CancerManual of Clinical Nutrition Management III- 11 Copyright © 2013 Compass Group, Inc.
supplements are not recommended for persons with head and neck cancer who are receiving radiation
therapy, because these supplements increase the risk of developing a second primary cancer and decrease
the survival rate (Grade III) (1). Doses of antioxidants (eg, vitamin C, vitamin E, beta-carotene, and selenium) that
are greater than the tolerable upper intake level, which are used in an attempt to improve treatment
outcomes, are not recommended for patients who are receiving chemotherapy for advanced non-small cell
lung cancer. Multiple, high-dose oral antioxidants do not significantly influence the treatment response,
survival rate, survival time, or toxicity in this patient population (Grade III) (1). Supplements of omega-3 fatty
acids, which are used in an attempt to improve weight gain, are not recommended for pancreatic cancer
patients due to limited data and the potential for drug-nutrient interactions (Grade III) (1). Refer to Table III- 5 for
suggested nutrition interventions and approaches to common problems experienced by cancer patients as a
result of the disease or adjunctive treatments.
Evidence remains limited as to the best methods for calculating enery and protein needs in patients with
cancer. In general, the Academy evidence anlaysis library suggests indirect calorimetry is the best method for
assessing resting metabolic rate (1). If indirect calorimetry is not available, using the Harris Benedict Equation
(HBE) has been suggested as it is one of the few equations that have been studied in this population (1). Using
the HBE in lung cancer patients receiving chemotherapy showed the HBE to underestimate energy needs by
an average of 12 to 13% (Grade III) (1). Limited evidence also suggests the HBE underestimates RMR in head and
neck cancer patients (Grade III) (1). Also refer to Section II: “Estimation of Energy Expenditures”. Protein
requirements vary depending on type of cancer and adjunctive treatment (1). Limited evidence indicates
patients with head and neck cancer receiving radition who consumed the RDA for protein experienced a
significant decrease in weight and lean body mass during treatment indicating these patients may need
higher intakes of protein (Grade III) (1). Also refer to the discussion on energy and protein requirements for
patients with hematologic malignancies undergoing allogeneic Hematopoietic Cell Transplant (HCT) later in
this section.
Table III- 4 : Cancer Treatments With Potential to Negatively Affect Nutritional Status
Treatment Nutrition-Related Adverse Effects
Chemotherapy
Corticosteroids (eg, cortisone, hydrocortisone,
methylprednisolone, prednisone,
prednisolone, triamcinolone)
Abdominal distention, anorexia, increased appetite,
diarrhea, ulcerative esophagitis, gastrointestinal
bleeding, hypocalcemia, hyperglycemia or
hypoglycemia, hypokalemia, hypertension, muscle-
mass loss, nausea, osteoporosis, pancreatitis, sodium
and fluid retention, vomiting, weight gain
Hormones/analogs (eg, androgens, estrogens,
progestins)Anorexia, anemia, increased appetite, diarrhea, edema,
fluid retention, glossitis, nausea, vomiting, weight gain
Immunotherapies (eg, B-cell growth factor,
interferon, interleukin)Anorexia, diarrhea, edema, nausea, vomiting, stomatitis,
taste perversion, weight loss
General chemotherapeutic agents (eg,
alkylating agents, antibiotics,
antimetabolites, mitotic inhibitors,
radiopharmaceuticals, other cytotoxic
agents)Abdominal discomfort, anorexia, diarrhea, oral and
gastrointestinal ulceration, nausea, stomatitis,
vomiting (Premedication with antiemetics will
sometimes relieve or decrease severity of symptoms.)Radiation therapy
Head, neck, chest
Dysgeusia, dysosmia, dysphagia, esophagus, fibrosis,
fistula, hemorrhage, odynophagia, stomatitis,
stricture, trismus, xerostomia, tooth decay, tooth loss
(Tooth decay and loss can be prevented by an
aggressive program of dental hygiene.)
Abdomen, pelvis Bowel damage, diarrhea, fistulization, malabsorption,
nausea, obstruction, stenosis, vomiting
Surgery
Radical head/neck
Altered appearance, chewing or swallowing difficulty,
chronic aspiration, dysgeusia, dysphagia, impaired
speech, odynophagia, voice loss
Esophagectomy Diarrhea, early satiety, gastric stasis, hypochlorhydria,
regurgitation, steatorrhea
Gastrectomy Abdominal bloating and cramping, achlorhydria with