How to help residents manage the nutritional side effects of cancer
Jessica A. Iannotta, Savor Health
Cancer treatment can cause a multitude of side effects for patient resident who is suffering from the disease, many of which can affect nutritional status. Nutrition-related side effects from chemotherapy, radiation, and/or surgery, can result in malnutrition, and research shows that malnutrition can increase the risks of treatment complications, reduce quality of life, and decrease survival rates.
Malnourished patients have a 54% higher rate of hospital readmission and a 4-6 day longer length of stay, significantly driving up cost of care as well as negatively impacting quality of life. Once a malnourished patient is admitted, their nutrition status often declines over the time they are in the hospital. Treatment side effects, including decreased appetite, nausea, vomiting, and diarrhea, can make maintaining adequate nutrition a challenge for both patients and caregivers.
Below are some useful tips for long-term care staff members working with residents who have cancer. These focus on strategies to help combat nutrition-related side effects and promote optimal nutrition for a better quality of life.
If the resident is experiencing a decreased appetite:
- Encourage the resident to stay on a meal schedule and eat every 2-3 hours to stimulate the appetite.
- Coordinate with the dietary department to choose menu items that are highest in calories and protein.
- Encourage the addition of heart healthy fats like avocado, chopped nuts such as walnuts and almonds, olive and canola oil, and seeds such as flaxseeds (note: those suffering from diverticulosis may need to limit or avoid nuts and seeds).
- Encourage family members to bring in favorite foods that the resident would enjoy that are allowed under the care plan.
- Offer snacks in between meals to increase calorie and protein intake. Examples include cottage cheese or yogurt with fruit, nut butter with crackers, or trail mix.
- Recommend high calorie smoothies, milkshakes, or oral nutrition drinks to increase calorie intake and prevent weight loss. Adding protein powder to soups and shakes can be helpful for those unable to consume adequate sources of protein.
If the resident is experiencing nausea and vomiting:
- Recommend that residents take their anti-emetics as prescribed, before mealtime. This can help prevent the onset of nausea.
- Ginger has been shown to have anti-nausea properties. When possible, keep ginger tea, ginger chews, and ginger ale on hand to help calm the patient's stomach.
- Having an empty stomach can cause or exacerbate queasiness. For this reason, recommend residents eat small frequent meals to prevent nausea. A helpful guideline is to have mealtime every 2 hours. Have dietary aides and long-term care staff save the extra snacks from the mealtime trays and keep them by the bedside for easy access by the patient.
- Coordinate with the dietary department to avoid serving the resident spicy, greasy, fried or acidic foods that tend to worsen nausea and vomiting.
If the resident is experiencing taste and/or smell aversions:
- Open the food container on the tray before entering the resident's room to prevent a sudden waft of potentially unwelcome smells. Temperature is important too; having the dietary department send foods that are at room temperature or below can help prevent triggering smell aversions, which can lead to nausea or loss of appetite.
- Lemon drops or other tart candies are good to have on hand for the resident to suck on before meals or snacks. Hard candies can activate the salivary gland, which in turn will cleanse the palette. This can help make foods taste fresher.
- Add distinct flavor condiments to the meals or the resident's trays to help enhance the flavor of food when they are experiencing bland taste or no taste at all. Pickles, mustard, and vinegar based dressings are a good example of condiments to suggest.
- Encourage routine oral care. Try this homemade rinse that includes: 1-2 teaspoons of baking soda, ½ teaspoon of salt mixed into 1 quart of room temperature water. Swish and spit the rinse before and after meals to cleanse the palette. Be sure that the resident uses a fresh mixture each day and does not swallow it.
If the resident is experiencing mouth sores or sore throat from treatment:
- High protein yogurt smoothies and milkshakes are an ideal option especially for residents struggling with mouth sores or sore throat. These are a helpful way to optimize nutritional intake in a tolerable form.
- Coordinate with the dietary department to offer residents non-spicy, and non-acidic foods to prevent irritating the throat and mouth.
- Coordinate with the dietary department to provide soft foods such as scrambled eggs, mashed potato, creamed soups, hot cereals, and yogurt. If needed, order a mechanical soft or pureed diet to guarantee optimal consistency, especially if dentition is affected.
- Encourage use of the homemade mouth rinse (mentioned above) before and after meals.
If the patient is experiencing diarrhea:
- Encourage residents to increase their fluid intake to prevent dehydration. An electrolyte replacement beverage such as unsweetened coconut water, sports drinks, or children's oral hydration drinks are recommended if the diarrhea is severe. Patients should also avoid caffeine, which can exacerbate the diarrhea.
- Coordinate with dietary to avoid serving residents high fiber foods such as raw vegetables, whole grain breads and pastas, nuts, and beans as well as spicy, creamy, or rich comfort foods. These foods can stimulate the digestive system, making the diarrhea worse.
- Coordinate with dietary to provide dry and bland foods such as chicken broth, crackers, and cream of rice cereal until the diarrhea has subsided. Even though simple carbohydrates provide less nutritional benefit, they won't overload the digestive system, which can help the patient avoid continuous and uncomfortable trips to the bathroom.
Nutrition-related side effects of cancer treatment can have profoundly negative effects on a resident's food intake, causing weight loss and malnutrition. Long-term care staff is vitally important in helping to address a resident's nutritional concerns.
First, they can help raise patient awareness of common issues affecting a cancer patient and share suggestions that can help mitigate these symptoms. Second, they can facilitate improved access to appropriate food choices that will substantially improve outcomes resulting from proper nutritional status during treatment and beyond. In doing so, cancer caregivers play an integral role in helping patients to achieve optimal nutrition during their cancer journey.