Manual of Clinical Nutrition Management III- 10 Copyright © 2013 Compass Group, Inc.
CANCER
Discussion
A cancer patient’s nutritional status and well-being are greatly impacted by the type of cancer and the
treatment methods (Table III-4). In turn, nutritional status and overall health affect the patient’s ability to
tolerate treatment and achieve the desired clinical outcome. To optimize clinical outcomes, patients who are
diagnosed with cancer should receive early nutrition intervention with a complete nutritional assessment
and a plan of care (1). When patients with colorectal cancer who are undergoing pelvic radiation receive
individualized nutrition counseling, they experience improvements in energy and protein intake, nutritional
status, and quality of life and reductions in symptoms of anorexia, nausea, vomiting, and diarrhea (Grade II)* (1).
Similar findings are seen in patients who are receiving chemotherapy for esophageal cancer, head and neck
cancer, lung cancer, or acute leukemia (1). Patients who receive a pretreatment nutrition evaluation and
weekly visits during chemoradiation and chemotherapy experience reduced weight loss, improved energy
and protein intake, and improved quality of life; these patients may also have fewer unplanned
hospitalizations, shorter hospital stays, and improved tolerance to treatments for a variety of cancers (Grade III)
(1).
Approaches
The Academy of Nutrition and Dietetics has published evidence-based guidelines that address the nutrition
interventions that are used in the management of specific types of cancers including:
breast cancer
colorectal cancer
esophageal cancer
head and neck cancer
hematological malignancies
lung cancer
pancreatic cancer
Because the evidence is limited (Grade III or IV) for many of the current recommendations, a
comprehensive overview is not presented; rather, a summary is provided in the following paragraphs. The
clinician, however, can refer to this resource for guidance when determining if specific therapeutic nutrition
interventions should be initiated or discontinued (1). Parenteral nutrition support is generally not
recommended for patients with the types of cancer listed above because of the risks of metabolic and
infectious complications and the limited evidence that parenteral nutrition affects the length of hospital stay
or patient survival (Grade III) (1). Enteral nutrition may be used to increase the energy and protein intake and
maintain the weight of esophageal cancer patients undergoing chemoradiation therapy (Grade III) (1). In
addition, the use of enteral nutrition to increase the energy and protein intake of outpatients who are
undergoing intensive radiation therapy for stage III or IV head and neck cancer maintains nutritional status
and improves tolerance to therapy (Grade II) (1). Medical food supplements that are used to improve the energy
and protein intake of patients who are undergoing radiation therapy for head and neck cancer are associated
with fewer treatment interruptions and reduced mucosal damage and may minimize weight loss (Grade II) (1).
Vitamin and mineral supplements, special foods, and alternative health products such as herbal products
are commonly used by patients diagnosed with cancer. The following discussion is based on the Oncology
Evidence-Based Nutrition Practice Guideline from the Academy of Nutrition and Dietetics (1). Limited evidence
supports the use of topical honey for the treatment of mouth sores in persons who are receiving radiation for
head and neck cancer (Grade III) (1). The limited evidence shows that the topical use of honey has been
associated with a decreased incidence of severe mucositis as well as weight gain and fewer treatment
interruptions (Grade III) (1). Oral arginine supplements, which are used in an attempt to improve the clinical
response, are not recommended prior to neoadjuvant chemotherapy for breast cancer (Grade III) (1). In addition,
arginine-enhanced medical food supplements or enteral nutrition is not recommended for head and neck
cancer patients, because data have demonstrated no improvements in nutrition-related outcomes or
treatment complications (Grade II) (1).
Vitamin E (in the form of 670 to 1,000 mg of alpha tocopherol) has not been shown to promote tolerance or
reduce the late effects of radiation in patients with breast cancer; rather, vitamin E may have adverse effects
such as nutrient-nutrient interactions, drug-nutrient interactions (eg, anticoagulant and anti-hypertensive
medications or herbal supplements), and disease-related complications (Grade III) (1). Vitamin E oral