1 of 31

Course: Oncology Nursing

Topic: Nursing Management of Nutrition in Cancer Patient

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 31

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 31

Module Goals

Learners will be able to:

Recognize the importance of promoting nutrition for the cancer patient in nursing care management and planning.
Identify the main cancer treatment-related nutrition issues.
Describe how well nutrition is assessed and addressed in cancer patients.
Identify nutrition therapy strategies forcancer patients.
Identify information for patient education/counselling on self-care related to nutrition.

Contact info: info@nursesinternational.org

4 of 31

Importance of Nutrition in Cancer

Nutrition is a process in which food is taken in and used by the body for growth, to keep the body healthy, and to replace tissue

Eating the right kinds of foods before, during, and after cancer treatment can help the patient feel better and stay stronger

A healthy diet includes eating and drinking enough of the foods and liquids that have important nutrients (vitamins, minerals, protein, carbohydrates, fat, and water) the body needs

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

5 of 31

Importance of Nutrition in Cancer

National Cancer Institute, 2018

Nutrition therapy is used to support healing in cancer patients:

Keep a healthy body weight,
Maintain strength,
Keep body tissue healthy, and
Decrease side effects both during and after treatment

Contact info: info@nursesinternational.org

6 of 31

Energy and Nutritional Requirements

Cancer patients have similar nutritional requirements as the healthy population:

Calorie requirements:Around 25–30 kcal/kg/day, with a balance between calorie intake and expenditure, including the degree of physical activity.
Protein requirements are: 1.2 and 1.5 g/kg/day (values should be modified according to patients’ renal function and other metabolic disturbances.
Water and minerals should be evaluated, especially in certain situations (hydro electrolyte disturbances).

Penas et al. 2019

Contact info: info@nursesinternational.org

7 of 31

Side Effects of Cancer Treatment and Effects on Nutrition

National Cancer Institute, 2018

Effects of cancer and cancer treatments make it difficult to eat well.
Cancer treatments that affect nutrition include:

Contact info: info@nursesinternational.org

8 of 31

Cancer Treatment-Related Nutrition Issues

National Cancer Institute, 2018

Cancer and cancer treatment related side effects that impact nutrition are:

Malnutrition
Anorexia/ Cachexia
Nausea/Vomiting
Dry Mouth
Mouth Sores
Taste Changes
Sore Throat and Trouble Swallowing
Lactose Intolerance
Weight Gain

Contact info: info@nursesinternational.org

9 of 31

Cancer Treatment-Related Nutrition Issues

Malnutrition:

Anorexia is the most common cause of malnutrition.
Taste, smell, appetite, and the ability to eat enough food or absorb the nutrients from food may affect cancer treatment.
Alcohol abuse and obesity may increase the risk of malnutrition.
Cause the patient to feel weak, tired, and unable to fight infection.
Eating the right amount of protein and calories is important for healing, fighting infection, and having enough energy.

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

10 of 31

Cancer Treatment-Related Nutrition Issues

Anorexia/ Cachexia:

Anorexia is loss of appetite or desire to eat.
Most common symptom in patients with cancer treatment.
Cachexia is a condition marked by weakness, weight loss, fat and muscle loss.

Malabsorption:

Surgical intervention may change peristaltic patterns, later gastrointestinal secretions, and reduce the absorptive surfaces of the gastrointestinal mucosa, all leading to malabsorption.

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

11 of 31

Dietary Management of Nutrition Issues

Anorexia/ Cachexia: Recommendations

Eat foods that are high in protein and calories (beans, chicken, fish, meat, yogurt, egg).
Sip small amounts of liquids during meals.
Drink smoothies, juices, or soups, if not feeling like eating solid foods.
Eat small meals and healthy food that smells good.
Eat larger meals when well and rested.
Be as active as possible to promote a good appetite.
Talk to your doctor or registered dietitian if problems such as nausea, vomiting.

