Methods of Nutrition Care
As outlined above, individuals diagnosed with cancer are at risk for malnutrition resulting from the disease itself; from anticancer therapy such as surgery, radiation, or pharmacologic therapy; and/or from anorexia due to emotional turmoil. The following sections highlight the benefits, contraindications, methods of administration, and home care issues for all forms of nutrition support-oral, enteral, and parenteral.
The preferred method of nutrition support is via the oral route, with the use of dietary modifications to reduce the symptoms associated with cancer treatments. Enteral nutrition is indicated when the gastrointestinal (GI) tract is functional but oral intake is insufficient to meet nutritional requirements. Common situations in which enteral nutrition may be needed include malignancies of the head and neck regions, esophagus, and stomach. When the GI tract is dysfunctional, total parenteral nutrition (TPN) or enteral nutrition may be indicated; however, the widespread use of TPN is controversial because little evidence of improved survival has been demonstrated in patients with advanced cancer. Parenteral nutrition has been shown to be beneficial in only a small group of patients-specifically, postoperative patients who are being aggressively treated and who have demonstrated a positive response rate. One study  reported that patients with GI cancer benefited from perioperative support with TPN, with one-third fewer complications and decreased mortality.
Optimal nutrition can improve the clinical course, outcome, and quality of life of patients undergoing treatment for cancer. Virtually every cancer patient could benefit from consultation with a registered dietitian or physician to formulate a plan for nutrition and to begin meal planning. Oral nutrition, or eating by mouth, is the preferred method of feeding and should be used whenever possible. Appetite stimulants may be used to enhance the enjoyment of foods and to facilitate weight gain in the presence of significant anorexia.
Recommendations during treatment may focus on eating foods that are high in energy, protein, and micronutrients to help maintain nutritional status. This may be especially true for individuals with early satiety, anorexia, and alteration in taste, xerostomia, mucositis, nausea, or diarrhea. Under most of these circumstances, eating frequently and including high-energy and high-protein snacks may help overall intake.
At-risk individuals who may benefit from nutritional support might have one or more of the following characteristics:
- Low body weight, as defined by less than 80% of ideal weight or recently experienced unintentional weight loss of more than 10% of usual weight.
- Malabsorption of nutrients due to disease, short bowel syndrome, or anticancer therapy.
- Fistulas or draining abscesses.
- Inability to eat or drink for more than 5 days.
- Moderate or high nutritional risk status as determined by screening or an assessment tool.
- The ability to demonstrate competencies for discharge planning on nutritional support (both individual and caregiver).