Cancer : Nutrition Screening and Assessment

by National Cancer Institute

(Page 3 of 8)

Finding and treating nutrition problems early may improve the patient's prognosis (chance of recovery).

Early nutrition screening and assessment can identify problems that affect the success of anticancer therapy. Patients who are underweight or malnourished may not respond well to cancer treatments. Malnutrition may be caused by the cancer or made worse as the cancer progresses. Finding and treating nutrition problems early may help the patient gain or maintain weight, improve the patient's response to therapy, and reduce complications of treatment.

Screening and assessment are done before beginning anticancer therapy, and assessment continues throughout treatment.

Because the ability to tolerate treatment is better for the well-nourished patient, screening and assessment are done before beginning anticancer therapy. Appropriate nutrition management is begun early, and nutritional status is checked often during treatment.

Screening is used to identify patients who may be at nutritional risk. Assessment determines the complete nutritional status of the patient and identifies if nutrition therapy is needed. The patient or caregiver may be asked for the following information:

• Weight changes over the past 6 months.
• Changes in the amount and type of food eaten compared to what is usual for the patient.
• Problems that have affected eating, such as nausea, vomiting, diarrhea, constipation, dry mouth, changes in taste and smell, mouth sores, pain, or loss of appetite.
• Ability to walk and perform the activities of daily living.

A physical exam is part of the assessment. The physical exam will check the body for general health and signs of disease, such as lumps or growths. The physician will look for loss of weight, fat and muscle, and fluid buildup in the body.

Ongoing assessment is completed by a healthcare team with expertise in nutritional management.

A nutrition support team will monitor the patient's nutritional status during cancer treatment and recovery. The team may include the following specialists:

• Physician.
• Nurse.
• Registered dietitian.
• Social worker.
• Psychologist.

Goals of Nutrition Therapy

The goals of nutrition therapy for cancer patients in active treatment and recovery are designed to restore nutrient shortages, maintain nutritional health, and prevent complications.

The goals of nutrition therapy for patients in active treatment and recovery are to do the following:

• Prevent or correct malnutrition.
• Prevent wasting of muscle, bone, blood, organs, and other lean body mass.
• Help the patient tolerate treatment.
• Reduce nutrition-related side effects and complications.
• Maintain strength and energy.
• Protect ability to fight infection.
• Help recovery and healing.
• Maintain or improve quality of life.

A patient whose religion forbids eating certain foods may consider speaking with a religious leader about waiving the restriction during cancer treatment and recovery.

Good nutrition continues to be important for patients who are in remission or whose cancer has been cured.

The goals of nutrition therapy for patients who have advanced cancer are designed to improve the quality of life.

The goals of nutrition therapy for patients who have advanced cancer are to do the following:

• Reduce side effects.
• Reduce risk of infection.
• Maintain strength and energy.
• Improve quality of life.

Methods of Nutrition Care

Nutrition support provides nutrition to patients who cannot eat normally.

Eating by mouth is the preferred method and should be used whenever possible, but some patients may not be able to take any or enough food by mouth due to complications from cancer or cancer treatment. This may include patients with cancer of the head, neck, esophagus, or stomach. A patient may be fed using enteral nutrition (through a tube inserted into the stomach or intestine) or parenteral nutrition infused into the bloodstream directly). The nutrients are delivered in formulas, liquids that contain water, protein, fats, carbohydrates, vitamins, and/or minerals. The content of the formula depends on the needs of the patient and the method of feeding.

Nutritional support can improve a patient's quality of life during cancer, but there are risks and disadvantages that should be considered before making the decision to use it. The effect of nutritional support on tumor growth is not known. Also, each form of nutrition therapy has its own benefits and disadvantages. For example, enteral nutrition keeps the stomach and intestines working normally and has fewer complications than parenteral nutrition; nutrients are used more easily by the body in enteral feeding. These and other issues should be discussed with the patient's health care providers so that an informed decision can be made. (See the Advanced Cancer section below 3 for more information on deciding whether to use nutritional support.)

Patients with certain conditions are most appropriate for treatment with nutrition support.

Nutrition support may be helpful for patients who have one or more of the following characteristics:

• Low body weight.
• Inability to absorb nutrients.
• Holes or draining abscesses in the esophagus or stomach.
• Inability to eat or drink by mouth for more than 5 days.
• Moderate or high nutritional risk.
• Ability, along with the caregiver, to handle tube feedings at home.

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