Nutrition Screening and Assessment
Goals of Nutrition Therapy
Methods of Nutrition Care
        Enteral Nutrition
        Parenteral Nutrition

Nutrition Screening and Assessment

Finding and treating nutrition problems early may improve the patient's prognosis (chance of recovery).

Early nutrition screening and assessment can identify problems that affect the success of anticancer therapy. Patients who are underweight or malnourished may not respond well to cancer treatments. Malnutrition may be caused by the cancer or made worse as the cancer progresses. Finding and treating nutrition problems early may help the patient gain or maintain weight, improve the patient's response to therapy, and reduce complications of treatment.

Screening and assessment are done before beginning anticancer therapy, and assessment continues throughout treatment.

Because the ability to tolerate treatment is better for the well-nourished patient, screening and assessment are done before beginning anticancer therapy. Appropriate nutrition management is begun early, and nutritional status is checked often during treatment.

Screening is used to identify patients who may be at nutritional risk. Assessment determines the complete nutritional status of the patient and identifies if nutrition therapy is needed. The patient or caregiver may be asked for the following information:

• Weight changes over the past 6 months.



• Changes in the amount and type of food eaten compared to what is usual for the patient.



• Problems that have affected eating, such as nausea, vomiting, diarrhea, constipation, dry mouth, changes in taste and smell, mouth sores, pain, or loss of appetite.



• Ability to walk and perform the activities of daily living.

A physical exam is part of the assessment. The physical exam will check the body for general health and signs of disease, such as lumps or growths. The physician will look for loss of weight, fat and muscle, and fluid buildup in the body.

Ongoing assessment is completed by a healthcare team with expertise in nutritional management.

A nutrition support team will monitor the patient's nutritional status during cancer treatment and recovery. The team may include the following specialists:

• Physician.



• Nurse.



• Registered dietitian.



• Social worker.



• Psychologist.

The goals of nutrition therapy for cancer patients in active treatment and recovery are designed to restore nutrient shortages, maintain nutritional health, and prevent complications.

The goals of nutrition therapy for patients in active treatment and recovery are to do the following:

• Prevent or correct malnutrition.



• Prevent wasting of muscle, bone, blood, organs, and other lean body mass.



• Help the patient tolerate treatment.



• Reduce nutrition-related side effects and complications.



• Maintain strength and energy.



• Protect ability to fight infection.



• Help recovery and healing.



• Maintain or improve quality of life.

A patient whose religion forbids eating certain foods may consider speaking with a religious leader about waiving the restriction during cancer treatment and recovery.

Good nutrition continues to be important for patients who are in remission or whose cancer has been cured.

The goals of nutrition therapy for patients who have advanced cancer are designed to improve the quality of life.

The goals of nutrition therapy for patients who have advanced cancer are to do the following:

• Reduce side effects.



• Reduce risk of infection.



• Maintain strength and energy.



• Improve quality of life.

Nutrition support provides nutrition to patients who cannot eat normally.

Eating by mouth is the preferred method and should be used whenever possible, but some patients may not be able to take any or enough food by mouth due to complications from cancer or cancer treatment. This may include patients with cancer of the head, neck, esophagus, or stomach. A patient may be fed using enteral nutrition (through a tube inserted into the stomach or intestine) or parenteral nutrition infused into the bloodstream directly). The nutrients are delivered in formulas, liquids that contain water, protein, fats, carbohydrates, vitamins, and/or minerals. The content of the formula depends on the needs of the patient and the method of feeding.

Nutritional support can improve a patient's quality of life during cancer, but there are risks and disadvantages that should be considered before making the decision to use it. The effect of nutritional support on tumor growth is not known. Also, each form of nutrition therapy has its own benefits and disadvantages. For example, enteral nutrition keeps the stomach and intestines working normally and has fewer complications than parenteral nutrition; nutrients are used more easily by the body in enteral feeding. These and other issues should be discussed with the patient's health care providers so that an informed decision can be made. (See the Advanced Cancer section below for more information on deciding whether to use nutritional support.)

Patients with certain conditions are most appropriate for treatment with nutrition support.

Nutrition support may be helpful for patients who have one or more of the following characteristics:

• Low body weight.



