Podcast
Questions and Answers
What is the estimated fluid requirement for a 60-year-old individual weighing 70 kg?
What is the estimated fluid requirement for a 60-year-old individual weighing 70 kg?
Which method calculates fluid needs based on body weight exceeding 20 kg?
Which method calculates fluid needs based on body weight exceeding 20 kg?
What should be considered in fluid requirements besides age?
What should be considered in fluid requirements besides age?
What is the recommended approach when micronutrient intake is inadequate?
What is the recommended approach when micronutrient intake is inadequate?
Signup and view all the answers
What potential effect should be considered regarding the use of antioxidants?
What potential effect should be considered regarding the use of antioxidants?
Signup and view all the answers
What is one way that lab-made antibodies stimulate an immune response against cancer cells?
What is one way that lab-made antibodies stimulate an immune response against cancer cells?
Signup and view all the answers
Which of the following cancers is primarily treated with Hematopoietic Stem Cell Transplant (HSCT)?
Which of the following cancers is primarily treated with Hematopoietic Stem Cell Transplant (HSCT)?
Signup and view all the answers
What types of stem cells are used in Hematopoietic Stem Cell Transplant (HSCT)?
What types of stem cells are used in Hematopoietic Stem Cell Transplant (HSCT)?
Signup and view all the answers
What is a potential adverse outcome of receiving lab-made antibodies for cancer treatment?
What is a potential adverse outcome of receiving lab-made antibodies for cancer treatment?
Signup and view all the answers
Which type of stem cell source is known as autologous in HSCT?
Which type of stem cell source is known as autologous in HSCT?
Signup and view all the answers
What is the primary cause of malnutrition in cancer patients?
What is the primary cause of malnutrition in cancer patients?
Signup and view all the answers
Which of the following is a common side effect of chemotherapy?
Which of the following is a common side effect of chemotherapy?
Signup and view all the answers
What distinguishes neoadjuvant chemotherapy from adjuvant chemotherapy?
What distinguishes neoadjuvant chemotherapy from adjuvant chemotherapy?
Signup and view all the answers
How does radiation therapy primarily affect cancer cells?
How does radiation therapy primarily affect cancer cells?
Signup and view all the answers
What is a late effect of radiation therapy directed at the head and neck region?
What is a late effect of radiation therapy directed at the head and neck region?
Signup and view all the answers
Which of the following treatments is classified as systemic therapy?
Which of the following treatments is classified as systemic therapy?
Signup and view all the answers
What symptom might indicate early eating difficulties in cancer patients?
What symptom might indicate early eating difficulties in cancer patients?
Signup and view all the answers
Diminished gastric emptying can lead to which symptom in cancer patients?
Diminished gastric emptying can lead to which symptom in cancer patients?
Signup and view all the answers
The use of corticosteroids in cancer treatment is primarily associated with which acute effect?
The use of corticosteroids in cancer treatment is primarily associated with which acute effect?
Signup and view all the answers
Which of the following best describes passive immunotherapy?
Which of the following best describes passive immunotherapy?
Signup and view all the answers
Which treatment modality is often combined with radiotherapy for enhanced effectiveness?
Which treatment modality is often combined with radiotherapy for enhanced effectiveness?
Signup and view all the answers
What is the primary treatment purpose of high-dose chemotherapy and total body irradiation in HSCT?
What is the primary treatment purpose of high-dose chemotherapy and total body irradiation in HSCT?
Signup and view all the answers
Which dietary strategy should be adopted for a patient experiencing acute GI GVHD?
Which dietary strategy should be adopted for a patient experiencing acute GI GVHD?
Signup and view all the answers
What is a common symptom associated with immunotherapy?
What is a common symptom associated with immunotherapy?
Signup and view all the answers
What is a common nutritional requirement for patients undergoing hematopoietic stem cell transplant during the first 1-3 months?
What is a common nutritional requirement for patients undergoing hematopoietic stem cell transplant during the first 1-3 months?
Signup and view all the answers
What is the primary aim of adjuvant chemotherapy?
What is the primary aim of adjuvant chemotherapy?
Signup and view all the answers
What type of food is recommended for the oral diet post-transplant, considering potential mucositis and stomatitis?
What type of food is recommended for the oral diet post-transplant, considering potential mucositis and stomatitis?
