CANCER-SPECIFIC GUIDELINES

In addition to universal nutrition-related difficulties for patients with cancer, some cancers produce specific side effects. The following guidelines are specific for these more common disease sites.

Head and neck cancer Patients with head and neck cancer often experience a sore mouth and have difficulty chewing. These patients should be evaluated for oral thrush to determine if that is the cause of the side effects, and treatment should focus on the cause of the oral thrush. Other steps can be taken to ease patients’ discomfort.


Continue Reading

  • Serve soft, bland-tasting foods at room temperature. Pureeing or liquefying foods make them easier to swallow and lukewarm, rather than hot, foods are less irritating to the mouth.
  • Moisten foods with broth, sauces, gravy, or fats (oil or butter)
  • Rinse often with a mouth rinse to remove food and germs and enhance healing4
  • Investigate potential need for a PEG tube to maintain nutrition and hydration during therapy.

Breast cancer These patients often have issues with weight gain, rather than weight loss, due in part to hormonal therapies.

  • Review caloric intake versus activity levels
  • Recommend exercises for maintaining strength and general conditioning specifically for patients with breast cancer
  • Suggest maintaining a low-fat, plant-based diet with attention to soy products.

Lung cancer These patients generally require surgery, chemotherapy, and radiation. Some of the recommendations for patients with head and neck cancers are helpful for patients with lung cancer.

  • Soft, bland foods served at room temperature. Pureeing or liquefying foods make them easier to swallow
  • Moisten food with broth, sauces, gravy, or fats (oil or butter)
  • Increased protein is needed for tissue-building benefits, oral liquid supplements can provide additional protein.

Colorectal cancer The most significant issue for these patients may be GI tract function, depending on the extent of the surgery required. Careful review of their nutritional needs and bowel functions are essential.

  • Understanding of the surgical procedure and its physical alterations to the GI tract
  • Identify foods that make bowel movements too loose or too hard (rare), or produce too much gas.
  • Eat more low fiber foods, such as white starches, because they are better tolerated than whole grains.
  • Recommend fruits and vegetables with hard skins or peels, or stringy parts

CAM THERAPIES

Complementary and alternative therapies (CAM) are widely used by cancer patients, and nurses should not overlook discussing them with patients. Complementary therapies are those that are administered alongside conventional, evidence-based treatments. Meditation to reduce stress and ginger to relieve nausea are examples of complementary therapies that can help control symptoms and improve how the patient is feeling.

Alternative therapies, on the other hand, are treatments that are promoted as cancer cures; however, they have not been scientifically tested and, therefore, lack proven safety and efficacy.7 In addition, some alternative therapies may even counteract scientifically proven treatments. Patients and caregivers often search the Internet for solutions, but they should be reminded that not everything they read is fact. As a general rule, commercial diets such as the Anti-Cancer Diet, the Maker’s Diet, the Paleo Diet, the anti-inflammatory diet, vegan and macrobiotic diets, and The South Beach Diet are not recommended for patients undergoing cancer treatment, as each is limited in meeting the nutritional needs of cancer patients. Some supplements actually impede cancer treatment, so nurses should ask patients for a list of the over-the counter medications he or she may be using.

Antioxidant vitamins A, E, and C, plus glutathione and selenium are extremely dangerous to take with chemotherapy because they may reduce the efficacy of the chemotherapy by protecting the cancer cells.  Herbal supplements, such as St. John’s wort and ginkgo biloba, may also impede cancer treatment. St. John’s wort, for example, can speed up or slow down the metabolism of the chemotherapy drug, changing its effects. Ginkgo biloba, a natural blood thinner, can cause spontaneous bleeding and seizures.8

Safe complementary and alternative therapies include meditation and ginger as mentioned above. Unfortunately, studies have not provided the hard evidence necessary to make general conclusions about the majority of other therapies, supplements, and products. Scientific evidence does support the belief that all nutrients for optimal cancer outcomes should come from natural foods and a well-balanced diet.2

CONCLUSION

Nutrition is always important but becomes critical for a patient undergoing cancer treatment. Eating a healthy diet will provide patients with the essential nutrients needed to fight the disease and relieve the side effects of the disease and its treatment. Providing patients with information, resources, and encouragement increases the chance of positive outcomes. Utilizing a multidisciplinary approach to nutrition, as well as treatment modalities, can increase the patient’s ability to maintain strength and endurance, tolerate care, and move towards survivorship. ONA 

BASIC NUTRITION REQUIREMENTS

Patients may find eating six to eight small, well-balanced, nutritious meals and snacks easier to tolerate than fewer, larger meals during treatment. Consuming small amounts of food frequently throughout the day helps alleviate nausea symptoms. To maximize the nutrition provided through these smaller meals, each meal should consist of a complex carbohydrate, a lean protein source, and a healthy fat.

Complex carbohydrates Fruits, vegetables, and whole grains are complex carbohydrates. Incorporating at least five servings of fruits and vegetables each day provides essential vitamins, minerals, and phytochemicals, as well as fiber. Whole grains are also an excellent source of fiber and nutrients, and consuming these types of grains is important to maximize carbohydrate intake. They can help alleviate GI effects such as constipation.