• Inability to absorb nutrients.



• Holes or draining abscesses in the esophagus or stomach.



• Inability to eat or drink by mouth for more than 5 days.



• Moderate or high nutritional risk.



• Ability, along with the caregiver, to handle tube feedings at home.

Enteral nutrition is also called tube feeding.

Enteral nutrition is food (in liquid form) given to the patient through a tube that is inserted into the stomach or the small intestine. The following types of tube feeding may be used:

• A tube inserted through the nose and throat down into the stomach or small intestine. This kind of tube is usually used for short-term use.



• A tube inserted into the stomach or small intestine through a stoma (an opening made on the outside of the abdomen). This kind of tube is usually chosen for long-term use or for patients who cannot tolerate a tube in the nose and throat.

If the tube is placed in the stomach, food may be given through the tube continuously or in batches several times a day. If the tube is placed in the small intestine, the food is delivered continuously. Different formulas are available. Some provide complete nutrition and others provide certain nutrients. Formulas that meet the patient's specific needs are selected. Formulas are available for patients who have other health conditions, such as diabetes.

Enteral nutrition is sometimes used when the patient is able to eat small amounts by mouth but cannot obtain enough food that way. The patient may continue to eat or drink as able, and the tube feeding provides the balance of calories and nutrients that are needed.

Enteral nutrition may be appropriate for patients whose gastrointestinal tract is still working.

Enteral nutrition continues to use the stomach and/or intestines to digest food. Enteral nutrition may be used for patients who have cancer of the head, neck, or digestive system and whose treatment with chemotherapy and radiation therapy causes side effects that limit eating or drinking.

Enteral nutrition is not appropriate for the following patients:

• Patients whose stomach and intestines are not working or have been removed.



• Patients who have a blockage in the bowel.



• Patients who have severe nausea, vomiting, and/or diarrhea.



• Patients whose platelet count is low. Platelets are blood cells that help prevent bleeding by causing blood clots to form.



• Patients who have low levels of all blood cells (white blood cells, red blood cells, and platelets).

Enteral nutrition may continue after a patient leaves the hospital.

If enteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in use of the tube and pump, and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.

Parenteral nutrition provides the patient with nutrients delivered into the blood stream.

Parenteral nutrition is used when the patient cannot take food by mouth or by enteral feeding. Parenteral feeding bypasses the normal digestive system. Nutrients are delivered to the patient directly into the blood, through a catheter (thin tube) inserted into a vein. Patients with the following problems may benefit from parenteral nutrition:

• Stomach and intestines that are not working or have been removed.



• Severe nausea, diarrhea, or vomiting.



• Severe sores in the mouth or esophagus.



• A fistula (hole) in the stomach or esophagus.



• Loss of body weight and muscle with enteral nutrition.

The catheter may be placed into a vein in the chest or in the arm.

A central venous catheter is placed beneath the skin and into a large vein in the upper chest. Placement of a central venous catheter is done by a surgeon.

A peripheral venous catheter is placed into a vein in the arm. Placement of a peripheral venous catheter is done by trained medical staff. This site may be used for short-term parenteral feeding.

The patient is checked often for infection or bleeding at the site (place) where the catheter enters the body.

Some drugs should not be given with parenteral formulas.

Many drugs and other substances do not mix safely with the formulas used for parenteral feeding. A pharmacist or doctor should be consulted before adding anything to the formula or using the catheter for another substance.

Trained medical staff should manage the use of parenteral nutrition.

The techniques and formulas involved in parenteral nutrition support are precise and require management by trained medical staff or a nutrition support team. Some of the serious complications that may occur with parenteral feeding include the following:

• Placement of the tip of the catheter into the wrong place.



• Blood clots.



• A collapsed lung.



• A high or low sugar level in the blood.



• A low potassium level in the blood.



• Elevated liver enzymes.

Parenteral nutrition support may continue after a patient leaves the hospital.

If parenteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in the procedures and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.

Experienced medical staff should manage the patient's removal from parenteral nutrition support.

Going off parenteral nutrition support needs to be done gradually and under medical supervision. The parenteral feedings are reduced by small amounts over time as the patient is changed to enteral or oral feeding.

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