Signup and view all the answers
An important consideration for patients undergoing HSCT is to manage toxicities which can cause several symptoms. What are these symptoms NOT likely to include?
An important consideration for patients undergoing HSCT is to manage toxicities which can cause several symptoms. What are these symptoms NOT likely to include?
Signup and view all the answers
What type of surgery is performed to remove tumors causing spinal cord compression?
What type of surgery is performed to remove tumors causing spinal cord compression?
Signup and view all the answers
In assessing energy needs for cancer patients, which factor is least influential?
In assessing energy needs for cancer patients, which factor is least influential?
Signup and view all the answers
Which is an inflammatory condition of the mouth that can occur as a result of treatment for cancer?
Which is an inflammatory condition of the mouth that can occur as a result of treatment for cancer?
Signup and view all the answers
What should be included in a patient's diet when they experience neutropenia post-transplant?
What should be included in a patient's diet when they experience neutropenia post-transplant?
Signup and view all the answers
The main risk associated with allogeneic transplants is Graft Versus Host Disease (GVHD). Which statement about acute GI GVHD is inaccurate?
The main risk associated with allogeneic transplants is Graft Versus Host Disease (GVHD). Which statement about acute GI GVHD is inaccurate?
Signup and view all the answers
Which factor affects protein requirements in cancer patients the most?
Which factor affects protein requirements in cancer patients the most?
Signup and view all the answers
During what period after a hematopoietic stem cell transplant should patients consume greater than 1.5g protein/kg?
During what period after a hematopoietic stem cell transplant should patients consume greater than 1.5g protein/kg?
Signup and view all the answers
Among the following options, which is characterized by the functional immune cells recognizing the recipient as 'foreign'?
Among the following options, which is characterized by the functional immune cells recognizing the recipient as 'foreign'?
Signup and view all the answers
What is a consequence of surgical interventions in cancer treatments affecting the stomach?
What is a consequence of surgical interventions in cancer treatments affecting the stomach?
Signup and view all the answers
Which treatment is recommended for managing hypercalcemia in patients with bone metastasis?
Which treatment is recommended for managing hypercalcemia in patients with bone metastasis?
Signup and view all the answers
What nutritional strategy should be employed to help manage early satiety?
What nutritional strategy should be employed to help manage early satiety?
Signup and view all the answers
Which food group should be avoided in managing diarrhea?
Which food group should be avoided in managing diarrhea?
Signup and view all the answers
What is a key recommendation for a patient experiencing nausea and vomiting?
What is a key recommendation for a patient experiencing nausea and vomiting?
Signup and view all the answers
What is the recommended source of nutrition when enteral nutrition is not viable?
What is the recommended source of nutrition when enteral nutrition is not viable?
Signup and view all the answers
Which of the following strategies should be employed for managing constipation?
Which of the following strategies should be employed for managing constipation?
Signup and view all the answers
Which of the following is NOT an appropriate strategy for managing xerostomia?
Which of the following is NOT an appropriate strategy for managing xerostomia?
Signup and view all the answers
What is a common characteristic of appetite stimulants used for managing patients' dietary intake?
What is a common characteristic of appetite stimulants used for managing patients' dietary intake?
Signup and view all the answers
How can protein and calorie intake be maximized during treatment times?
How can protein and calorie intake be maximized during treatment times?
Signup and view all the answers
Which type of oral nutrition supplement is specifically designed for patients with diabetes?
Which type of oral nutrition supplement is specifically designed for patients with diabetes?
Signup and view all the answers
Which is the best strategy for managing thickened saliva?
Which is the best strategy for managing thickened saliva?
Signup and view all the answers
What is a main concern when considering enteral nutrition in advanced cancer patients?
What is a main concern when considering enteral nutrition in advanced cancer patients?
Signup and view all the answers
Which strategy is recommended for improving food intake in patients experiencing fatigue?
Which strategy is recommended for improving food intake in patients experiencing fatigue?
