After a cancer diagnosis, the patient with cancer will meet many people on their journey, including health care and nonmedical professionals who can have a dramatic impact on the patient and caregiver experience. Although these people may influence the patient in a variety of ways, the oncology nurse is one of the most important points of contact. They provide a broad range of care to patients with cancer including medical management of side effects, basic guidance on nutritional implications of cancer treatment, and referrals to supportive services, as well as emotional support and encouragement. In addition, oncology nurses have ongoing and continual exposure to patients before, during, and after cancer treatment.
To effectively educate patients during these critical points in their cancer journey, oncology nurses need to understand common nutrition-related effects of cancer treatments. This article offers a practical review of evidence-based nutrition management of adverse effects and how to approach common nutrition-related scenarios.
Nutrition During Cancer Treatment
Research extensively supports the role of nutrition in cancer. Yet, maintaining adequate nutrition status is often a challenge because patients face a variety of symptoms related to the cancer and its treatment. Metabolic rates are increased due to higher levels of inflammatory cytokines.1 Therefore, patients with cancer may require higher amounts of calories and protein to maintain their body weight throughout treatment. However, decreased appetite and persistent nutrition-related adverse effects make maintaining adequate oral intake a significant challenge. Major surgeries to the head and neck or gastrointestinal areas, pain, fatigue, depression, and existing or lingering effects of cancer treatment also may impair nutritional status.1 Malnourished patients are more likely to develop infections due to lack of vitamins, minerals, calories, and protein to support the immune system.2
Early determination of a patient’s risk for malnutrition is important to help prevent rapid decline in nutritional status. Malnutrition is present in 15% to 80% of all cancer cases, and more prevalent with advanced stage cancers.3 It can occur from both the cancer itself as well as the treatment.3 Proper nutrition during cancer treatment can promote improved quality of life and performance status, result in less treatment toxicity and treatment breaks, and improve survival rates.4-6 Patients at high risk for malnutrition include those with lung, pancreatic, gastrointestinal, head and neck, or esophageal cancer, those with a weight loss greater than 5% of normal body weight, and those with persistent anorexia and/or significant vomiting or diarrhea.1
Oncology nurses’ strong clinical expertise enables them to more easily identify which patients are at risk for malnutrition and place referrals, and nurses who have a good understanding of nutrition can promote timely nutrition interventions. Early and ongoing nutritional intervention has been shown to help patients maintain or increase weight, stabilize or reverse weight loss, reduce postoperative complications, and improve appetite7-10; all of which may result in enhanced treatment tolerance and better outcomes.11
Many cancer centers employ a registered dietitian, designated by the credential RD or RDN, or a registered dietitian who is a certified specialist in oncology nutrition, designated by the credentials RD, CSO. Dietitians with the added credential of CSO are the ideal referral for cancer patients at risk for malnutrition or to address any nutritional concerns due to their additional clinical expertise in oncology nutrition. To earn a CSO, a dietitian is required to practice as an RD for 2 years, have 2000 documented practice hours in oncology services, and successfully complete a board exam, then attain recertification every 5 years. If a cancer center does not have a specialist dietitian on staff, the “Find a Dietitian” function of the Academy of Nutrition and Dietetics’ website (www.eatright.org) can help find a local oncology-credentialed dietitian in the community.