How to maintain nutritional status during cancer therapy
Nutritional intervention is an integral step in the care process for patients undergoing treatment and recovery of cancer. A wealth of evidence-based statistics supports the importance of good nutritional balance throughout the continuum of cancer care. Healthy eating practices can alleviate certain side effects as well as maintain strength and endurance before, during, and after cancer treatments. While interventions should be individualized, overall general guidelines for symptom management can be helpful for patients and caregivers. Regardless of whether a clinical dietitian is part of the health care team that works with patients with cancer, nurses need basic knowledge of nutrition and its role to assist patients along their journey.
The primary goals of nutrition therapy are to prevent or reverse nutrient deficiencies, preserve lean body mass, minimize and manage the impact of nutrition-related symptoms and side effects, and maximize quality of life. However, with the increased emphasis on cancer prevention and recurrence, opportunities exist to promote healthy lifestyle behaviors and eating habits. Nutritional status and appetite should be assessed at each patient visit. The question “Have you had an increase/decrease in your appetite or weight since your last visit?” is a starting point for this assessment. A patient-generated scoring assessment can help caregivers better understand the needs of the patient and allow an appropriate referral to a clinical dietitian as necessary.1 However, although the majority of cancer patients may experience a decrease in appetite and weight loss through treatment, some patients—especially those with breast cancer receiving hormonal therapy—may have the opposite experience. Nutrition interventions should be individualized to the therapy and nutritional impact affecting the patient. This article presents guidelines for helping patients maintain adequate nutrition intake throughout the course of their cancer treatment and nutrition-related care tips for specific types of cancer.
One of the most significant nutritional issues that can arise during cancer treatment is malnutrition. Side effects from chemotherapy, radiation, immunotherapy, and surgery can contribute to deterioration in nutritional status. Overall survival rates, performance status, productivity, and quality of life can decline concurrently with weight loss in cancer patients.2
Eating well-balanced and nutritious meals requires planning and preparation. Advise patients and their caregivers to have foods and drinks that are easy to consume readily available for when they can eat. Keeping their pantries, refrigerators, and freezers stocked with an assortment of healthy foods can help patients maintain their nutrition, especially during periods when their appetite is low from treatment.
Prepackaged foods, available in the freezer section of grocery stores should be used with caution. These foods may contain high levels of sodium and saturated fat and lower amounts of nutrients such as fiber, vitamins, and minerals. Intake of these food items should be minimal or avoided.5 Instead, encourage patients to create their own easy-to-eat and ready-to-serve foods to maintain energy and strength during treatment. For example, prepare food ahead of time and freeze it. Single-serving packages of nuts, whole grain crackers, granola bars, and fruit can help patients have the foods they like in amounts they can tolerate available for treatment periods when nausea, vomiting, or fatigue impede eating.
Oncology patients have weakened immune systems from the cancer or its treatment, and as a consequence are at increased risk for infection. Special precautions are necessary to avoid food-borne illnesses. Proper hand washing and carefully washing fresh or raw fruits and vegetables are essential food-handling practices. Furthermore, all food, especially raw meats and fish, should be obtained from reputable sources. Bacteria growth is the main culprit of food-related infections. Hot foods should be kept hot (above 140°F) and cold foods should be kept cold (below 40°F) to inhibit bacteria growth.
DIETARY TECHNIQUES FOR MANAGING SIDE EFFECTS
Managing the side effects of radiation and chemotherapy is crucial to enabling patients to complete their recommended course of treatment. Although predicting exactly how a prescribed treatment may affect a patient is difficult, some side effects directly affect the patient's appetite and ability to consume necessary calories. Reducing the discomfort inherent with common side effects can ensure that associated weight loss is minimized and treatment can be completed as planned.
Nausea and vomiting is common and can be caused by the cancer, chemotherapy, or radiation therapy. Eating smaller, more frequent meals throughout the day can ease these side effects for many patients. In addition, foods should be served at room temperature to eliminate strong odors. Fatty, greasy, or spicy foods should be avoided. Antinausea medications or hard candies (eg, peppermints, lemon drops) may also help relieve nausea. In some cases, physicians may order an appetite stimulant, such as megestrol acetate (Megace), to improve a patient's oral intake. Over-the-counter (OTC) oral liquid nutrition supplements (such as Ensure or Boost) can be recommended for patients who are unable to meet their nutritional needs through food alone. These products are designed to be meal supplements, not meal replacements, and patients should still try to eat solid foods. If a patient is vomiting, sipping clear liquids as often as possible aids in maintaining hydration. These side effects, generally, do not last for long periods of time; so, patients should be reminded to eat when they are hungry or not experiencing nausea. Once the nausea or vomiting has subsided, consuming high-calorie, high-protein foods is essential to make up for any resulting weight loss.