energy, protein and carbohydrate held after adjusting for baseline intake, baseline appetite, age, type of surgery and time since surgery; fat did not in the women operated on first. The second cohort (127 patients, five Japanese hospitals, June 2020 to March 2024, 15 weeks of questionnaires) was analysed with machine-learning models; we report only the paper's description of it. Limitations the authors state: single centre, moderate size, questionnaire diet data, mismatched time frames for diet and appetite, mostly mild appetite loss, possible selection bias, no zinc or other blood nutrient tests, no follow-up after chemotherapy. Funding: JSPS KAKENHI grant 24K12621 (Japan Society for the Promotion of Science). Competing interests: three authors report financial relationships with DUMSCO Inc., one also holding intellectual property jointly with the company; one reports advisory fees from Takeda, AstraZeneca, Eisai and Nippon Shinyaku; the others declare none. The advice in the last paragraph of the story is ours, in line with the paper's call for dietary counselling and taste-adapted food.
- The question used to sort the women was one line on a standard cancer questionnaire used around the world: 'Have you lacked appetite?', answered not at all, a little, quite a bit or very much. In this study, 'a little' was enough to show a real drop in eating.
- Zinc is involved in taste, and experimental studies cited by the authors suggest even a mild shortage can dull it. Less food means less zinc, which could feed a loop of worse taste and less eating. Nobody's zinc level was measured in this study, so that loop is still a hypothesis.
- The paper reports that meat is the food most often turned away during cancer treatment, and in this study red and processed meat was the food group that fell most clearly. Eggs, dairy, tofu, beans or fish can carry the protein when meat stops appealing.
- Drugs are being tested for this too. The Kyoto authors cite a randomised, placebo-controlled trial of olanzapine, a psychiatric medicine, for loss of appetite during chemotherapy in advanced stomach, liver, pancreatic and lung cancers, and say olanzapine and mirtazapine have been reported to improve both appetite and quality of life. That is a decision for the cancer team, not something to try on your own.
- Quality of life in the second group of patients dipped in the week after each chemotherapy dose and came back the week after. The authors suggest electronic symptom check-ins at home could catch problems that clinic visits miss.
- Appetite loss during chemotherapy is associated with reduced dietary intake and quality of life in patients with gynecologic cancer: a prospective observational studySupportive Care in Cancer, 2 October 2026 · The study. Open access, read in full; supplementary file not read
- Full text on PubMed Central (PMC13633162)US National Library of Medicine · Version read for this item
- PubMed record (PMID 42825843)US National Library of Medicine · Abstract, authors and competing interests
- Randomized double-blind placebo-controlled study of olanzapine for chemotherapy-related anorexia in patients with locally advanced or metastatic gastric, hepatopancreaticobiliary, and lung cancerJournal of Clinical Oncology, 2023 · Cited in the paper; described here from the paper's summary, not read
- Miso soup overheadWikimedia Commons · Image, CC0, Douglas Perkins
General information, not medical advice. If you are having cancer treatment, talk to your oncology team or a cancer dietitian before changing your diet or taking supplements, including zinc: some supplements interact with chemotherapy. Tell them about any change in appetite, taste or weight, even a small one.
Analysis by NutroPractic from the sources listed. Written for general readers; it does not replace advice from your own doctor.
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