Signup and view all the answers
Study Notes
Cancer and Malnutrition
- Cancer is a heterogeneous disease that can lead to chronic disease-related malnutrition
- Prevalence of malnutrition in cancer patients ranges from 8-84% due to factors like:
- Tumor location (head & neck, GI, lung)
- Disease stage (all advanced cases)
- Cancer treatments (surgery, radiation, chemotherapy)
- Malnutrition in cancer is caused by:
- Tumor growth and development
- Body's response to the tumor (including inflammation)
- Side effects of cancer treatments like surgery, radiation, and chemotherapy
- Psychological factors like fear, anxiety, and depression
Factors Affecting Diminished Food Intake
-
Anorexia (loss of appetite) can be caused by:
- Early stages of cancer
- Body's response to the disease
- Side effects of cancer treatments
- Emotional factors like fear, anxiety, and depression
-
Early satiety (feeling full quickly) can be caused by:
- Delayed gastric emptying
- Decreased gastric transit time
- Inability to eat due to pain or discomfort
-
Gastrointestinal discomfort includes symptoms like:
- Nausea and vomiting
- Diarrhea
- Cramping and bloating
- General discomfort
- Food avoidance to manage symptoms
- Acquired food aversions develop due to negative experiences with food during or after cancer treatments.
Cancer Treatment Modalities
- Surgery is used to remove cancerous tumors.
-
Chemotherapy involves using chemical agents to treat cancer:
- Over 100 chemotherapy drugs are available, administered orally or intravenously.
- Used alone or in combination with other treatments.
- Aims to eradicate cancer cells, control tumor size, and alleviate symptoms.
- Can be used as adjuvant therapy (after surgery) or neoadjuvant therapy (before surgery).
- Systemic treatment that affects the whole body.
- Affects both normal and cancerous cells, particularly those with rapid turnover (e.g., bone marrow, hair follicles, GI mucosa).
- Severity of side effects depends on various factors.
-
Radiation therapy uses electromagnetic rays to destroy cancer cells:
- Commonly applied to the cancerous tumor.
- Purposes include curative, adjuvant, therapeutic, and palliative.
- Often used alongside surgery and/or chemotherapy.
- Side effects are usually localized to the treated area.
- Side effects may appear within a week or two of treatment and resolve within a few weeks after treatment completion.
- Late effects can occur months or even years later.
-
Immunotherapy (biotherapy) helps the body's immune system fight cancer:
- Active immunotherapy stimulates the immune system.
- Passive immunotherapy uses lab-made immune system components.
- Works by destroying cancer cells through various mechanisms.
- Side effects include fatigue, chills, fever, flu-like symptoms, and potentially impacting food intake.
-
Hematopoietic Stem Cell Transplant (HSCT) replaces damaged stem cells with healthy ones.
- Used primarily for hematologic and lymphoid cancers (e.g., leukemia, lymphoma).
- Stem cells can be sourced from the bone marrow, peripheral blood, or umbilical cord.
- Transplant types:
- Autologous: self-derived stem cells
- Allogeneic: donor-derived stem cells
Chemotherapy Side Effects
- Anemia
- Fatigue
- Nausea and vomiting
- Diarrhea
- Loss of appetite
- Mucositis
- Changes in taste and smell
- Xerostomia (dry mouth)
- Dysphagia (difficulty swallowing)
- Constipation
- Neutropenia (low white blood cell count)
- Immunosuppression
- Alopecia (hair loss)
Radiation Therapy Effects by Site
-
Central Nervous System (brain & spinal cord)
- Acute Effects: nausea, vomiting, fatigue, loss of appetite, hyperglycemia
- Late Effects: headache, lethargy
-
Head and Neck (tongue, larynx, pharynx, oropharynx, nasopharynx, tonsils, salivary glands)
- Acute Effects: xerostomia, mucositis, sore mouth/throat, thick saliva, dysphagia, odynophagia, altered taste and smell, fatigue, loss of appetite
- Late Effects: mucosal atrophy/dryness, salivary gland dysfunction (xerostomia, fibrosis), trismus (jaw stiffness), osteoradionecrosis (bone death), altered taste and smell
-
Thorax (esophagus, lung, breast)
- Acute Effects: esophagitis, dysphagia, odynophagia, heartburn, fatigue, loss of appetite
- Late Effects: esophageal fibrosis, stenosis, stricture, ulceration; cardiac angina, pericarditis, enlargement; pulmonary dry cough, fibrosis, pneumonitis
-
Abdomen and Pelvis (stomach, ovaries, uterus, colon, rectum)
- Acute Effects: nausea, vomiting, changes in bowel function (diarrhea, cramping, bloating, gas), changes in urinary function (increased frequency, burning sensation), acute colitis or enteritis, fatigue, loss of appetite
- Late Effects: diarrhea, malabsorption, maldigestion, chronic colitis or enteritis, intestinal stricture, ulceration, obstruction, perforation, fistula; urinary hematuria, cystitis
- Late effects occur more than 90 days after treatment*
Hematopoietic Stem Cell Transplant (HSCT)
- A procedure where stem cells are harvested, surgically (bone marrow) or apheresis, and then infused after a conditioning regimen.
