Cancer
Manual of Clinical Nutrition Management III- 12 Copyright © 2013 Compass Group, Inc.
Table III- 4 : Cancer Treatments With Potential to Negatively Affect Nutritional Status
Treatment Nutrition-Related Adverse Effects
lack of intrinsic factor, diarrhea, dumping syndrome,
early satiety, hypoglycemia, mineral deficiencies, fat
malabsorption, fat-soluble vitamin deficiency
Intestinal resectiona Vitamin B 12 deficiency, dehydration, diarrhea, fluid or
electrolyte imbalance, hyperoxaluria, malabsorption,
mineral depletion, renal stone formation, steatorrhea
aProblems that develop are determined by the nature and extent of resection; nutritional intervention must be highly individualized.
Source: Barrocas A. Cancer. In: White J, ed. The Role of Nutrition in Chronic Disease Outcome. Washington, DC: Nutrition Screening
Initiative; 1997.
Reprinted by permission from the Nutrition Screening Initiative, a project of the American Academy of Family Physicians, the Academy of
Nutrition and Dietetics, and the National Council on Aging, and funded in part by a grant from Ross Products division, Abbott
Laboratories.
Table III- 5 : Suggested Nutrition Interventions (1,2)
Problem (Signs and Symptoms) Nutrition Intervention
Chewing or swallowing difficulty
(secondary to surgery, radiation therapy)
Modify consistency (See “Full Liquid Blenderized Diet”;
“Nutrition Management of Dysphagia” in Section IB).Dryness, soreness, or inflammation of oral
mucosa (secondary to tumor, chemotherapy,
radiation therapy)
Evaluate effect of medications.
Consume fluids with meals.
Avoid acidic foods.
Avoid very coarse foods that do not soften in the mouth.
Cut foods into small pieces.
Moisten dry foods; modify diet consistency.
Use oral mouth rinses.
Evaluate use of glutamine (10 g orally three or four times per
day) (3).
Patients applying topical honey experienced a significant
reduction in grade 3/4 mucositis with 54% either
maintaining or gaining weight (Grade III) (1,4).
Try artificial saliva products.
For prevention of dental caries, between-meal candies and
gum should be sugarless.
Avoid hot foods to reduce the risk of burning the mouth.
Cold foods may be soothing.
Avoid alcohol.
Lidocaine (Xylocaine) can be used to relieve pain before
eating.
Use a straw or spoon for consuming liquids.
Saliva stimulants, such as sugarless candy or gum, may be
beneficial.
Anorexia and altered taste perception
(secondary to systemic effects of cancer,
radiation therapy to head and neck,
chemotherapeutic agents)
Determine if other problems, such as pain, fear of vomiting,
medication, or constipation, could be factors.
Recommend modifications in diet order as necessary.
Monitor intake.
Take a nutrition history to identify well-liked foods.
Vigorous nutrition intervention may reverse some of the
factors causing anorexia and taste abnormalities.
Consider the use of pharmacotherapy (eg, progestational
agents, cannabinoids, anabolic agents, prokinetic agents,
antiserotonergic agents) (2).
Cold foods may be more acceptable than warm foods.
Chocolate and fruit-flavored supplements are well accepted.
Recommend well-seasoned foods (liberal use of herbs, spices,
flavorings).
Patient should rinse mouth with tea, ginger ale, or salt water
before and after eating.
Use zinc supplementation only if there is a clinically validated
deficiency ( 5 ).