Chapter 14 Consequences of Cancer

BOX 14.7 Nutrition and Supportive Care Intervention Strategies for Cancer-Related Side Effects or Symptoms

Altered Taste or Smell (Dysgeusia and Dysosmia)

Identify the cause(s) of taste alterations (eg, chemotherapy agents, medications, oral infection, poor oral hygiene), and treat appropriately. Counsel the patient to do the following: ●

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Maintain good oral hygiene by rinsing the mouth frequently with a bland rinse (a solution mixed daily that contains salt, baking soda, and water or a commercial product such as Biotene). The National Cancer Institute’s website recommends mixing ¾ tsp salt and 1 tsp baking soda in 4 c of water and rinsing the mouth three to four times a day, or as directed by a physician.

● Avoid mouthwashes or mouth rinses containing alcohol. ● Cook foods using marinades and spices to mask strange tastes.

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Enhance the flavor of food by using the FASS (fat, acid, salt, and sweet) technique. By adding or avoiding different flavor elements, the taste of foods can be altered (eg, add a pat of butter to hot cereal, add a few drops of lemon or lime juice to a smoothie, sprinkle sea salt on fresh melon cubes, or add a drizzle of maple syrup to steamed carrots).

● Use plastic utensils if metallic tastes are a problem. Avoid foods that come from a can or metal container. ● Eat cooler foods rather than warm or hot foods.

● Place liquids with strong odors in a cup with a lid and drink through a straw. Anorexia or Poor Appetite

Identify symptoms and adverse effects related to cancer and its treatment that negatively affect appetite and nutritional status (eg, fatigue, pain, nausea, vomiting, diarrhea, constipation, depression, anxiety, taste changes), and treat appropriately.

Counsel the patient to do the following: ● ●

Eat small, more frequent meals and snacks.

Increase intake of nutrient-dense foods (eg, energy- and protein-containing foods). ● Drink liquid medical food supplements or homemade drinks and smoothies. ● Take advantage of times when feeling good. ● Eat meals and snacks in a pleasant atmosphere.

● Try to be as physically active as able to stimulate the appetite.

● Enlist the help of family and caregivers to assist with food procurement and preparation. ● Consult with a physician for consideration of pharmacological interventions to stimulate the appetite.

Constipation

Identify the cause(s) of constipation (eg, opioid analgesics, chemotherapy agents, antiemetics, iron supplemen- tation, poor oral food, fluid intake), and treat appropriately. Counsel the patient to do the following: ●

Increase intake of high-fiber foods such as whole grains; fresh or cooked fruits and vegetables, especially those with skins and seeds; dried fruits; beans; and nuts.

● Avoid gas-producing foods and beverages such as beans, broccoli, cabbage, and carbonated beverages. ● Consume hot liquids to promote bowel movements. ● Try to eat and snack at the same times each day. ● Try to increase physical activity as able.

● Consume probiotic-containing foods such as yogurt, kefir, or acidophilus milk. ●

Consult with a physician for consideration of pharmacological interventions to manage constipation, such as bulking agents, stool softeners, laxatives, or probiotic supplements.