- Conditioning regimen consists of high-dose chemotherapy and/or total body irradiation (TBI).
- Purpose of conditioning regimen: to provide sufficient immunosuppression to prevent rejection and eradicate malignant cells.
- Toxicities associated with HSCT: from chemotherapy, TBI, graft rejection (GVHD), and infectious complications due to immunosuppression.
- Energy and protein requirements: 30-35 kcal/kg and 1.5 g protein/kg for the first 1-3 months after transplant.
Nutritional Implications of HSCT
- Goal: Patients are well nourished before the transplant.
- First few weeks: Typically enteral nutrition (EN) or parenteral nutrition (PN), with TPN used often as GI tract is compromised.
- PO diet: Bland and soft solids, bland liquids. No strong flavored, acidic or spicy foods.
- Toxicities of immunosuppression: Can last 2-4 weeks and cause nausea, vomiting, anorexia, dysgeusia, stomatitis, oral and esophageal mucositis, fatigue, and diarrhea.
- Dietary precautions with neutropenia: Food safety is crucial, due to weakened immune system.
Graft Versus Host Disease (GVHD)
- Major complication after allogenic (genetically different donor) transplants.
- Mechanism: The recipient’s body identifies the transplanted marrow as foreign and attacks it.
- Symptoms: Damage to the liver, skin, mucosa, and GI tract
- Acute GI GVHD: Secretory diarrhea, abdominal pain, nausea/vomiting
- Treatment of Acute GI GVHD: Immunosuppressive medications, IV corticosteroids
- Chronic GVHD: Develops within 3 months after transplant.
- Symptoms of Chronic GVHD: Can affect skin, oral mucosa (ulcerations, stomatitis, xerostomia), GI tract (anorexia, reflux symptoms, diarrhea) and can lead to weight changes.
-
MNT for acute GI GVHD:
- Total bowel rest until diarrhea resolves.
- When PO diet begins, use low residue, lactose-free oral feedings.
- Gradually introduce low-fiber, low-lactose, low-fat and low-acidity solid foods as tolerated.
- Progressively reduce dietary restrictions as tolerance increases.
- Eventually, progress to a normal diet.
Nutrition Related Effects of Surgery in Cancer Treatment
- Oral cavity: difficulty with chewing and swallowing, aspiration potential, sore mouth and throat, xerostomia, alteration in taste and smell
- Esophagus: gastroparesis, indigestion, acid reflux, alterations in normal swallowing, dysphagia, decreased motility, anastomotic leak
- Lung: shortness of breath, early satiety
- Stomach: dumping syndrome, dehydration, early satiety, gastroparesis, fat malabsorption, vitamin and mineral malabsorption (B12, vit D, Ca, Fe)
- Gallbladder, bile duct: fluid and electrolyte imbalance, gastroparesis, hyperglycemia, vitamin and mineral malabsorption (vitamins A, D, E, and K; Mg, Ca, Zn, Fe)
- Liver: hyperglycemia, hypertriglyceridemia, fluid and electrolyte malabsorption, vitamin & mineral malabsorption (vitamins A, D, E, K, B12; Ca, Zn, Fe)
- Small bowel: lactose intolerance, bile acid depletion, diarrhea, fluid & electrolyte imbalance, vitamin & mineral malabsorption (vits A, D, E, K, B12; Ca, Zn, Fe)
- Colon and rectum: increased transit time, diarrhea, bloating, cramping, gas, fluid and electrolyte imbalance, vitamin & mineral malabsorption (B12, Na, K, Mg, Ca)
- Ovaries and uterus: early satiety, bloating, cramping, gas
- Brain: nausea, vomiting, hyperglycemia associated with corticosteroids
Complementary and Alternative Therapies
- Whole medical systems: Chinese medicine, homeopathy, naturopathy
- Mind-body interventions: Mindfulness, meditation
- Biologically based therapies: Botanicals, dietary supplements, vitamins, minerals
- Manipulative and body-based methods: Massage, yoga, reflexology
- Massive megavitamin therapy
- Dietary restrictions: Majority not evidence-based.
