CancerManual of Clinical Nutrition Management III- 13 Copyright © 2013 Compass Group, Inc.
Table III- 5 : Suggested Nutrition Interventions (1,2)
Problem (Signs and Symptoms) Nutrition Intervention
Lower threshold for bitterness (meat rejection,
especially beef)
Use nonmeat sources of protein: eggs, dairy products,
poultry, or vegetable sources; poultry or fish may be better
tolerated than red meat; fish with a strong aroma may not
be accepted.
Eat with plastic utensils rather than metal utensils.
Elevated threshold for sweetness Add sugar to foods (sweet sauces, marinades).
Early satiety
(secondary to malnutrition, obstruction,
pain, effects of decreased secretions and
peristalsis, chemotherapeutic effects on
digestive tract)
Eat small, frequent meals with high-energy, nutrient-dense
foods (addition of glucose polymers).
Drink liquids between meals rather than with meals.
Keep head elevated following a meal; avoid meals at bedtime.
Low-fat foods may be better tolerated; avoid fatty, greasy
foods.
Light exercise is allowed if tolerated.
Intake may be best at breakfast.
Keep high-protein, high-energy snacks on hand for nibbling.
Chew thoroughly and eat slowly.
Nausea and vomiting (associated with
chemotherapy, radiation therapy to
abdominal and gastric areas, partial
obstruction of the gastrointestinal tract)
(Note: Nausea and vomiting are usually over
within 24-48 hours after chemotherapy and
24 hours after total body irradiation.)
Evaluate effects and timing of medications.
Use antiemetic drugs ½ hour before meals.
Take deep breaths, sip a carbonated beverage, or suck on ice
chips. Try a dry diet (liquid between meals).
Decrease intake of fatty foods.
Avoid cooking odors.
Avoid favorite foods when nauseated to prevent development
of permanent dislike for such foods.
Eat foods without strong odors.
Cold foods are often better accepted than hot foods.
Vigorous nutritional intervention may reverse atrophy due to
malnutrition.
Enteral route may be preferable to the parenteral route, as it
supplies nutrition directly to mucosal cells.
Use lactose-free supplements.
Decrease fiber content.
Steatorrhea and diarrhea (secondary to
thoracic esophageal resection, gastric
resection, cancerous involvement of
lymphatics, blind loop syndrome,
obstruction of the pancreatic or bile ducts)
Decrease proportion of energy from fat.
Use medium-chain or long-chain triglycerides if diarrhea
related to malabsorption (2).
Decrease fiber content as needed; however, bulking agents
and foods high in water-soluble fiber may be helpful if
diarrhea is secondary to radiation.
Promote adequate fluid intake.
Recommend a lactose-controlled diet, if required.
Evaluate all medications (eg, magnesium-containing
medications, prokinetic agents) and herbal supplements
(especially milk thistle, aloe, cayenne, saw palmetto, and
ginseng) that can cause diarrhea (2).
Evaluate intake of foods high in sugar and sorbitol, as both
may cause diarrhea if consumed in large amounts.
Probiotic supplementation (yogurt with live cultures) may be
appropriate if diarrhea is related to altered microflora from
antibiotics (2,6).
Glutamine, a powdered protein supplement, has been
recommended to help control cancer treatment–related
diarrhea. Not all studies have demonstrated efficacy, but it
may be related to the dose (7,8). In general, a dose of 10 g
three times per day has been recommended (2,7,8).
Protein-losing enteropathy
(secondary to fistula, disruption of intestinal
epithelium or lymphatics)
Recommend a high-protein intake.
Monitor nutritional status.