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Nutritional Strategies for Managing Side Effects During Cancer Treatment. Presentation Agenda. Importance of nutrition Prevalence of side effects Nutritional strategies. Feel better Fight fatigue Maintain body weight and nutrient stores.

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  1. Nutritional Strategies for Managing Side Effects During Cancer Treatment

  2. Presentation Agenda • Importance of nutrition • Prevalence of side effects • Nutritional strategies

  3. Feel better Fight fatigue Maintain body weight and nutrient stores Improve strength and energy Reduce risk of infection Manage side effects Improve quality of life Good Nutrition Is Important • Good nutrition can help people to: • Cancer deaths: Up to half are malnourished1 and 20% die from malnutrition rather than cancer2 • Capra S, Bauer J, Davidson W, Ash S: Nutritional therapy for cancer-induced weight loss. Nutr Clin Pract 2002;17(4):210-213. • 2. Ottery FD: Cancer cachexia: Prevention, early diagnosis, and management. Cancer Pract 1994;2:123-131.

  4. People With CancerNeed Extra Nutrition • Levine JA, Morgan MY: Preservation of macronutrient preferences in cancer anorexia. Br J Cancer 1998;78(5):579-581.

  5. Prevalence of Side Effects =Treatment in which side effect is common

  6. Weight Loss Is Significant • 50% – 90% of people with cancer experience weight loss1 • A weight loss of as little as 5% of body weight can cause reduced response to treatment2 • Weight loss is associated with poor quality of life and reduced survival3 • Dewys WD, Begg C, Lavin PT, et al (Eastern Cooperative Oncology Group): Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 1980;69:491-497. • Andreyev HJ, Norman AR, Oates J, Cunningham D: Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998;34(4):503-509. • Davidson W, Ash S, Capra S, et al: Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr 2004;23(2):239-247.

  7. Infections & Medications Mouth sores Diarrhea Decreased appetite Eat less Too tired to eat CYCLE OFMALNUTRITION Lose weight Too tired to cook Lose strength Tire out quickly Cycle of Malnutrition

  8. Weight Loss: Patients With Cancer Dewys WD, Begg C, Lavin PT, et al (Eastern Cooperative Oncology Group): Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 1980;69:491-497.

  9. Nutritional Strategies for Weight Loss • Recommend small, frequent meals • Suggest eating favorite foods • Encourage physical activity to stimulate appetite • Recommend medical nutritional shakes and drinks for caloric/protein density

  10. Fatigue Is Common • Fatigue is most common side effect • Fatigue is associated with treatment, pain, stress, and/or weight loss • Effect on nutritional status: • Weight gain/loss • Caloric intake changes • Fluid and electrolyte imbalances

  11. Nutritional Strategies for Fatigue • Recommend small, frequent meals • Encourage preparation of meals in quantity when feeling well • Suggest easy-to-prepare foods • Recommend ready-to-serve medical nutritional shakes for convenience

  12. Nausea/Vomiting Can Impact Nutritional Status • Common side effect, especially with chemotherapy and radiation • Effect on nutritional status: • Dehydration/electrolyte imbalance • Loss of appetite • Inability to consume adequate food and fluid • Food aversions • Weight loss

  13. Nutritional Strategies for Nausea/Vomiting • Recommend small, frequent meals • Encourage cold foods, ice chips, dry foods, and room-temperature foods • Discourage greasy, fatty, or spicy foods, strong food odors, very sweet foods, hot foods, drinking liquids with meals • Discourage favorite foods around treatment times

  14. Oral Mucositis • Inflammation of the mucous membranes; red, burn-like sores and ulcers • Effect on nutritional status: • Decreased dietary intake • Dehydration • Malnutrition and weight loss

  15. Nutritional Strategies for Oral Mucositis • Encourage selection of soft foods • Suggest drinking through a straw to make swallowing easier • Recommend that patients avoid acidic, spicy, and dry foods

  16. Taste Alterations Are Significant • Mouth blindness — bitter/metallic taste • Meat aversions • Reduced ability to taste salt and sugar • Effect on nutritional status: • Food aversions • Loss of appetite • Decreased dietary intake, especially of protein • Weight loss

  17. Nutritional Strategiesfor Taste Alterations • Recommend use of tart or sour foods to reduce metallic taste • Suggest use of herbs to season foods • Encourage serving foods cold or at room temperature

  18. Constipation • Constipation is common, especially among people taking opioid analgesics • Effect on nutritional status: • Loss of appetite • Decreased dietary intake • Weight loss

  19. Nutritional Strategies for Constipation • Recommend high-fiber foods • Encourage drinking plenty of fluids • Emphasize the importance of adequate exercise • Suggest avoiding or limiting gas-forming foods and beverages

  20. Summary • Nutritional status is critical during cancer and its treatment • Treatment-related side effects are common • Nutritional strategies can help manage many side effects

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