Energy Requirements
- Calorie needs vary based on nutritional status, type and stage of cancer, type of treatment, and other medical conditions.
- Indirect calorimetry: Gold standard to determine needs.
- Standardized equations: Based on facility standards or available data -- increased stress factors should be considered.
-
Patient types and estimated energy needs:
- Cancer, general: 25-35kcal/kg; >30kcal/kg with weight loss
- Non-stressed, normal weight: 25-30kcal/kg
- Non-stressed, obese: 21-25kcal/kg, no clear consensus
- Slightly hypermetabolic; those needing to gain weight; anabolic patients: 30-35kcal/kg
- Hypermetabolic or severely stressed; patients with malabsorption: >35kcal/kg
- Hematopoietic cell transplant: 30-35kcal/kg
Protein Requirements
-
Consider degree of malnutrition, extent of disease, degree of stress, and ability to metabolize and use protein.
-
General:
- Non-stressed: 1-1.5 g Pro/kg
- Stressed: 1.5-2.5 g Pro/kg
-
Patient types and estimated protein needs:
- Normal, maintenance : 0.8-1.0g/kg
- Non-stressed cancer patient: 1.0-1.2g/kg
- Nutritional repletion, weight gain: 1.0-1.5g/kg
- Hypermetabolic, stressed cancer patient: 1.5-2.5g/kg
- Hematopoietic stem cell transplant: >1.5g/kg
Fluid Requirements
-
Estimated fluid needs:
- Age-based:
- 20-55 years of age: 30-35ml/kg
- 55-75 years of age: 25-30ml/kg,
-
75 years of age: 20-25 mL/kg
- Daily Baseline needs: 1 mL fluid/kcal of estimated needs.
- Holliday-Seger method: >20 kg of body weight = 1500 mL +20 mL/kg for each kg >20 kg.
- Age-based:
- Take fluid losses into consideration (I/O).
Micronutrient Requirements
-
Micronutrients:
- Regular foods preferred if possible.
- If intake is inadequate, provide a multivitamin to meet 100% DRI.
- Pre-existing deficiencies: May require supplement.
-
Effect on treatment:
- Antioxidants with chemotherapy --?
Calcium
- Hypercalcemia can occur in bone metastasis.
- This is caused by the osteolytic activity of tumor cells releasing calcium into the extracellular fluid.
- It can be fatal.
- Treatment for hypercalcemia involves medications.
- There's little need to restrict intake of foods containing calcium as it has minimal effect on management.
- Calcium supplements should be avoided.
Symptom Management
- Anorexia, Poor appetite, Early satiety: Encourage frequent energy-dense snacks and meals.
- Anorexia, Poor appetite, Early satiety: Consume liquids between meals.
- Anorexia, Poor appetite, Early satiety: Educate on ways to add protein and calories to favorite foods.
- Anorexia, Poor appetite, Early satiety: Utilize oral nutrition supplements between meals.
- Anorexia, Poor appetite, Early satiety: Add calorie-dense smoothies and beverages.
- Anorexia, Poor appetite, Early satiety: Maximize intake when appetite is most normal.
- Anorexia, Poor appetite, Early satiety: Suggest eating meals in a pleasant environment.
- Anorexia, Poor appetite, Early satiety: Avoid noxious odors and ensure good ventilation in the eating area.
- Anorexia, Poor appetite, Early satiety: Encourage daily living activities and physical activity as tolerated.
- It's ideal to have favorite foods available when feeling good.
Strategies to Increase Calories and Protein
- Consume small, frequent meals and snacks six to eight times per day.
- Avoid "skim" or "low-fat" foods.
- Keep easy-to-eat, high protein snacks readily available, like nuts, seeds, nut butters on crackers, hard-boiled eggs, and yogurt.
- Encourage consumption of energy-dense meals.
