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Part II Nutrition Assessment, Consequences, and Implications

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

Diarrhea

Identify the type and cause(s) of diarrhea (eg, osmotic, malabsorptive, secretory, infectious, dysmotility, medication induced, chemotherapy induced, radiation therapy induced), and treat appropriately. Counsel the patient to do the following: ●

● Eat small amounts of soft, bland foods. ● Choose easy-to-digest protein foods (chicken, turkey, fish, and eggs).

● Decrease intake of high-fiber foods (nuts, raw fruits and vegetables, and whole-grain breads and cereals). ●

Avoid gas-causing foods that contain sugar alcohols (esorbitol, xylitol, mannitol), such as sugar-free drinks, candies, and gums.

●

Eat foods high in soluble fiber, such as applesauce, bananas, canned peaches, and white rice or pasta, which are easy to digest and can firm up the stool.

● Eat foods at room temperature. ● Consult with a physician for consideration of pharmacological interventions to manage diarrhea. Fatigue

Identify symptoms related to fatigue (eg, cancer treatment, pain, anemia, anorexia, deconditioning), and treat appropriately. Counsel the patient to do the following: ●

Consume easy-to-prepare, easy-to-eat foods. ● Keep nutrient-dense snacks close at hand, and snack frequently.

● Enlist the help of family and caregivers to assist with food procurement and preparation. ● After periods of physical activity and/or exercise, plan periods of rest.

Nausea and Vomiting

Identify the cause and type of nausea and vomiting (eg, chemotherapy induced [anticipatory, acute, break- through, or delayed], radiation therapy induced, medication induced), and treat appropriately. Counsel the patient to do the following: ●

Eat small, more frequent meals and snacks.

● Sip on cool or room-temperature, clear liquids in small amounts. ● Avoid high-fat, greasy, spicy, or overly sweet foods.

● Place liquids with strong odors in a cup with a lid and drink through a straw. ● Avoid foods with strong odors.

● Emphasize bland, easy-to-digest foods on scheduled treatment days.

● Consult with a physician for consideration of pharmacological interventions to manage nausea and vomiting. Sore Mouth (Oral Mucositis)

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

Maintain good oral hygiene: rinse mouth frequently with a bland rinse. ● Keep oral mucosa moist by maintaining adequate hydration. ● Eat soft, moist foods with extra sauces, dressings, and gravies.

● Avoid alcohol, citrus, caffeine, tomatoes, vinegar, and hot peppers, as well as dry, coarse, or rough foods. ● Eat foods at room temperature, cool, or chilled.

● Consult with a physician for consideration of pharmacological interventions to manage oral mucositis.

Sip clear liquids (water; clear juices; broth or bouillon; gelatin; sports drinks; weak, tepid teas) throughout the day.