Sunday, August 19, 2012

Dietary Management of some Cancer and Cancer Treatment Related Issues



Anemia

-Increase the intake of foods high in B-complex vitamins, vitamin C, protein and iron.  Long term supplemention of Iron is discouraged.   Small meals every few hours is advised.

Aversion to foods/Anorexia/Cachexia/Colder Food Preference

-Appetite stimulants and small feedings throughout the day are recommended.  If patient finds food to have a metallic taste, using plastic utensils, ginger ale and/or mint may help to mask that.  Try different seasonings.   If patient is found to have an aversion towards meat, encourage consumption of poultry, fish, legumes and dairy products.   Cleansing the palate with baking soda and water or salty water before meals may help.  Nutritional supplements to help increase nutrient intake can also be used.   Some patients may better tolerate colder food items. 

Dental cavities

-Being extra diligent about  good oral hygiene, avoidance of sweets, and the use of sodium fluoride three times a day is recommended to help prevent  cavities in cancer patients.

Constipation

-Increasing fluid and fiber intake as well as getting extra fiber into the diet can help.   Hot drinks and milk (if tolerated) are said to be helpful as well.

Diarrhea

-Patient should be encouraged to limit consumption of the following items:  sorbitol, sugar substitutes,  caffeine,  carbonated drinks,  and foods which are fatty, acidic, gas forming or spicy.  The patient should be monitored for development of  lactose intolerance due to the illness or associated therapies.  If patient is lactose intolerant, dairy products should be avoided.  Foods which may be helpful  for those suffering from diarrhea include  potato’s, skinless chicken, rice, and eggs.

Nausea/Vomiting

-Bland foods are recommended for patients  experiencing nausea.  Also small meals throughout the day and drinking fluids between meals can be helpful.  Extra hydration is also advised prior to and following chemotherapy treatments.  If patient is vomiting, following the episode patient should sip liquids every 10 to 15 minutes.  Additionally, “flat” carbonated drinks can provide some relief. 



Escott-Stump, S. Nutrition and Diagnoses-Related Care.  7th ed.  Philadelphia, PA: Lippincott, Williams and Wilkins:2012.

Sunday, August 12, 2012

MNT of Head and Neck Cancers


      The grouping, “Head and Neck Cancers,” is descriptive of the cancers found in the following areas: esophagus, lips, mouth, salivary glands, pharynx, nasal sinuses and lymph nodes.   Diets low in fruits, vegetables,  zinc, folate and selenium, as well as, obesity and tobacco use predisposes individuals to these cancers.   General symptoms of this type of diagnoses include voice changes, dysphagia, or persistent lump or sore throat that will not heal on it’s own.   Chemoradiotherapy ( a combination of chemotherapy and radiation) treatments are usually employed in the treatment of head and neck cancers.  The chemotherapeutic drugs Cisplatin, Carboplatin, and/or Taxol along with radiation is usually given over several weeks.  This type of therapy can lead to conditions like mucositis, odynophagia, and dysphagia which make it difficult to eat and therefore obtain the required nutrition to deal with these illnesses.   As such, the expertise of dietitians and speech pathologists in providing supportive care is invaluable in improving patients quality of life. 

     Prior to treatment, an RD should evaluate the patients nutritional status.   The main goal of nutrition therapy is to limit weight loss and help to prevent malnutrition.   It is highly recommended that these patients have a PEG feeding tube inserted prophylactically to help meet patients nutrient needs without disruption to the treatment plan.   Before the onset of treatment, patients are encouraged to gain weight via a high calorie and high protein diet.  As treatment progresses and symptoms resulting in poorer oral food intake take into effect, PEG feedings should be implemented to assist in meeting nutritional needs.   Tube feedings high in omega 3 fatty acids and arginine are recommended.   When and if food is being consumed orally, it is advised that patients follow a soft bland diet plan.  To help encourage oral food intake, fluids should be consumed between meals.  High calorie and high protein nutrition supplements  are recommended to improve nutritional intake.   As the treatment progresses, diet consistency will need to be downgraded to liquid or pureed consistency as required.   Eventually patients diet will be advanced as tolerated to soft and then to regular. 

     Patients should visit the speech pathologist before and after treatment is completed.   In so doing, patients will be educated on, “compensatory swallowing strategies,”  as well as electrical stimulation to improve swallowing as needed post treatment.    



 Cheek, B. Scott, MD, Eric Nadler, MD, MPP, Caroline Nickel, MS, CCC-SLP, and Andrea Nguyen, MS, RD, CSO, CNSC. "Head and Neck Cancer: A Multidisciplinary Approach to Treatment." New Frontiers in Oncology Symposium. Texas, Dallas. 27 Apr. 2012. Lecture.

Escott-Stump, S. Nutrition and Diagnoses-Related Care.  7th ed.  Philadelphia, PA: Lippincott, Williams and Wilkins:2012.