- Add butter, margarine, oils, sour cream, salad dressing, peanut butter, avocado, hummus, mayonnaise, or cheese.
- For example, add cream or yogurt to soups, peanut butter to oatmeal, avocado to sandwiches, dried fruit or nuts to cereal.
- Drink calorie-dense liquids between meals.
- Examples include regular milk, soy milk, oral nutrition supplements like Ensure and Boost.
- Think about adding milk powder to milk for "double protein."
- Try peanut butter additions to chocolate or vanilla shakes.
- Consider making a fruit smoothie with whole milk or cream.
- Other options include fruit nectars or fruit shakes.
Oral Nutrition Supplements
- There are numerous oral supplement options.
- Boost (Nestle) and Ensure (Abbott) offer many different versions, including Ensure, Ensure Plus, Ensure Enlive, Ensure Compact, Boost, Boost Plus, and Boost Very High Calorie.
- Some products are specialized for specific needs, such as Glucerna (diabetes) and Nepro (renal).
- Clear liquid options include Ensure Clear and Boost Breeze, while pudding versions are available as Ensure Pudding and Boost Pudding.
- Modified consistency choices include Magic Cup (frozen dessert) and Gelatin Plus/20.
- Other supplement brands include Orgain (organic), Enu (meal replacement), Compleat (blenderized), Kate Farms (plant-based), OWYN (vegan), Impact Advanced Recovery, and modular choices like Benecalorie and Beneprotein.
Appetite Stimulants
- These are medications that promote appetite.
- They include corticosteroids, megesterol acetate (Megace), medroxyprogesterone acetate, dronabinol (Marinol), and Remeron (anti-depressant).
Symptom Management
- Nausea & vomiting: Encourage small, frequent meals and snacks as tolerated.
- Nausea & vomiting: Offer dry foods like crackers and toast throughout the day.
- Nausea & vomiting: Sip on cool or room temperature clear liquids.
- Nausea & vomiting: Avoid high-fat, greasy, spicy, or overly sweet foods.
- Nausea & vomiting: Avoid foods with strong odors.
- Nausea & vomiting: Focus on bland, soft, easy to digest foods during treatment days.
- Nausea & vomiting: Medications can be prescribed to help control nausea.
- Nausea & vomiting: Ginger tea may offer some relief.
- Fatigue: Recommend small, frequent meals and snacks.
- Fatigue: Suggest intake of easy-to-prepare, easy-to-eat foods.
- Fatigue: Advise keeping nutrient-dense snacks close at hand, snack frequently.
- Fatigue: Keep oral nutrition supplements at bedside.
- Fatigue: Suggest eating when appetite is best.
- Diarrhea: Encourage adequate hydration.
- Diarrhea: Recommend binding foods like applesauce, bananas, white rice or pasta, peanut butter, white toast, and potatoes without skin.
- Diarrhea: Avoid high-fiber foods (insoluble fiber).
- Diarrhea: Avoid sugar alcohols found in sugar-free candies or gum.
- Diarrhea: Evaluate for fat malabsorption or intolerance.
- Diarrhea: Medications can be prescribed to help control diarrhea.
- Constipation: Increase intake of high-fiber foods.
- Constipation: Consume at least 64 ounces of fluids daily.
- Constipation: Consider probiotic containing foods or supplements occasionally.
- Constipation: Encourage daily living activities and physical activity as tolerated.
- Constipation: Consider fiber supplements.
- Constipation: Medications can be prescribed to help with constipation.
- Sore throat, esophagitis: Intake of softer, moister foods with extra sauces, dressings, and gravies.
- Sore throat, esophagitis: Avoidance of dry, coarse, rough foods.
- Sore throat, esophagitis: Avoid alcohol, citrus, caffeine, tomatoes, vinegar, and hot pepper.
- Sore throat, esophagitis: Experiment with different food temperatures (warm, cool, icy) to find the most soothing.
- Sore throat, esophagitis: Medications may be prescribed to manage esophagitis or pain during swallowing.
- Sore mouth, mucositis, or oral thrush: Recommend good oral hygiene (frequent rinsing, keep the mouth clean).
- Sore mouth, mucositis, or oral thrush: Intake of softer, moister foods with extra sauces, dressings, and gravies.
