Chapter 14 Consequences of Cancer

TABLE 14.3 Nutrition-Impact Signs and Symptoms Global

Anorexia Pain Fever Fatigue, muscle weakness Depression, anxiety Dementia, delirium Food aversions Financial problems

191

Upper Aerodigestive Tract

Stomatitis Odynophagia Sensory changes of taste and smell Loose denture, edentulism Poor oral hygiene Xerostomia Dysphagia Esophagitis

Gastrointestinal Tract

Nausea Vomiting Dyspepsia Early satiety Delayed gastric emptying Abdominal pain Cramping, bloating Excessive flatus Constipation Diarrhea Food intolerances Fat malabsorption

Source: Reprinted with permission from McMahon K, Decker G, Ottery FD. Integrating proactive nutritional assessment in clinical practices to prevent complications and cost. Semin Oncol. 1998;25(suppl 6):23, with permission from Elsevier.

together to any part of the head and neck or GI tract). The nutrition goals vary for each person, and individ- ualization of the care plan is essential. The effects from radiation treatment may be acute, and some may continue for more than 90 days after completion of treatment (16). Radiation therapy to the head and neck area may cause alterations in taste and smell, dry mouth, severe stomatitis, sore throat, dysphagia, odynophagia, loss of appetite, gagging, or fatigue. Radiation to the brain and spine area may cause nausea, vomiting, hyperglycemia if steroids are used, fatigue, and loss of appetite. Radiation treatment to the abdominal or pelvic area may cause nausea, vom- iting, changes in bowel movements and urinary func- tion, lactose intolerance, fatigue, or loss of appetite (19). Table 14.3 lists common nutrition-impact signs and symptoms associated with cancer and its treat- ments (19,20).

SPECIAL CONSIDERATIONS FOR OLDER ADULTS

Cancer screening recommendations for older adults (especially those over 70 to 75) remain controversial primarily due to limited evidence. Physicians currently recommend individualized decision-making based on estimated life expectancy (usually beyond 5 years), the potential benefits and harms from screening (eg, risk of dying from the disease), and the potential benefits and harm related to the individual’s values, preferences, and advance directives.

The National Comprehensive Cancer Network (NCCN) guides cancer treatment across the United States and in hundreds of countries worldwide by pub- lishing consensus and evidence-based clinical practice guidelines for oncology (20). The NCCN has also pro- duced NCCN Guidelines: Older Adult Oncology, which offers specific recommendations for the care of older adults. This guideline also provides approaches for decision-making when working with older adults and algorithms for the assessment of risk factors for possi- ble adverse outcomes from cancer treatment. Box 14.5 (see page 192) contains an overview for the assessment of risk factors in this population. Box 14.6 (see page 192) provides questions to consider when giving cancer treatment to older adults. NCCN Guidelines: Older Adult Oncology also contains treatment modality–spe- cific and cancer-specific considerations for older adults able to tolerate cancer treatment (21).

Nutritional Consequences of Cancer

Treatment–Related Fatigue Cancer fatigue is the most common and can be the most distressing symptom associated with cancer and its treat- ment, which can continue into post-treatment and beyond. Chronic cancer fatigue may cause a significant decline in physical activity and functioning, lower the quality of life, and affect whether the individual com- pletes the full course of treatment (6,19).