Severe malnutrition and cachexia is a well-known phenomenon in oncology nursing, and there is not really much evidence available on how to support the nutritional intake with advanced cancer patients.
We know that cachexia is associated with poor quality of life, loss of functional status, and poor prognosis. In Australia, we are targeting cachexia with pharmacological intervention (steroids), providing Sustagen supplements to promote calorie intake, and specific nutrient supplements such as polyunsaturated fatty acids.
Poor appetite can be caused by pain, nausea and vomiting, fatigue, fever, anxiety, and depression to name just a few. Not being able to eat can cause feelings of guilt and powerlessness, social isolation, and conflicts with caregivers. I often explain to caregivers that insisting on food intake can have the opposite effect in patients who already have a poor appetite.
Screening of patients who are at risk of malnutrition is of importance to detect chronic malnutrition issues. A number of screening tools are available; however, unintentional weight loss of more than 10% of the patient's body weight should raise concerns.
The most frequently used screening tools are the Malnutrition Universal Screening Tool (MUST) and the Short Nutritional Assessment Questionnaire (SNAQ). When a screening tool identifies a result, the patient will be referred to a dietitian. We also use the Distress Thermometer as a tool to identify diet issues with our patients.
As a team, we take extra care for patients with head and neck, esophageal, and gastric cancers. We use proactive and systemic nutritional advice before, during, and after chemo/radiotherapy treatment with the aim to improve weight and symptoms with patients. Patients are easily admitted in hospital to receive nutritional and hydration support when they present with symptoms.
Special considerations in feeding patients need to be taken into account. Not all cancer diagnoses require nutritional adjustments. There are also social considerations where we have to take the patient's views and wishes into account. We also need to raise the question if nutritional support will benefit the patient's quality of life and outweigh the disadvantages. What are the ethnic and life style factors we need to consider? Tube feeding means that participating in a regular meal with others is no longer possible. Also, when a patient approaches the terminal phase and nutritional status decreases, a change in diet will not change the prognosis.
Behavioral changes are often required to improve nutrition over a long period of time. Advice on healthy diet choices, increased physical activity, and drinking habits can be met with resistance. Professional advice is needed to motivate the patient and to improve health and outcomes.
- ArgilÚs JM, et al. Optimal management of cancer anorexia-cachexia syndrome. Cancer Manag Res. 2010; 22:27-38.
- Blum D, et al. Cancer cachexia: A systematic literature review of items and domains associated with involuntary weight loss in cancer. Crit Rev Oncol Hematol. 2011; 80: 114-144.