Attention to nutrition essential in the cancer therapy continuum

NEW ORLEANS – Nutrition as an integral part of cancer care is often overlooked, according to Meghan Routt, CNP, inpatient nurse practitioner for the James Cancer Hospital at the Ohio State University Medical Center in Columbus. The consequences of unrecognized malnutrition include increased length of hospital stays, impaired wound healing, increased muscle and/or functional loss and even death.

Perspective from Theresa L. Koetters, RN, MS, Assistant Clinical Professor

“At diagnosis, approximately 50% of patients present with some sort of nutritional issue,” Routt says. “Then, we treat them with radiation, chemotherapy or surgery, and that in and of itself can result in weight loss and further deterioration.” Nausea, vomiting and diarrhea are common side effects of chemotherapy and radiation, and as a result, patients are unable to absorb key nutrients from their diet. In addition, hospitals and clinic staff members can contribute to patient malnutrition due to lack of nutrition education, lack of screening and assessment or failure to record food intake.

Continuous malnutrition in patients with cancer can lead to cancer cachexia, a symptom of which is debilitating loss of skeletal and muscle mass. Cachexia cannot be fully reversed by conventional nutritional support.

“We need to look at this upfront. We want to get involved early before the patient experiences refractory cachexia, where, no matter what we do, we cannot get the patient back on track,” says Suzanne Dixon, RD, registered dietician and consultant for The Health Geek, LLC. With refractory cachexia, the patient becomes nonresponsive to anticancer treatments.

The American Cancer Society touts proper nutrition as a means of increasing energy and strength, maintaining weight, decreasing risk of infection and healing quickly with fewer complications. Nurses can help tailor this message to each patient, but behavioral readiness must first be addressed. Behavioral stages include precontemplation (resistance to the message), contemplation (openness to the message yet not ready for a change) and planning (openness to the message and ready for change). When the patients finally feels empowered by being an active member of the healthcare team, nurses must then provide continued support to keep patients on track.

It is also important to dispel common nutritional myths. For example, organic foods are the fastest growing sector in the food industry, but patients need to learn that “organic” does not necessarily mean “healthy.” The more informed the patients, the more control they have over their treatment regimen. Conveying the truth about all foods encourages patients to make better choices tailored to individual needs of health and wellbeing.

Disclosure: Meghan Routt, CNP and Suzanne Dixon, RD report no relevant financial disclosures.

Perspective

Theresa L. Koetters, RN, MS, Assistant Clinical Professor

We need to acknowledge that the majority of us do not have access to dieticians, let alone oncology dieticians, because we work in community-based or private physician infusion centers. Nurses have to do a better job at this than we have thus far. I have had the opportunity to work with a chef, Rebecca Katz, who published The Cancer-Fighting Kitchen and One Bite at a Time. In addition, we conducted programs in the Bay Area called “The Power of Yum” specifically for patients and their families to learn how to get back in the kitchen and deal with issues around taste and appetite changes from a whole-food perspective.

Theresa L. Koetters, RN, MS, Assistant Clinical Professor

Department of Physiological Nursing, University of California, San Francisco

Disclosures: Theresa Koetters, RN, MS, reports no relevant financial disclosures.