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Part II Nutrition Assessment, Consequences, and Implications

cytokines, cancer vaccine therapies, and radio- pharmaceuticals (19).

Commonly experienced side effects include myelosuppression, nausea, vomiting, fatigue, diarrhea, constipation, mucositis, alterations in taste and smell, oral infections (eg, candidiasis), neuropathy, skin rash, and decreased appetite (19). Most side effects are tem- porary and resolve after treatment has ended; however, sometimes resolution can take weeks, months, and even years. Websites providing information regarding the effects of specific systemic agents and their possi- ble side effects include Chemocare (www.chemocare. com; drug information section) and the National Cancer Institute (www.cancer.gov).

Radiation Therapy

Radiation therapy is the use of ionizing radiation or other radioactive particles (eg, neutrons, electrons, protons, beta particles, or gamma rays) to treat cancer (16). Radiation therapy is used alone or in combina- tion with surgery and/or systemic therapy. It is esti- mated that 50% to 60% of people receive radiation therapy as part of their cancer treatment. Types of radiation therapy include external beam therapy or

brachytherapy. External beam radiation therapy is given daily for a period of days or weeks and is most frequently administered Monday through Friday. Its effects are site-specific. Brachytherapy is the use of a temporary or permanent radioactive material that is placed in a body cavity, tissue, or surface. Nutrition- impact symptoms of radiation therapy will vary based on the following:

● ● ●

area of the body treated with radiation; dose delivered;

type of radiation therapy given (eg, external beam therapy, brachytherapy, radiopharmaceutical therapy); and

● individual’s tolerance of the symptoms.

Acute effects of radiation therapy occur during or immediately after treatment. Late or chronic effects of therapy can occur months to years after treatment and are usually the result of damage to the body’s microcir- culation. Box 14.4 covers nutritional implications of radiation therapy.

Intensive nutrition-related side effects are most common in those receiving combined modality treat- ment (eg, chemotherapy and radiation therapy

BOX 14.4 Nutritional Implications of Radiation Therapy

Head and Neck Cancers Oral cavity, tongue, oropharynx, nasopharynx, salivary glands, pharynx, larynx, tonsils, sinuses ●

●

acute effects: mucositis, sore mouth, esophagitis, dysphagia, odynophagia, dysgeusia, dysosmia, thickened saliva, xerostomia, anorexia, fatigue, weight loss, dental problems

late effects: xerostomia, dysgeusia, dysosmia, dysphagia, odynophagia, dental caries, oral ulcers, osteora- dionecrosis, trismus, anorexia

Thoracic Cancers

Esophagus, lungs ●

● acute effects: dysphagia, odynophagia, esophagitis, gastric reflux, nausea, anorexia, fatigue, weight loss

late effects: esophageal stricture, fibrosis, stenosis, perforation, fistula, anorexia Abdominal and Pelvic Cancers

Cervix, uterus, prostate, testicles, and other reproductive organs; pancreas, liver, colon, rectum, and other parts

of the GI tract ●

●

acute effects: nausea, vomiting, early satiety, changes in urinary function, changes in bowel function (eg, diarrhea, gas, cramping, bloating, malabsorption), colitis, enteritis, lactose intolerance, proctitis, fatigue, anorexia, weight loss

late effects: GI stricture, fibrosis, stenosis, perforation, fistula; diarrhea, maldigestion, malabsorption, colitis, enteritis, anorexia

Central Nervous System Cancers

Brain and spinal cord ●

● acute effects: nausea, vomiting, early satiety, fatigue late effects: headache, dysphagia, hyperglycemia, lethargy, cognitive changes

Source: Adapted with permission from Grant BL. Pocket Guide to the Nutrition Care Process and Cancer. Appendix B: Effects of Surgical Oncology by Site. Chicago, IL: Academy of Nutrition and Dietetics; 2015.