Hydration and dehydration
Adequate hydration is critically important for health maintenance. There are several common scenarios found in cancer treatment that may lead to altered hydration status and electrolyte imbalance. Hydration status can become compromised with prolonged disease or treatment-related diarrhea and/or episodes of nausea and vomiting. Acute and chronic pain can also adversely affect the appetite and hence the desire to eat and drink. Fatigue, an all-too-common complaint of people with cancer, can be one of the first signs of dehydration. Once the underlying cause for altered hydration is appropriately managed, some suggestions to promote adequate hydration include the following:[32,57,58]
- Drink 8 to 12 cups of liquids a day; take a water bottle whenever leaving home. It is important to drink even if not thirsty, as the thirst sensation is not a good indicator of fluid needs.
- Add food to the diet that contains a significant portion of fluid, such as soup, flavored ice pops, flavored ices, and gelatins.
- Limit consumption of caffeine-containing products, including colas and other caffeine-containing sodas, coffee, and tea (both hot and cold); these foods may not be as nourishing as noncaffeinated beverages.
- Drink most liquids after and/or between meals to increase overall consumption of both liquids and solids.
- Use antiemetics for relief from nausea and vomiting; antiemetic use can be very helpful and may prevent hospital admissions from dehydration. The classes of available antiemetics include anticholinergics, phenothiazines, antihistamines, butyrophenones, benzamides, and serotonin receptor antagonists. Of note, all of these antiemetics have side effects that many individuals would consider less problematic than nausea and vomiting.
Constipation is defined as fewer than three bowel movements per week. It is a very common problem among individuals with cancer and may result from lack of adequate fluids or dehydration, lack of fiber in the diet, physical inactivity or immobility, anticancer therapies such as chemotherapy, and medications used in the treatment of side effects of anticancer therapy such as antiemetics and opioids.[59,60][Level of evidence: I] In addition, commonly used pharmacologic agents such as minerals (calcium, iron), nonsteroidal anti-inflammatory drugs, and antihypertensives can cause constipation.
An effective bowel regimen should be in place before the problem of constipation occurs. Preventive measures should be common practice, and special attention should be paid to the possibility of constipation as a side effect of certain therapies. Suggestions include the following:[57,59]
- Eat more fiber-containing foods on a regular basis. The recommended fiber intake is 25 to 35 grams per day. Fiber should be gradually added to the diet, and adequate fluids must be consumed at the same time (see list below).
- Drink 8 to 10 cups of fluid each day; beverages such as water, prune juice and warm juices, decaffeinated teas, and lemonade can be particularly helpful.
- Take walks and exercise regularly (proper footwear is important).