Nutritional Strategies for Side Effects of Cancer Treatment by HC120730062942

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   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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