7.1 Nutritional Support During Cancer Treatments
4 min read•july 30, 2024
Cancer treatments can wreak havoc on your body and eating habits. From to , it's a wild ride. But don't worry, there are ways to stay nourished and strong during treatment.
Personalized nutrition plans are key. Your dietitian will consider your cancer type, treatment, and food preferences to create a plan that works for you. From to special supplements, they'll help you get the nutrients you need to fight back.
Nutritional Needs of Cancer Patients
Impact of Cancer on Nutrition
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- Cancer and treatments significantly impact nutritional status necessitating individualized assessment and intervention strategies
- Malnutrition in cancer patients decreases treatment tolerance, increases complications, and worsens overall outcomes
- Cancer treatments affect nutritional status through altered taste perception, nausea, and gastrointestinal disturbances
- Chemotherapy often causes metallic taste and appetite loss
- Radiation to head/neck area can lead to difficulty swallowing
- Nutrient requirements alter due to metabolic changes, increased energy expenditure, and treatment-induced catabolism
- needs may increase by 50-100% in some cancer patients
- Calorie requirements can increase by 20-30% above normal
Nutritional Assessment Methods
- Comprehensive nutritional assessment includes:
- Anthropometric measurements (weight, BMI, body composition)
- Biochemical markers (albumin, prealbumin, CRP)
- Clinical symptoms (appetite changes, GI issues)
- Dietary intake evaluation (24-hour recall, food frequency questionnaire)
- Screening tools like Patient-Generated Subjective Global Assessment (PG-SGA) specifically assess nutritional risk in cancer patients
- PG-SGA evaluates weight changes, food intake, symptoms, and functional capacity
- Timing of nutritional assessment occurs at diagnosis, throughout treatment, and during follow-up care
- Initial assessment establishes baseline status
- Ongoing evaluations monitor changes and guide interventions
Personalized Nutrition Plans for Cancer Treatment
Tailoring Nutritional Interventions
- Personalized nutrition plans address individual factors:
- Cancer type and stage (breast, lung, colorectal)
- Treatment modality (surgery, chemotherapy, radiation)
- Nutritional status (well-nourished, at-risk, malnourished)
- Personal preferences (food likes/dislikes, cultural considerations)
- Calorie and protein requirements often increase to support healing and maintain lean body mass
- Calorie needs may range from 25-35 kcal/kg/day
- Protein needs typically range from 1.2-2.0 g/kg/day
- Specific nutrient interventions address treatment-related deficiencies or support immune function
- Omega-3 fatty acids reduce inflammation (fish oil supplements)
- Glutamine supports gut mucosal integrity (oral or enteral )
- Antioxidants combat oxidative stress (vitamin C, E, selenium)
Practical Dietary Strategies
- Texture modifications and food fortification increase nutrient density and improve intake
- Pureed or soft foods for swallowing difficulties
- Adding protein powder to foods for increased protein content
- Meal and snack timing coordinates with treatment schedules to optimize tolerance
- Small, frequent meals (every 2-3 hours) to manage nausea
- Avoiding meals immediately before chemotherapy sessions
- Food safety education reduces foodborne illness risk in immunocompromised patients
- Proper food handling and storage techniques
- Avoiding high-risk foods (raw seafood, unpasteurized dairy)
- Careful evaluation of complementary therapies avoids potential interactions
- Herbal supplements may interfere with chemotherapy effectiveness
- Consultation with oncology dietitian for safe integration of complementary approaches
Effectiveness of Nutritional Interventions
Managing Treatment Side Effects
- Regular monitoring assesses intervention effectiveness through:
- Nutritional status markers (weight, body composition)
- Biochemical parameters (albumin, electrolytes)
- Functional outcomes (grip strength, quality of life measures)
- Chemotherapy-induced nausea and vomiting management includes:
- Small, frequent meals to prevent an empty stomach
- Ginger supplementation (tea, capsules) for antiemetic effects
- Cold foods to minimize odors that trigger nausea
- Radiation-induced mucositis interventions involve:
- Glutamine supplementation to support mucosal healing
- Zinc lozenges to promote wound healing
- Probiotics to maintain oral microbiome balance
- Taste alteration strategies encompass:
- Flavor enhancement with herbs and spices
- Use of plastic utensils to minimize metallic taste
- Cold food options to reduce taste bud sensitivity
Optimizing Nutritional Support
- Dietary fiber modifications and probiotics manage treatment-related gastrointestinal issues
- Soluble fiber for diarrhea management (oats, psyllium)
- Insoluble fiber for constipation relief (wheat bran, vegetables)
- Probiotic strains (Lactobacillus, Bifidobacterium) to support gut health
- Oral nutritional supplements address inadequate intake