Whole grains include whole grain breads, whole grain cereals (oatmeal, shredded wheat, bran flakes), whole wheat pasta, and brown rice. At least half of carbohydrate consumption from grains should be from whole grains.

Lean protein Consumption of lean protein sources helps keep up strength and rebuilds tissue. Protein needs are higher in cancer patients to prevent catabolism, or the depletion of muscle mass, potentially from the cancer itself as well as during the different stages of treatment; therefore, consuming adequate amounts of lean protein is crucial for patients with cancer. Lean protein sources include fish, low-fat dairy products, nuts, eggs, and legumes. A meal or snack substituting legumes (eg, lentils, chickpeas, or soybeans) for meat at least once a week is recommended since they are typically low in fat, contain no cholesterol, and are high in protein, folate, potassium, iron and magnesium. Soybeans, for example, contain all of the amino acids needed to make a complete protein, just like meat.

Fats Healthy fats help the body repair cells, which is especially important as the body repairs itself during cancer treatment. Monounsaturated and polyunsaturated fatty acids are healthy fats. These types of fats have been linked to improved blood cholesterol levels, stabilize insulin levels, lower blood pressures, and protects against heart disease. Sources include canola and olive oils, avocado, fish, nuts, and seeds. Diets high in saturated fats have been linked to elevated total cholesterol levels, which could lead to heart disease and stroke.

Fluids Adequate hydration helps prevent fatigue, light-headedness, dry mouth, altered taste (metallic taste), and nausea during the course of cancer treatment. Recommended fluid intake for men is about 3.7 liters of water a day; recommended fluid intake for women is about 2.7 liters a day. A large portion of fluids come from foods consumed; therefore, overall recommendations for both men and women is to consume 8 to 12 cups of liquids each day. Maintaining adequate hydration is especially important for those patients experiencing vomiting or diarrhea because they are susceptible to dehydration due to resultant fluid loss.Sugar-sweetened drinks add large amounts of calories to the diet, which can ultimately lead to weight gain and may affect cancer outcomes. Many foods and drinks that are high in added sugar do not offer needed nutrients and may replace more nutritious food choices. To prevent weight loss or regain weight lost from the cancer and its treatment, foods that are nutrient-dense are recommended. Patients should limit their intake of foods and drinks with added sugar, which lack nutrients are only calorically-dense.Caffeinated beverages should be consumed in moderation. They can increase the risk of dehydration and sodium excretion from the body, which may contribute to fatigue, headaches, and nausea. The severity of some side effects of chemotherapy (eg, fatigue, nausea, and even headaches) can be worsened by dehydration.

SOURCES

• Eldridge B, Hamilton K. Management of Nutrition Impact Symptoms in Cancer and Educational Handouts. Chicago, IL: American Dietetic Association; 2003.
• National Institutes of Health, US Department of Health and Human Services. Eating Hints: Before, During and After Cancer Treatment. Bethesda, MD: National Institutes of Health; 2011. NIH publication 11-2079. http://www.cancer.gov/cancertopics/coping/eatinghints. Accessed September 17, 2013.


Carolyn Farhy and Gretchen Skwer are oncology outpatient dietitians with Lankenau Medical Center, Wynnewood, Pennsylvania. Rosemarie Tucci is an oncology program manager at Lankenau Medical Center in Wynnewood, Pennsylvania.  



REFERENCES

1. Marino MJ, Patton A, eds. Cancer Nutrition Services: A Practical Guide for Cancer Programs. Rockville, MD: Association of Community Cancer Centers; 2012.

2. Marian M, Roberts S. Introduction to the nutritional management of oncology patients. In: Marian M, Roberts S, eds. Clinical Nutrition for Oncology Patients. Sudbury, MA: Jones and Bartlett Publishers; 2010:7,12.

5. Lanford J. Salt (sodium) and Cancer. Oncology Nutrition, A dietetic Practice Group of the Academy of Nutrition and Dietetics. http://dpg-storage.s3.amazonaws.com/ondpg/documents/b2bb9268e052da5/ondpg_-_salt_and_cancer_handout.pdf. Accessed September 18, 2013.

6. Orenstein BW. 6 ways to treat excessive gas. Everyday Health Web site. http://www.everydayhealth.com/digestive-health/gas/diagnosing-and-treating-excessive-gas.aspx. Last updated July 1, 2009. Accessed September 17, 2013

7. Hyodo I, Amano N, Eguchi K, et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. J Clin Oncol. 2005;23(12):2645-254.

4. National Institutes of Health, US Department of Health and Human Services. Eating Hints: Before, During and After Cancer Treatment. Bethesda, MD: National Institutes of Health; 2011. NIH publication 11-2079. http://www.cancer.gov/cancertopics/coping/eatinghints. Accessed September 17, 2013.

8.  Robin Wood-Moch (2013, August 16). Vitamins, Cancer and Chemotherapy. Livestrong.com. Retrieved September 18, 2013, from http://www.livestrong.com/article/318898-vitamins-cancer-chemotherapy/.