Malnutrition and nutritional interventions will include different symptoms and patient factors (such as age, performance status, and frailty) and disease factors, including primary tumor site, tumor stage, comorbidities, metastatic disease, and treatment plan. For example, patients undergoing chemotherapy for GI cancers will experience different nutrition impact symptoms than those undergoing chemoradiation for head and neck cancer. In addition, patients with advanced metastatic disease and short life expectancy are less likely to benefit from aggressive nutritional interventions than patients with lower-stage cancers and longer life expectencies.1 Dietary counseling and planning are typically the responsibility of licensed dieticians, whereas oncology nurses are involved in symptoms management, patient education, and care, such as antiemetic pharmacotherapy for nausea, or analgesics for swallowing or abdominal pain, and appetite-stimulating progestin (megestrol acetate and medroxyprogesterone acetate) therapy.1

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Supportive feeding via parenteral or enteral feeding might be necessary for patients whose symptoms prevent normal eating and food retention (without vomiting).1 Gastrostomy is recommended for long term (4 weeks or longer) nutritional support; it is associated with better nutritional outcomes and patient convenience than nasogastric tubes.1 Short-term parenteral nutritional support is considered when enteral support is not possible, such as among patients with acute GI complications associated with radiation enteritis.1 Long-term enteral feeding complications such as tube obstruction, displacement, diarrhea, or intestinal motility issues resulting in constipation, can occur among patients of any age.1

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At every stage, nutritional intervention decision-making should involve patients as much as possible, to ensure that they are consistent with patient values and goals. When interventions are likely to prove futile, this should be communicated gently but plainly to patients and their caregivers to ensure informed decision making that respects patient autonomy as much as possible.


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