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Cancer: Nutritional
Strategies for Managing
Side Effects
During Treatment
Review Date 10/13 G-1505
Objectives
1. Importance of nutrition
2. Prevalence of side effects
3. Nutritional strategies
Good Nutrition
Is Important
• Good nutrition can help people with cancer:
–
–
–
–
–
–
–
–
Feel better
Fight fatigue
Maintain body weight
Consume enough vitamins and minerals
Improve strength and energy
Reduce risk of infection
Manage treatment-related side effects
Improve quality of life
People With Cancer
Need Extra Nutrition
Healthy Individual
Individual With Cancer
Calories
25-30 Cal/kg
Maintenance: 25-35 Cal/kg
Gain: 30-40 Cal/kg
Protein
0.8 g/kg
Maintenance: 1.5-2.5 g/kg
with severe stress
Healthy
Individual
Calories needed
per day for a
150-lb person
1703-2043
Individual With
Cancer
Maintenance: 1703-2383
Gain: 2043-2742
Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders;
2012:832-863.
Cal=Calorie, kg=kilogram, lb-pound
Prevalence
of Side Effects
Fatigue
Nausea/
Vomiting
Oral
Mucositis
Taste
Alterations
Constipation
50%90%
70%100%
30%90%
40%100%
35%70%
40%50%
Chemotherapy






Radiation





Surgery



Immunotherapy


Treatment
Overall %
Weight
Loss
= treatment in which side effect is common

Weight Loss
Is Significant
• 50%–90% of people with cancer
experience weight loss
• A weight loss of as little as 5% of body
weight can cause reduced response to
treatment
• Weight loss is associated with poor
quality of life and reduced survival
Cycle of Malnutrition
Infections and Medications
Mouth Sores
Decreased
Appetite
Diarrhea
Eat Less
Too Tired
to Eat
Too Tired
to Cook
CYCLE OF
MALNUTRITION
Tire Out Quickly
Lose
Weight
Lose Strength
Nutritional Strategies
for Weight Loss
• Eat small, frequent meals
• Serve favorite foods
• Plan physical activity to stimulate appetite
• Use medical nutritional shakes and drinks to
provide extra calories and protein
Fatigue Is Common
• Fatigue is most common side effect
• Associated with treatment, pain, stress,
and/or weight loss
• Effect on nutritional status:
– Weight gain/loss
– Changes in calorie intake
– Fluid and electrolyte imbalances
Nutritional Strategies
for Fatigue
• Have small, frequent meals
• Prepare meals in quantity when feeling well
• Make easy-to-prepare foods
• Use ready-to-serve medical nutritional
products for convenience and extra nutrition
Nausea/Vomiting
• Common with chemotherapy and radiation
• Effect on nutritional status:
– Dehydration/electrolyte imbalance
– Loss of appetite
– Poor intake of food and fluid
– Food aversions
– Weight loss
Nutritional Strategies
for Nausea/Vomiting
• Eat small, frequent meals and snacks
• Try cold foods, ice chips, dry foods, and
room-temperature foods
• Drink liquids between meals to avoid
feelings of fullness
Nutritional Strategies
for Nausea/Vomiting
• Avoid:
(cont’d)
– Greasy, fatty, or spicy foods
– Strong food odors
– Very sweet foods
– Hot foods
– Drinking liquids with meals
– Favorite foods around treatment time
Oral Mucositis
• Inflammation of the mucous
membranes; red, burnlike sores
and ulcers
• Effect on nutritional status:
– Decreased dietary intake
– Dehydration
– Malnutrition and weight loss
Nutritional Strategies
for Oral Mucositis
• Select soft foods
• Use a straw to make swallowing easier
• Avoid acidic, spicy, and dry foods
• Use high-calorie drinks and/or medical
nutritional supplements
Taste Alterations Are
Significant
• Mouth blindness—bitter/metallic taste
• Meat aversions
• Reduced ability to taste salt and sugar
Taste Alterations Are
Significant (cont’d)
• Effect on nutritional status:
– Food aversions
– Loss of appetite
– Decreased dietary intake, especially of
protein
– Weight loss
Nutritional Strategies
for Taste Alterations
• Use tart or sour foods to reduce metallic
taste
• Season foods with herbs
• Serve foods cold or at room temperature
Constipation
• Constipation is common, especially
among people taking opioid analgesics
• Effect on nutritional status:
– Loss of appetite
– Decreased dietary intake
– Weight loss
Nutritional Strategies
for Constipation
• Choose high-fiber foods
• Drink plenty of fluids
• Keep physically active if you are able
• Avoid or limit gas-forming foods
and beverages
Summary
• Nutritional status is critical during cancer
and its treatment
• Treatment-related side effects are common
• Nutritional strategies can help manage many
side effects
References
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.
Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer. J Palliat Care.
1991;7(2):25-29.
Davidson W, Ash S, Capra S, Bauer J; Cancer Cachexia Study Group. Weight stabilisation is associated
with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr.
2004;23(2):239-247.
Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer
patients: Eastern Cooperative Oncology Group. Am J Med. 1980;69(4):491-497.
Leonard M, Navari RM. Special Report: 5-HT3 Receptor Antagonists and ECG Effects. Philadelphia, PA:
McMahon; 2003.
Levine JA, Morgan MY. Preservation of macronutrient preferences in cancer anorexia. Br J Cancer.
1998;78(5):579-581.
References (cont’d)
Lin EM. In: Yasko JM, ed. Nursing Management of Symptoms Associated With Chemotherapy. 5th ed.
West Conshohocken, PA: Meniscus LTD; 2001.
Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis,
MO: Elsevier Saunders; 2012:832-863.
National Cancer Institute. Oral complications of chemotherapy and head/neck radiation (PDQ®), Health
Professional Version. Cancer.org Web site.
http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/HealthProfessional/page1.
Accessed October 17, 2013.
National Comprehensive Cancer Network. Cancer-related fatigue: clinical practical guidelines in oncology.
J Natl Comp Can Netw. 2003;1(3):308-331.
Ottery FD. Cancer cachexia: prevention, early diagnosis, and management. Cancer Pract. 1994;2(2):123131.
Prommer E. Taste alterations in cancer. Proc Am Soc Clin Oncol. 2003;769(abstract 3093).