- Selection based on individual tolerability and nutrient needs
- High-protein, high-calorie options for increased nutritional demands
- Specialized formulas for specific conditions (diabetes, renal insufficiency)
- Quality of life measures alongside nutritional parameters provide comprehensive evaluation
- Functional status assessments (ECOG performance status)
- Symptom burden scales (Edmonton Symptom Assessment System)
- Patient-reported outcomes on daily activities and well-being
Enteral vs Parenteral Nutrition Support
Enteral Nutrition in Cancer Care
- Indications for support include:
- Severe malnutrition (>10% unintentional weight loss)
- Prolonged inadequate oral intake (< 60% of requirements for > 1-2 weeks)
- Gastrointestinal tract dysfunction (mucositis, enteritis)
- Enteral formula selection considers:
- Specific nutritional requirements (standard, high-protein, immune-enhancing)
- Gastrointestinal function (elemental vs polymeric formulas)
- Treatment-related limitations (low-residue for radiation enteritis)
- Monitoring enteral nutrition involves:
- Regular assessment of tolerance (gastric residuals, abdominal distension)
- Metabolic parameters (electrolytes, glucose, liver function tests)
- Achievement of nutritional goals (calorie and protein intake)
Parenteral Nutrition Considerations
- indications encompass:
- Severe malabsorption (short bowel syndrome)
- Bowel obstruction preventing enteral feeding
- Prolonged ileus (>7 days) precluding adequate enteral nutrition
- Decision to initiate parenteral nutrition weighs benefits against risks:
- Benefits: rapid nutritional repletion, bypass of non-functional GI tract
- Risks: catheter-related infections, metabolic complications (hyperglycemia, electrolyte imbalances)
- Timing of nutrition support initiation impacts outcomes
- Early intervention in malnourished patients improves treatment tolerance
- Delayed initiation may be appropriate in well-nourished patients
- Transition from artificial nutrition to oral intake requires careful management
- Gradual reduction of enteral/parenteral support as oral intake increases
- Ongoing monitoring to ensure nutritional needs are met during recovery
- Collaboration between dietitian, nurse, and physician for optimal transition planning
Key Terms to Review (20)
Academy of Nutrition and Dietetics: The Academy of Nutrition and Dietetics is the largest organization of food and nutrition professionals in the United States, dedicated to advancing the science and practice of dietetics. This organization provides resources for evidence-based practice, nutrition education, and promotes the importance of nutrition in healthcare, especially in areas like medical nutrition therapy, nutritional support during cancer treatments, and the ethical considerations in genomics related to nutrition.
American Cancer Society: The American Cancer Society (ACS) is a nationwide, community-based voluntary health organization dedicated to eliminating cancer. It focuses on cancer research, education, advocacy, and providing support for patients and their families, especially in the context of nutritional support during cancer treatments, where it plays a vital role in promoting healthy dietary practices and lifestyle changes that can improve treatment outcomes and overall well-being.
Anorexia: Anorexia is an eating disorder characterized by an intense fear of gaining weight and a distorted body image, leading to restricted food intake and significant weight loss. It often arises in the context of psychological factors, which can exacerbate the physical effects of inadequate nutrition, particularly during illness or medical treatment. The condition can complicate recovery efforts in various health scenarios and profoundly affects the nutritional status of individuals receiving care.
Aspen Guidelines: The Aspen Guidelines are evidence-based recommendations developed by the American Society for Parenteral and Enteral Nutrition (ASPEN) to optimize the nutritional care of patients receiving medical nutrition therapy. These guidelines focus on various aspects of nutrition support, including indications for enteral and parenteral nutrition, assessment of nutritional needs, and monitoring and management of therapy across different patient populations.
Cachexia: Cachexia is a complex metabolic syndrome characterized by severe weight loss, muscle wasting, and a decline in appetite, often seen in patients with chronic illnesses such as cancer. It plays a significant role in the overall nutritional status and treatment outcomes of individuals dealing with serious health conditions, making it crucial to address in various healthcare settings.
Calories: Calories are a unit of measurement used to quantify the amount of energy provided by food and beverages. In the context of nutritional support during cancer treatments, understanding caloric intake is crucial as it directly affects a patient's energy levels, nutritional status, and overall ability to cope with the demands of both the disease and its treatments. Adequate calorie consumption helps prevent malnutrition, supports immune function, and improves recovery outcomes.
