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Where Health Care Professionals Go for Information Cancer: Nutritional Strategies for Managing Side Effects During Treatment Review Date 2/12 O-0538 Objectives 1. Importance of nutrition 2. Prevalence of side effects 3. Nutritional strategies Good Nutrition Is Important Good nutrition can help people with cancer: • Feel better • Fight fatigue • Maintain body weight • Consume enough vitamins and minerals • Improve strength and energy • Reduce risk of infection • Manage treatment-related side effects • Improve quality of life People With Cancer Need Extra Nutrition Healthy Individual Individual With Cancer Calories 25–30 Cal/kg Maintenance: 25–35 Cal/kg Gain: 30–40 Cal/kg Protein 0.8 g/kg Maintenance: 1.5–2.5 g/kg with severe stress Healthy Individual Individual With Cancer Calories needed Maintenance: 1703–2383 per day for a 1703–2043 Gain: 2043–2742 150-lb person Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. St Louis, MO: Elsevier Saunders; 2012:832-863. Cal=Calories, kg=kilograms, lb-pounds Prevalence of Side Effects Weight Nausea/ Oral Taste Treatment Loss Fatigue Vomiting Mucositis Alterations Constipation 50%– 70%– 30%– 40%– 35%– 40%– Overall % 90% 100% 90% 100% 70% 50% Chemotherapy Radiation Surgery Immunotherapy = treatment in which side effect is common Weight Loss Is Significant • 50%–90% of people with cancer experience weight loss • A weight loss of as little as 5% of body weight can cause reduced response to treatment • Weight loss is associated with poor quality of life and reduced survival Cycle of Malnutrition Infections and Medications Decreased Mouth Sores Diarrhea Appetite Too Tired Eat Less to Eat CYCLE OF Lose Too Tired MALNUTRITION Weight to Cook Tire Out Quickly Lose Strength Nutritional Strategies for Weight Loss • Eat small, frequent meals • Serve favorite foods • Plan physical activity to stimulate appetite • Use medical nutritional shakes and drinks to provide extra calories and protein Fatigue Is Common • Fatigue is most common side effect • Associated with treatment, pain, stress, and/or weight loss • Effect on nutritional status: – Weight gain/loss – Changes in calorie intake – Fluid and electrolyte imbalances Nutritional Strategies for Fatigue • Have small, frequent meals • Prepare meals in quantity when feeling well • Make easy-to-prepare foods • Use ready-to-serve medical nutritional products for convenience and extra nutrition Nausea/Vomiting • Common with chemotherapy and radiation • Effect on nutritional status: – Dehydration/electrolyte imbalance – Loss of appetite – Poor intake of food and fluid – Food aversions – Weight loss Nutritional Strategies for Nausea/Vomiting • Eat small, frequent meals and snacks • Try cold foods, ice chips, dry foods, and room-temperature foods • Drink liquids between meals to avoid feelings of fullness Nutritional Strategies for Nausea/Vomiting • Avoid: – Greasy, fatty, or spicy foods – Strong food odors – Very sweet foods – Hot foods – Drinking liquids with meals – Favorite foods around treatment time Oral Mucositis • Inflammation of the mucous membranes; red, burnlike sores and ulcers • Effect on nutritional status: – Decreased dietary intake – Dehydration – Malnutrition and weight loss Nutritional Status for Oral Mucositis • Select soft foods • Use a straw to make swallowing easier • Avoid acidic, spicy, and dry foods • Use high-calorie drinks and/or medical nutritional supplements Taste Alterations Are Significant • Mouth blindness—bitter/metallic taste • Meat aversions • Reduced ability to taste salt and sugar Taste Alterations Are Significant (cont’d) • Effect on nutritional status: – Food aversions – Loss of appetite – Decreased dietary intake, especially of protein – Weight loss Nutritional Strategies for Taste Alterations • Use tart or sour foods to reduce metallic taste • Season foods with herbs • Serve foods cold or at room temperature Constipation • Constipation is common, especially among people taking opioid analgesics • Effect on nutritional status: – Loss of appetite – Decreased dietary intake – Weight loss Nutritional Strategies for Constipation • Choose high-fiber foods • Drink plenty of fluids • Keep physically active if you are able • Avoid or limit gas-forming foods and beverages Summary • Nutritional status is critical during cancer and its treatment • Treatment-related side effects are common • Nutritional strategies can help manage many side effects References Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34:503-509. Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer. J Palliat Care. 1991;7:25-29. Davidson W, Ash S, Capra S, Bauer J; Cancer Cachexia Study Group. Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr. 2004;23:239-247. Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients: Eastern Cooperative Oncology Group. Am J Med. 1980;69:491-497. Leonard M, Navari RM. Special Report: 5-HT3 Receptor Antagonists and ECG Effects. Philadelphia, PA: McMahon; 2003. Levine JA, Morgan MY. Preservation of macronutrient preferences in cancer anorexia. Br J Cancer. 1998;78:579-581. References (cont’d) Lin EM. In: Yasko JM, ed. Nursing Management of Symptoms Associated with Chemotherapy. 5th ed. West Conshohocken, PA: Meniscus LTD; 2001. Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. St Louis, MO: Elsevier Saunders; 2012:832-863. National Cancer Institute. Oral complications of chemotherapy and head/neck radiation (PDQ®), Health Professional Version. Available at: http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/HealthProfessional/page 1. Accessed February 23, 2012. National Comprehensive Cancer Network. Cancer-related fatigue: clinical practical guidelines in oncology. J Natl Comp Can Netw. 2003;1:308-331. Ottery FD. Cancer cachexia: prevention, early diagnosis, and management. Cancer Pract. 1994;2:123-131. Prommer E. Taste alterations in cancer. Proc Am Soc Clin Oncol. 2003;769(abstract 3093).
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