Nutrition support for people living with cancer

– an oncology dietitian’s perspective

Whether personally or professionally, cancer has likely touched us all. It is no secret that people with cancer can face significant difficulties eating and drinking enough to maintain weight, hydration and overall nutritional status.

The challenges come from multiple fronts. Sometimes it’s mechanical, with the location of a cancer itself preventing adequate intake. Sometimes treatment-related side effects can impact upon a person’s ability to eat and drink; despite advancements in oncology treatments, with new chemotherapy agents, targeted therapies, surgical innovations and immunotherapy, side effects can be highly distressing. Some that impact oral intake include dysgeusia (taste alterations), mucositis, dysphagia, nausea, vomiting, xerostomia (dry mouth), pain, fatigue, anorexia, diarrhoea and constipation. Additionally, some of the treatments themselves can increase nutrition requirements, particularly for protein and energy. 

Medical nutrition therapy (MNT) is an evidence-based approach to managing chronic medical conditions using an individually-tailored nutrition intervention. The goal of MNT in the oncology patient is to reduce the impact of side effects and provide strategies to meet individual nutrition requirements, to minimise weight loss and the risk of malnutrition. A range of strategies are utilised, including food fortification, tailored dietary education, symptom management, oral nutrition supplement prescription, enteral nutrition and parenteral nutrition. 

When people are unable to meet their nutrition requirements with food alone, oral nutrition supplements (ONS) can be prescribed. These supplements are nutritionally dense, low volume drinks, and can provide up to 100% of nutrition requirements if required. Choosing the right product involves consideration of clinical requirement, taste, volume, viscosity, tolerance, palatability, patient preferences and nutritional density of the product. 

When people are unable to meet their nutrition requirements with food alone, oral nutrition supplements (ONS) can be prescribed. These supplements are nutritionally dense, low volume drinks, and can provide up to 100% of nutrition requirements if required. Choosing the right product involves consideration of clinical requirement, taste, volume, viscosity, tolerance, palatability, patient preferences and nutritional density of the product. 

Sometimes diet and ONS are still not adequate. In these cases, enteral and parenteral nutrition can be used. In some treatment modalities, provision of enteral or parental nutrition is standard practice and can be prescribed prior, during or postsurgery, chemotherapy or radiotherapy.

As you can see, nutrition is a major concern for those living with cancer. With such pressure on nutritional status, nutrition support is crucial in the management of people living with cancer. A Dietitian within the multidisciplinary team is paramount to optimise nutrition.

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