Dietary Counseling: Dietary counseling is a personalized approach to nutrition education that helps individuals understand their dietary needs and make informed choices about food to support their health and well-being. This process involves assessing a person’s nutritional status, discussing dietary habits, and providing tailored recommendations to optimize nutrition, especially for those undergoing medical treatments or managing health conditions. It plays a crucial role in enhancing nutritional support during medical therapies and managing side effects associated with various treatments.
Enteral Nutrition: Enteral nutrition is a method of providing nutrition to individuals through the gastrointestinal tract via a feeding tube. This approach is often used when individuals cannot consume food orally, yet their digestive system is functional enough to absorb nutrients effectively.
High-protein snacks: High-protein snacks are foods that contain a significant amount of protein relative to their total caloric content, making them a valuable option for those looking to support muscle maintenance, repair, and overall health. These snacks can help manage hunger and stabilize blood sugar levels, which is particularly important for individuals undergoing certain treatments or managing side effects from medications.
Hypermetabolism: Hypermetabolism is a state characterized by an increased metabolic rate, where the body uses energy at an accelerated pace, often in response to stress, illness, or injury. This heightened metabolic demand can significantly impact nutritional needs and energy balance, especially in individuals facing serious health conditions.
Malnutrition screening tools: Malnutrition screening tools are standardized assessments designed to identify individuals at risk of malnutrition due to inadequate nutrient intake or increased nutritional needs. These tools help healthcare professionals quickly evaluate a patient's nutritional status, allowing for timely intervention, especially in vulnerable populations such as cancer patients or those experiencing medication side effects. Effective screening can lead to improved patient outcomes by ensuring that appropriate nutritional support is provided early in the treatment process.
Micronutrients: Micronutrients are essential nutrients required by the body in small amounts for various physiological functions, including enzyme activity, immune function, and energy production. These nutrients, which include vitamins and minerals, play a critical role in maintaining overall health and well-being, especially during periods of stress such as illness or recovery from medical treatments.
Nausea: Nausea is an unpleasant sensation in the stomach that often leads to the urge to vomit. It can be caused by various factors, including illness, medication side effects, or dietary issues. Understanding nausea is essential, as it can significantly impact nutrient intake, management of treatment-related side effects, and overall patient quality of life during health challenges.
NCCN Recommendations: NCCN Recommendations are evidence-based guidelines developed by the National Comprehensive Cancer Network to assist healthcare professionals in making informed decisions about the care of cancer patients. These guidelines cover a range of topics, including treatment options, supportive care, and nutritional support during cancer treatments, ensuring that patients receive optimal care tailored to their specific needs.
Nutritional Risk Index: The Nutritional Risk Index is a tool used to assess the nutritional status of patients, particularly those undergoing cancer treatments, by evaluating various factors such as weight changes, dietary intake, and the presence of comorbidities. This index helps identify individuals at risk of malnutrition, which is crucial during cancer therapies due to their effects on appetite and metabolism. A higher nutritional risk indicates a greater need for nutritional intervention to improve patient outcomes.
Parenteral Nutrition: Parenteral nutrition is a medical method of delivering nutrients directly into the bloodstream, bypassing the gastrointestinal tract. This approach is crucial for patients who are unable to consume food orally or have non-functioning digestive systems, providing them with essential nutrients like carbohydrates, proteins, fats, vitamins, and minerals to support their health and recovery.
Protein: Protein is a macronutrient made up of amino acids that are essential for the growth, repair, and maintenance of body tissues. It plays a crucial role in various physiological functions, including enzyme activity, hormone production, and immune response. In clinical nutrition, protein needs can vary based on health conditions and treatment protocols.
Small frequent meals: Small frequent meals refer to a dietary approach where individuals consume several small meals throughout the day instead of the traditional three larger meals. This method can help manage symptoms associated with certain health conditions, including those undergoing cancer treatments or experiencing medication side effects, by providing consistent energy and nutrients while minimizing discomfort.
Supplementation: Supplementation refers to the process of providing additional nutrients to an individual's diet in order to address deficiencies, enhance overall health, or support specific medical conditions. This practice is particularly important for individuals undergoing cancer treatments, as these therapies can lead to nutritional imbalances and increased nutrient needs. By using supplements, patients can help maintain their nutritional status and improve their resilience during treatment.
Taste changes: Taste changes refer to alterations in the perception of flavors that can occur during cancer treatments, often impacting a patient's ability to enjoy food and maintain adequate nutrition. These changes can manifest as a heightened or diminished sensitivity to certain tastes, or even an aversion to previously liked foods, which complicates meal planning and can lead to nutritional deficiencies.