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), 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.
Surgery may take a tremendous toll on the body, but it has reduced mortality and morbidity from gastrointestinal cancers. Anticancer therapy for aerodigestive cancers (e.g., esophageal, gastric, pancreatic, liver, gallbladder, bile duct, and small and large intestine) can result in gastric paresis, alterations in digestion, malabsorption of nutrients, hyperglycemia, elevated lipid levels, hepatic encephalopathy, fluid and electrolyte imbalance, anastomotic and chyle leaks, dumping syndrome, and vitamin and mineral deficiencies. The use of enteral nutritional support is common in the treatment of gastrointestinal cancers. The feeding tube may be placed in the stomach (gastrostomy) or down into the jejunum (jejunostomy).[2,5]
Additional complications and side effects from surgical oncology
Many individuals experience fatigue, pain, and loss of appetite and are unable to consume their regular diet as the result of surgery. Prompt nutritional therapy can help relieve or reduce these problems. Avoiding carbonated or known gas-producing foods will help, as will altering the fiber content in the diet to encourage bowel regularity. A well-balanced diet that contains the recommended amounts of essential nutrients and calories will help promote good wound healing. Finally, proper nutrition and adequate rest may help prevent or treat fatigue.
In 2000, more than 90 different chemotherapy agents were approved for use. These agents are divided into several functional categories. Chemotherapy agents can be used in combination or as single agents, depending on the disease type and health condition of the individual.
Unlike surgery and radiation therapy, cancer chemotherapy is a systemic treatment (not a localized treatment) that affects the whole body (not just a specific part). Consequently, there are potentially more side effects with chemotherapy than with surgery and radiation therapy. The most commonly experienced nutrition-related side effects are anorexia, taste changes, early satiety, nausea, vomiting, mucositis/esophagitis, diarrhea, and constipation (see the Nutritional Suggestions for Symptom Management section). Because side effects of chemotherapy, as well as the cancer itself, can greatly affect nutritional status, healthcare providers need to anticipate possible problems and educate the patient about them  in an effort to prevent malnutrition and weight loss (see the Nutrition Screening and Assessment section). Malnutrition and weight loss can affect a patient's ability to regain health and acceptable blood counts between chemotherapy cycles; this can directly affect the patient's ability to stay on treatment schedules, which is important in achieving a successful outcome.