The nutritional status of patients diagnosed with cancer entering the treatment process varies. Not everyone begins therapy with anorexia, weight loss, and other symptoms of nutritional problems. For patients who have such symptoms, however, anticancer therapies can complicate the treatment and expected recovery. Many individuals also present with preexisting comorbid diseases and illnesses that further complicate their treatment. Surgery, chemotherapy, and radiation can have a direct (or mechanical) and/or an indirect (or metabolic) negative effect on nutritional status. The success of the anticancer therapy will be influenced by a patient's ability to tolerate therapy, which will, in turn, be affected by nutritional status preceding treatment. The treating clinician should assess baseline nutritional status (see the Nutrition Screening and Assessment section) and be aware of the possible implications of the various therapies. Patients receiving aggressive cancer therapies typically need aggressive nutrition management.

Surgery

Surgery is often the primary treatment modality for cancer. Approximately 60% of individuals diagnosed with cancer will have some type of cancer-related surgery.[1] Malnourished surgical patients are at increased risk for postoperative morbidity and mortality. Steps should be taken to attempt to correct nutritional macronutrient and micronutrient deficiencies before surgery if time permits.[2] This involves identification and assessment of the problem, with the possible use of oral liquid nutritional supplements, enteral or parenteral nutritional support, and/or use of pharmacologic therapies to stimulate the appetite (see the Tumor-Induced Effects on Nutritional Status section).[2]

Depending on the procedure, surgery can cause mechanical or physiologic barriers to adequate nutrition, such as a short gut that results in malabsorption after bowel resection.[2] In addition to these mechanical barriers, surgery frequently imposes an immediate metabolic response that increases the energy needs and changes the nutrient requirements necessary for wound healing and recovery at a time when baseline needs and requirements are often not being met.

The following sections highlight various surgical issues for specific cancers. Nutritional complications are usually most notable and severe with cancerous growths and anticancer therapy involving the alimentary canal.

Head and neck cancers

Alcohol abuse is a major risk factor for cancer in the head and neck region and can itself lead to malnutrition.[3] Cancer occurring in this region coupled with curative or palliative surgery can alter a patient's ability to speak, chew, salivate, swallow, smell, taste, and/or see.[2] Treatment for head and neck cancer can have a profound negative effect on nutritional status.

Nutrition assessment is advised at the initial visit. Clinicians should anticipate additional complicating factors such as the side effects of combined modality therapy (chemotherapy and radiation therapy),[4] as well as the increased nutritional requirements for withstanding these therapies. Because head and neck cancer patients are often malnourished at diagnosis and will undergo therapies that may directly affect their ability to eat, many of these individuals have enteral feeding tubes placed prophylactically before undergoing surgery.[2]