Nutrition-related side effects may occur or become worse as cancer becomes more advanced.
The following are the most common nutrition -related symptoms in patients who have advanced cancer:
- Weight loss of more than 10% of normal body weight
- Feeling too full to eat enough food
- Dry mouth
- Taste changes
- Inability to swallow
The usual treatment for these problems in patients with advanced cancer is palliative care to reduce the symptoms and improve the quality of life.
The goal of palliative care is to improve the quality of life of patients who have a serious or life-threatening disease. It involves the prevention or early treatment of symptoms, side effects, and psychological, social, and spiritual problems caused by a disease or its treatment.
Palliative care includes nutrition and/or drug therapy.
Eating less solid food is common in advanced cancer. Patients usually prefer soft foods and clear liquids. Those who have problems swallowing may do better with thick liquids than with thin liquids. Terminally ill patients often do not feel much hunger at all and may be satisfied with very little food.
When cancer is advanced, food should be viewed as a source of enjoyment. Eating should not just be about calories, protein, and other nutrient needs.
Dietary restriction is not usually necessary, as intake of "prohibited foods" (such as sweets for a patient with diabetes) is not enough to be of concern. Some cancer patients, however, may need certain diet restrictions. For example, patients who have pancreatic cancer, uterine cancer, ovarian cancer, or another cancer affecting the abdominal area may need a soft diet (no raw fruits and vegetables, no nuts, no skins, no seeds) to prevent a blockage in the bowel. Diet restrictions should be considered in terms of quality of life and the patient’s wishes.
The benefits and risks of nutrition support vary for each cancer patient.
Decisions about using nutrition support should be made with the following considerations:
- Will quality of life be improved?
- Do the possible benefits outweigh the risks and costs?
- Is there an advanced directive? An advanced directive is a written instruction about the provision of health care or power of attorney in the event an individual can no longer make his or her wishes known.
- What are the wishes and needs of the family?
Cancer patients and their caregivers have the right to make informed decisions. The healthcare team, with guidance from a registered dietitian, should inform cancer patients and their caregivers about the benefits and risks of using nutrition support in advanced disease. In most cases, the risks outweigh the benefits. However, for someone who still has good quality of life but also physical barriers to achieving adequate food and water by mouth, enteral feedings may be appropriate. Parenteral support is not usually appropriate. Advantages and disadvantages of enteral nutrition include the following:
- May improve alertness.
- May provide comfort to the family.
- May decrease nausea.
- May decrease hopelessness and fears of abandonment.
- May cause diarrhea or constipation.
- May increase nausea.
- Requires surgery for the placement of a tube through the abdomen.
- Increases risk of choking or pneumonia.
- Increases risk of infection.
- Creates a greater burden on the caregiver.
Cancer patients may be treated with a number of drugs throughout their care. Some foods or nutritional supplements do not mix safely with certain drugs. The combination of these foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information on some of the drug-nutrient interactions that may occur with certain anticancer drugs:
Some herbs do not mix safely with certain drugs or foods. The combination of some herbs with certain foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information about herbs commonly taken by cancer patients. The information provided covers known interactions only; additional side effects are possible for these herbs. A pharmacist or updated herbal supplement references may provide more information.
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