When dealing with cancer patients and their illness, oncologists must also pay careful attention to the overall nutritional status of each and every patients.
Progressive weight loss and poor nutrition are common findings amount cancer patients undergoing various types of therapy. This state of malnourishment can impact our ability to administer therapy and will subsequently impact the patient’s day to day sense of well-being.
When possible, malnourished cancer patients should be identified prior to the initiation of therapy and aggressive attempts to improve their nutritional intake should be initiated. This will assist in the delivery of a planned course of treatment for their cancer.
Cancer patients often suffer from what has been described as “cachexia,” a group of symptoms which include weight loss, loss of body mass, weakness and possibly organ malfunction. Although it often occurs in patients with advanced disease, it can also be seen in patients with localized cancers.
The amount of “cachexia” is often related to the type of cancer and the extent of cancer treatment each individual patient is requiring. Many factors play a role in this complicated process. A decrease in the intake of proper amounts of nutrients will lead to “cachexia.”
Often, a loss of appetite is an important symptom of cancer. This poor intake can also be related to side effects from therapy making it difficult to ingest proper amounts of nutrition, by altering a patient’s sense of taste to certain foods, or by decreasing a patient’s taste sensitivity. Certain tumors can also mechanically interfere with the ability to take in adequate amounts of nutrition such as cancer of the esophagus, throat or stomach.
This mechanical blockage to adequate nutritional intake can greatly decrease the caloric intake of the patient. Another factor is related to the increased demand for energy placed on the body when a cancer is present. This increased use of energy by a cancer places a high demand upon the body.
Certain cancers can also cause abnormalities in the metabolism of protein when it is taken in.
Cancer therapy can also play a major role in the ability to ingest an adequate amount of calories. Surgery will require an additional increase in the energy requirement of a patient to assist in the recovery and healing process that follows surgery.
Often, cancer patients have lost weight prior to surgery and their ability to deal with this stress is impaired.
Chemotherapy may also alter a patient’s nutritional status. These effects may be due to the effects on the normal cells of the body or due to the side effects of therapy such as nausea, vomiting and diarrhea which may interfere with the ability to consume and absorb nutrients.
Chemotherapy may also alter taste sensation and cause an aversion to certain types of foods. Radiation therapy can also interfere with a patient’s nutritional status secondary to nausea, vomiting, diarrhea or local irritation of the mouth, throat or esophagus which may limit the intake of calories.
These side effects vary widely from one type of cancer to another and are also related to the location of the body receiving radiation treatments.
The clinical relevance of malnutrition and response to cancer therapy has been difficult to document. Many trials have been undertaken to evaluate the response of treatment with intense nutritional support and most have shown no large difference in treatment outcomes. It is, however, clear that malnutrition can contribute the overall sense of well-being the patient experiences and in severe cases can lead to serious medical problems.
Therefore, aggressive nutritional support is an important part of all cancer therapy. It improves the patient’s sense of well-being and will allow the oncologist to proceed with cancer therapy without interruptions secondary to malnutrition. This may also allow the oncologist to administer more aggressive treatment.
To date, definite improvements in the control or cure of cancer have not been linked to improvements in nutrition. This, however, does not mean that aggressive nutritional management is not important, since many factors may play a role in successful outcome. One must never forget that a patient’s sense of well-being is also important in their participation with a treatment protocol.
Dr. C. Joseph Bennett Jr. is a board-certified radiation oncologist. If you have any suggestions for topics, or have any questions, contact him at 522 N. Lecanto Highway, Lecanto, FL 34461, or email email@example.com.