For patients undergoing cancer treatment, the stress and anxiety of the diagnosis itself may challenge one’s appetite.  When treatment-related symptoms are also factored in, however, keeping patients well-nourished can be difficult. 

Up to 85% of patients with cancer develop clinical malnutrition, but the good news is that being well-nourished can lead to a better prognosis.1

Current Recommendations

Nutritional assessment is important for all patients, especially those who have been diagnosed with cancer but do not necessarily exhibit symptoms. The National Cancer Institute (NCI) recommends conducting an assessment of the patient’s nutritional status at the point of diagnosis, as the outcome of cancer treatment can be negatively affected by poor nutrition.2

This assessment should begin by evaluating the patient’s eating habits before the diagnosis, the types of food the patient typically ate prior to diagnosis, whether they had experienced a recent fluctuation in weight, or had gastrointestinal irregularities. This data can help the medical team learn what they can do to prevent or treat muscle and bone loss; and lessen the severity of side effects from treatment.2

While NCI has developed basic nutritional guidelines for patients, the information is broad so it is important to learn how different cancer types may affect the ability of a patient to digest food and absorb nutrients; this is of particular importance for those individuals with gastrointestinal cancers.3

Nutrition Changes in Patients with Cancer

Once treatment begins, many patients may experience a change in appetite. Even if the appetite of the patient is or was good, there are several treatment-related symptoms that may make eating difficult; these include, but are not limited to, dry mouth, mouth sores, nausea, trouble swallowing, emesis, diarrhea, or constipation.2

Often times, food that a patient is used to eating may become unpalatable during cancer treatment, making it more difficult for patients to maintain their normal eating habits. A recent study in Cancer looked at how patients with head and neck cancer or esophageal cancer tolerated enteral nutrition formula. The aim of the study was to see if there was a change in body cell mass following chemoradiotherapy (CRT), and also to determine if there were changes in body composition and nutritional and functional status.4 

The 111 patents who underwent concurrent CRT received either an enteral standard nutrition or disease-specific enteral nutrition Supportan®-containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) via percutaneous endoscopic gastrostomy. The study concluded that enteral nutrition with EPA and DHA may be advantageous in patients with these cancer types by improving nutritional and functional status during CRT.4

Patients with later stages of cancer may experience anorexia and cachexia, both of which are very common. Not only is the desire to eat diminished— if not gone entirely—but the severe weight loss and muscle loss can increase physical weakness, making mobility difficult for the patient.5 Typical features of cachexia include loss of body weight, fat and muscle, which in turn may increase morbidity and mortality.3

This is just one of many reasons why members of the healthcare team can play an important role in keeping patients not only fed but well-nourished. Patients who have a loss of appetite may need extra encouragement to take fluids and continue eating regular meals or nutritional supplements, which may help alleviate some of the nutritional deficiencies associated cancer treatment. 2

The outcomes of additional studies, similar to the one mentioned earlier, will help patients know what their options are when undergoing cancer treatment, while highlighting the importance of the nutritional assessment at the point of diagnosis.


References

1. Davies, M. Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9 Suppl 2:S64-73.

2. The National Cancer Institute. Nutrition in Cancer Care. http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/Patient/page1. Last accessed July 11, 2013

3. Alberici Pastore C, Paiva Orlandi S, González MC. Association between an inflammatory-nutritional index and nutritional status in cancer patients. Nutr Hosp. 2013 January-February;28(1):188-193.

4. Fietkau R, Lewitzki V, Kuhnt T, et al. A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: Results of a randomized, controlled, multicenter trial. Cancer. 2013 Jun 13. doi: 10.1002/cncr.28197. [Epub ahead of print]

5. Valenzuela-Landaeta K, Rojas P, Basfi-fer K. Nutritional assessment for cancer patient. Nutr Hosp. 2012 Mar-Apr;27(2):516-23.