Oncology
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Questions and Answers

What is the estimated fluid requirement for a 60-year-old individual weighing 70 kg?

  • 1800 mL
  • 2000 mL
  • 2300 mL
  • 2100 mL (correct)

    • Which method calculates fluid needs based on body weight exceeding 20 kg?

  • Age-based requirement
  • Holliday-Seger method (correct)
  • Daily Baseline method
  • Fluid loss calculation

    • What should be considered in fluid requirements besides age?

  • Type of exercise
  • Dietary fiber intake
  • Fluid losses (correct)
  • Body temperature

    • What is the recommended approach when micronutrient intake is inadequate?

    <p>Provide a multivitamin to meet 100% DRI</p> Signup and view all the answers

    What potential effect should be considered regarding the use of antioxidants?

    <p>They may interfere with chemotherapy treatment</p> Signup and view all the answers

    What is one way that lab-made antibodies stimulate an immune response against cancer cells?

    <p>Triggering cell apoptosis</p> Signup and view all the answers

    Which of the following cancers is primarily treated with Hematopoietic Stem Cell Transplant (HSCT)?

    <p>Chronic leukemia</p> Signup and view all the answers

    What types of stem cells are used in Hematopoietic Stem Cell Transplant (HSCT)?

    <p>Hematopoietic stem cells from bone marrow and peripheral blood</p> Signup and view all the answers

    What is a potential adverse outcome of receiving lab-made antibodies for cancer treatment?

    <p>Flu-like symptoms</p> Signup and view all the answers

    Which type of stem cell source is known as autologous in HSCT?

    <p>Stem cells from the individual undergoing the transplant</p> Signup and view all the answers

    What is the primary cause of malnutrition in cancer patients?

    <p>Host response to the tumor</p> Signup and view all the answers

    Which of the following is a common side effect of chemotherapy?

    <p>Alopecia</p> Signup and view all the answers

    What distinguishes neoadjuvant chemotherapy from adjuvant chemotherapy?

    <p>Neoadjuvant is given prior to surgery.</p> Signup and view all the answers

    How does radiation therapy primarily affect cancer cells?

    <p>By destroying cancer cells with electromagnetic rays</p> Signup and view all the answers

    What is a late effect of radiation therapy directed at the head and neck region?

    <p>Mucosal atrophy and dry mouth</p> Signup and view all the answers

    Which of the following treatments is classified as systemic therapy?

    <p>Chemotherapy</p> Signup and view all the answers

    What symptom might indicate early eating difficulties in cancer patients?

    <p>Anorexia</p> Signup and view all the answers

    Diminished gastric emptying can lead to which symptom in cancer patients?

    <p>Early satiety</p> Signup and view all the answers

    The use of corticosteroids in cancer treatment is primarily associated with which acute effect?

    <p>Hyperglycemia</p> Signup and view all the answers

    Which of the following best describes passive immunotherapy?

    <p>It uses immune system components to fight cancer.</p> Signup and view all the answers

    Which treatment modality is often combined with radiotherapy for enhanced effectiveness?

    <p>Chemotherapy</p> Signup and view all the answers

    What is the primary treatment purpose of high-dose chemotherapy and total body irradiation in HSCT?

    <p>To provide sufficient immunosuppression and eradicate malignant cells</p> Signup and view all the answers

    Which dietary strategy should be adopted for a patient experiencing acute GI GVHD?

    <p>Provide total bowel rest until diarrhea is reduced</p> Signup and view all the answers

    What is a common symptom associated with immunotherapy?

    <p>Fatigue</p> 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?

    <p>30-35 kcal/kg</p> Signup and view all the answers

    What is the primary aim of adjuvant chemotherapy?

    <p>To kill cancer cells that were missed during surgery.</p> Signup and view all the answers

    What type of food is recommended for the oral diet post-transplant, considering potential mucositis and stomatitis?

    <p>Bland and soft solids or bland liquids</p> 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?

    <p>Increased energy levels</p> Signup and view all the answers

    What type of surgery is performed to remove tumors causing spinal cord compression?

    <p>Palliative surgery</p> Signup and view all the answers

    In assessing energy needs for cancer patients, which factor is least influential?

    <p>Patient's age</p> Signup and view all the answers

    Which is an inflammatory condition of the mouth that can occur as a result of treatment for cancer?

    <p>Stomatitis</p> Signup and view all the answers

    What should be included in a patient's diet when they experience neutropenia post-transplant?

    <p>Food safety precautions and cooked foods</p> 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?

    <p>It is a slow-developing condition.</p> Signup and view all the answers

    Which factor affects protein requirements in cancer patients the most?

    <p>Degree of stress</p> Signup and view all the answers

    During what period after a hematopoietic stem cell transplant should patients consume greater than 1.5g protein/kg?

    <p>First month after transplant</p> Signup and view all the answers

    Among the following options, which is characterized by the functional immune cells recognizing the recipient as 'foreign'?

    <p>Graft Versus Host Disease (GVHD)</p> Signup and view all the answers

    What is a consequence of surgical interventions in cancer treatments affecting the stomach?

    <p>Dehydration and fat malabsorption</p> Signup and view all the answers

    Which treatment is recommended for managing hypercalcemia in patients with bone metastasis?

    <p>Avoid calcium supplements</p> Signup and view all the answers

    What nutritional strategy should be employed to help manage early satiety?

    <p>Add protein and calories to favorite foods</p> Signup and view all the answers

    Which food group should be avoided in managing diarrhea?

    <p>High-fiber foods</p> Signup and view all the answers

    What is a key recommendation for a patient experiencing nausea and vomiting?

    <p>Focus on bland, soft foods on treatment days</p> Signup and view all the answers

    What is the recommended source of nutrition when enteral nutrition is not viable?

    <p>Parenteral nutrition</p> Signup and view all the answers

    Which of the following strategies should be employed for managing constipation?

    <p>Increase hydration and fiber intake</p> Signup and view all the answers

    Which of the following is NOT an appropriate strategy for managing xerostomia?

    <p>Using alcoholic mouth wash for hygiene</p> Signup and view all the answers

    What is a common characteristic of appetite stimulants used for managing patients' dietary intake?

    <p>They include corticosteroids</p> Signup and view all the answers

    How can protein and calorie intake be maximized during treatment times?

    <p>Providing frequent snacks and using nutrient-dense foods</p> Signup and view all the answers

    Which type of oral nutrition supplement is specifically designed for patients with diabetes?

    <p>Glucerna</p> Signup and view all the answers

    Which is the best strategy for managing thickened saliva?

    <p>Use a humidifier while sleeping</p> Signup and view all the answers

    What is a main concern when considering enteral nutrition in advanced cancer patients?

    <p>Survival is generally short (&lt; 3 months)</p> Signup and view all the answers

    Which strategy is recommended for improving food intake in patients experiencing fatigue?

    <p>Keep nutrient-dense snacks close at hand</p> 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.
    • 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.
    • 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.

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