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

12 of 31

Dietary Management of Nutrition Issues

Lactose Intolerance: Recommendations

Use lactose-free or low-lactose milk products and yogurt
Try products made with soy or rice (such as soy and rice milk and frozen desserts) which do not contain lactose.
Avoid only the dairy products that give you problems. Eat small portionc, such as milk, yogurt, or cheese
Try non-dairy drinks and foods with added calcium
Eat calcium-rich vegetables, such as broccoli and greens
Take lactase tablets when eating or drinking dairy products
Prepare your own low-lactose or lactose-free foods

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

13 of 31

Dietary Management of Nutritional Issues

National Cancer Institute, 2018

Vomiting: Recommendations

Do not eat or drink anything until the vomiting stops.
Drink small amounts of clear liquids after vomiting stops.
When able to drink clear liquids without vomiting, drink liquids such as strained soups, or milkshakes, that are easy on your stomach.
Eat 5 or 6 small meals every day instead of 3 large meals.
Sit upright and bend forward after vomiting.
Medicine to prevent or control vomiting.

Contact info: info@nursesinternational.org

14 of 31

Dietary Management of Nutrition Issues

Weight Gain: Recommendations

Eat a lot of fruits and vegetables
Eat foods that are high in fiber, such as whole-grain breads, cereals
Choose lean meats, such as lean beef, pork trimmed of fat, and poultry without skin
Choose low-fat milk products
Cook with low-fat methods, such as broiling, steaming, grilling
Eat less salt
Exercise daily
Talk with a doctor before going on a diet to lose weight

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

15 of 31

Case Study/Critical Thinking Question/What would the nurse do?

Miss Anna 24 yrs old has metastatic cancer. A registered dietician has suggested a balanced diet to maintain a healthy body weight. What is the normal protein requirement for Miss Anna? (Select the correct answer)

1 - 1.1 g/kg/day
1.2 -1.5 g/kg/day
1.5 -1.18 g/kg/day
1.9-2.0 g/kg/day

Contact info: info@nursesinternational.org

16 of 31

Nutritional Assessment in Cancer Care

National Cancer Institute, 2018

General History:

Weight changes over the past year.
Changes in the amount and type of food eaten.
Problems that have affected eating, such as loss of appetite, nausea, vomiting, diarrhea, constipation, mouth sores, dry mouth, changes in taste and smell, or pain.
Ability to walk and do other activities of daily living (dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet).

Contact info: info@nursesinternational.org

17 of 31

Nutritional Assessment in Cancer Care

Physical Examination:

Anthropometric variables:

BMI (wt/[ht]2 ) is a global measure of nutritional status

If BMI <18.5kg/m2 patient is underweight
If BMI 18.5-25kg/m2 patient is in normal BMI range
If BMI >25kg/m2 patient is overweight

PABEN, 2016

Contact info: info@nursesinternational.org

18 of 31

Nutritional Assessment in Cancer Care

Physical Examination:

Weight and % of weight change:

% weight change = (current weight - previous weight/ current weight) x 100

A patient is indicated for nutrition support if they have:

BMI <18.5kg/m2
Unintentional weight loss of >10% in the previous 3-6 months
BMI <20kg/m2 and unintentional weight loss >5% in the previous 3-6 months

PABEN, 2016

Contact info: info@nursesinternational.org

19 of 31

Nutritional Assessment in Cancer Care

Physical Examination:

Nutritional Index: Two diffused scoring systems are:

The Nutritional Risk Index (NRI) and
The Maastricht Index (MI)

The NRI is scored as follows:

>100 indicates patient well nourished;
97.5 to 100 indicates mild malnourishment
83.5 to 97.5 moderate malnourishment and
<83.5 severe malnourishment

Andreoli et al, 2011

Contact info: info@nursesinternational.org

20 of 31

Nutritional Assessment in Cancer Care

Physical Examination:

The Subjective Global Assessment Generated by the Patient (PG-SGA): is a tool that combines qualitative and semi-quantitative data; it is valid and reliable in identifying malnutrition as part of a comprehensive nutritional assessment in oncology patients.