- Sore mouth, mucositis, or oral thrush: Suggest eating foods at room temperature or chilled, cool.
- Sore mouth, mucositis, or oral thrush: Avoid dry, coarse, rough foods.
- Sore mouth, mucositis, or oral thrush: Avoid foods that irritate the mouth like citrus, spicy, and salty foods.
- Sore mouth, mucositis, or oral thrush: Medications may be prescribed to manage oral pain or infection.
Severe Oral Mucositis
- Requires specialized nutrition management to address severe oral pain and discomfort.
Symptom Management
- Xerostomia, dry mouth: Suggest sipping on liquids throughout the day to keep the oral cavity moist.
- Xerostomia, dry mouth: Try tart foods to stimulate saliva - if open sores are not present.
- Xerostomia, dry mouth: Alternate bites of food with sips of liquids during meals.
- Xerostomia, dry mouth: Eat softer, moister foods with extra sauces, dressings, and gravies.
- Xerostomia, dry mouth: Avoid alcoholic beverages or alcohol-containing mouthwash.
- Xerostomia, dry mouth: Recommend good oral hygiene (frequent rinsing, keep the mouth clean).
- Xerostomia, dry mouth: Use a cool mist humidifier while sleeping.
- Thickened saliva: Suggest sipping on liquids throughout the day to keep the oral cavity moist.
- Thickened saliva: Thin oral secretions with club soda or seltzer water.
- Thickened saliva: Use a cool mist humidifier while sleeping.
- Dysguesia: Use more spices and flavorings.
- Dysguesia, altered taste or smell: Use marinades.
- Dysguesia, bitter taste: Add condiments to enhance flavor.
- Dysguesia, metallic taste: Adjust food temperatures as some foods may taste better when cool or warm rather than at room temperature.
- Dysguesia, metallic taste: Try sour or salty foods, extreme flavors.
- Dysguesia, metallic taste: Use plastic utensils to avoid the metallic taste.
- Dysguesia, metallic taste: Recommend good oral hygiene (frequent rinsing, keep the mouth clean).
- Dysguesia, metallic taste: Rinse mouth before meals when metallic or strange tastes occur.
- Dysguesia, metallic taste: Food presentation can make a difference.
- Dysguesia, metallic taste: Choose poultry, fish and eggs instead of meats.
Symptom Management
- Neutropenia: Advise frequent hand washing and keep kitchen surfaces and utensils clean.
- Neutropenia: Avoid raw or undercooked animal products, including meat, pork, poultry, eggs, and fish; stick to pasteurized dairy.
- Neutropenia: Cook food thoroughly (heat food above 140°F).
- Neutropenia: Wash all fruits and vegetables thoroughly before consumption.
- Neutropenia: Avoid items that cannot be washed thoroughly.
- Neutropenia: Discard perishable foods left at room temperature for longer than 2 hours.
- Neutropenia: Avoid leftovers that are older than 2 days.
- Neutropenia: Avoid any spoiled or moldy foods.
- Neutropenia: When in doubt about whether or not a food is spoiled, err on the side of caution.
- Neutropenia: Be cautious when dining out (avoid salad bars, fountain beverages, etc.).
- Neutropenia: Watch out for cross-contamination.
Nutrition Support
- Enteral nutrition: Consider EN if nutritional counseling and pharmacological interventions for enhancing oral intake have failed.
- Enteral nutrition: EN has fewer complications than parenteral nutrition support and is known to preserve gut integrity.
- Enteral nutrition: Some cancer types, like head and neck cancer and GI malignancies, have a higher need for and benefit from EN support.
- Enteral nutrition: For uncomfortable GI fullness, more concentrated formulas (2 kcal/mL) can be used to get more nutrients with less volume.
- Parenteral nutrition: Use when aggressive nutrition support is a part of the medical care plan and enteral nutrition is contraindicated.
Nutrition Support
- The use of enteral and parenteral nutrition support in patients with advanced incurable cancer is controversial.
- It's not indicated if the estimated survival is less than 3 months.
- Families may find it difficult to discontinue support.
- Consider:
- Patient or family wishes.
- Potential risks versus benefits.
- Estimated survival.
- A.S.P.E.N. (American Society for Parenteral and Enteral Nutrition) provides guidelines and recommendations for nutrition support in cancer patients.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
