NUTRITIONAL CARE OF THE CANCER CLIENT
The nutrient and calorie needs of the cancer client are actually greater than they were before the onset of the disease. The cancer causes an increase in the metabolic rate, tissue must be rebuilt, and the nutrients lost to the cancer must be replaced. Clients who can maintain their weight or minimize its loss increase their chances of responding to treatment and, thus, their survival. Clients on high-protein and high-calorie diets tolerate the side effects of therapy and higher doses of drugs better than those who cannot eat normally. And those clients who can eat will feel better than those who cannot.
Despite their nutritional needs, however, anorexia is a major problem for cancer clients. It is particularly difficult to combat because cancer clients tend to develop strong food aversions that are thought to be caused by the effects of chemotherapy. Clients receiving chemotherapy near mealtime associate the foods at that meal with the nausea caused by the chemotherapy and often form aversions to those particular foods. These aversions result in limited accep-tance of food and contribute further to the client’s malnutrition. It is preferable that chemotherapy be withheld for 2 to 3 hours before and after meals. Theappetite and absorption usually improve after chemotherapy, so the client can improve nutritional status between chemotherapy treatments.
Obviously, diet plans for cancer clients require special attention. The client’s diet history should be taken, as usual, at the outset of hospitaliza-tion. Nutrient and calorie needs must be determined by the dietitian, and the client’s diet plan should be made in consultation with the client. It is essential that favorite foods, prepared in familiar ways, be included. Nutri-tious food is useless if the client refuses it.
If chewing is a problem, a soft diet may be helpful. If diarrhea is a problem, a low-residue diet may help. Clients should be evaluated inconspicuously.
If the client is scheduled to undergo radiation or chemotherapy, these factors must be included in the diet planning. High-protein and high-calorie diets may be recommended. Energy demands are high because of the hypermetabolic state often caused by cancer. Calorie needs will vary from client to client, but 45 to 50 calories per kilogram of body weight may be recommended.
Carbohydrates and fat will be needed to provide this energy and spare protein for tissue building and the immune system. Clients with good nutri-tional status will need from 1.0 to 1.2 grams of protein per kilogram of body weight a day. Malnourished clients may need from 1.3 to 2.0 grams of protein per kilogram of body weight a day. Vitamins and minerals are essen-tial for metabolism and tissue maintenance, and they may be supplied in supplemental form. During chemotherapy and radiation therapy, the recom-mendation is to eliminate vitamin A and vitamin E in supplemental form and in the diet. Intake of these vitamins may prevent cancer cells from self-destructing and work against cancer therapy. Fluids are important to help the kidneys eliminate the metabolic wastes and the toxins from drugs.
The client’s food habits may require change if, before the illness, the client had avoided desserts and high-calorie foods to maintain normal weight.
Sometimes clients may be willing to eat foods that are brought from home. Some may find cold foods more appealing than hot foods. Meats may taste bitter so milk, cheese, eggs, and fish may be more appealing. If foods taste sweeter to the cancer client than to the well person, then foods with citric acid may be more acceptable.
Supplementation with high-calorie, high-protein, liquid foods between meals may be useful but should not be used if their consumption reduces the client’s appetite at meals.
If the client suffers from dry mouth, salad dressings, gravies, sauces, and syrups appropriately served on foods can be helpful. Several small meals may be better tolerated than three large meals. It is preferable to serve the nutrition-ally richer meals early in the day because the client is less tired and may have a better appetite at that time. If nausea or pain is a continuous problem, drugs to control the problem, particularly at mealtimes, may be helpful. Although oral feedings are definitely preferred, enteral or total parenteral feedings may become necessary if cachexia is extreme. Sometimes an oral diet with a nutri-tional supplement may be used in conjunction with total parenteral feeding. As the client improves, calorie and nutritional content of the diet should be gradually increased.