Reduction in muscle mass assessment measurment:

Dual X-ray absorptiometry (DEXA)
Computed tomography scans at lumbar level or
Bioimpedance analysis (BIA)

Penas et al., 2019

Contact info: info@nursesinternational.org

21 of 31

Nutrition Therapy in Cancer Patients

National Cancer Institute, 2018

Nutrition support helps patients who cannot eat or digest food normally

Nutrition support can be given in different ways:

Nutritional supplement drinks
Enteral Nutrition
Parenteral Nutrition

Contact info: info@nursesinternational.org

22 of 31

Nutrition Therapy in Cancer Patients

National Cancer Institute, 2018

A patient who is not able to take in the right amount of calories and nutrients by mouth may be fed using the following:

Enteral Nutrition:

Also called tube feeding
Enteral nutrition is giving the patient nutrients in liquid form (formula) through a tube that is placed into the stomach or small intestine

Contact info: info@nursesinternational.org

23 of 31

Nutrition Therapy in Cancer Patients

Enteral Nutrition (feeding tubes):

Nasogastric tube:

Inserted through the nose and down the throat into the stomach or small intestine.
This is used when enteral nutrition is only needed for a few week.

Gastrostomy tube:

Inserted into the stomach.

Jejunostomy tube:

Inserted into the small intestine through an opening made on the outside of the abdomen usually used for long-term enteral feeding or for patients who cannot use a tube in the nose and throat.

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

24 of 31

Nutrition Therapy in Cancer Patients

Contact info: info@nursesinternational.org

25 of 31

Nutrition Therapy in Cancer Patients

Parenteral Nutrition:

Carries nutrients directly into the bloodstream
Used when the patient cannot take food by mouth or by enteral feeding.
Parenteral feeding does not use the stomach or intestines to digest food nutrients (protein, fats, vitamins and minerals) are given directly into the blood, through a catheter inserted into a vein.

National Cancer Institute, 2018

Contact info: info@nursesinternational.org

26 of 31

Nutrition Therapy in Cancer Patients

National Cancer Institute, 2018

Parenteral Nutrition:

The catheter may be placed into a vein in the chest or in the arm.

Central venous access catheter:

Is placed beneath the skin and into a large vein in the upper chest.
The catheter is put in place by a surgeon.
This is used for long-term parenteral feeding.

Contact info: info@nursesinternational.org

27 of 31

Nutrition Therapy in Cancer Patients

National Cancer Institute, 2018

Parenteral Nutrition:

Peripheral venous catheter:

Is placed into a vein in the arm.
A peripheral venous catheter is put in place by trained staff.
This is usually used for short-term parenteral feeding for patients who do not have a central venous access catheter.

Contact info: info@nursesinternational.org

28 of 31

Nursing Role in Nutritional Management in Cancer

Providing patient education/counseling:

Importance of good nutrition in cancer.
Eating foods that are high in calories, protein, vitamins, and minerals.
Strategies for management of nutritional issues.

Provide direct care to the patient:

Assess and identify nutritional problems accurately.
Ensure adequate hydration.

especially in patient on fluid restrictions.

Be knowledgeable about different types of local nutritious foods.
Apply aseptic technique while providing parenteral nutrition to prevent infection.

Contact info: info@nursesinternational.org

29 of 31

Case Study/Critical Thinking Question/What would the nurse do?

Miss Mala is 26 years old, has ALL, and she has completed the second cycle of chemotherapy treatment. She has anorexia, nausea and vomiting. She has not been to able to eat properly and a nurse finds her BMI is <18.5kg/m2. What does this reading indicate?

Normal range
Overweight
Underweight
Obese

Contact info: info@nursesinternational.org

30 of 31

References

National Cancer Institute, 2018.Nutrition in Cancer Care (PDQ®)–Patient Version.Retrieved from:https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq

PABEN, 2016. Nutritional Assessment. Retrieved from:https://www.bapen.org.uk/nutrition-support/assessment-and-planning/nutritional-assessment?start=1

R.de Las Peñas, R., Majem, M., Perez-Altozano, J., Virizuela, J. A., Cancer, E., Diz, P., Donnay, O., Hurtado, A., Jimenez-Fonseca, P., & Ocon, M. J. (2019). SEOM clinical guidelines on nutrition in cancer patients (2018). Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 21(1), 87–93. https://doi.org/10.1007/s12094-018-02009-3
Andreoli, A., De Lorenzo, A., Cadeddu, F., Iacopino, L., & Grande, M (2011). New trends in nutritional status assessment of cancer patients. European Review for Medical and Pharmacological Sciences.15: 469-480. Retrieved from:https://www.europeanreview.org/wp/wp-content/uploads/936.pdf

Contact info: info@nursesinternational.org

31 of 31

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org