Side Effects of Oncology Treatment: Nutrition Solutions to Help

Nutrition intervention can help minimize the number of complications patients may experience during oncology treatment.¹ Research studies as well as expert reviews have demonstrated that improvement in patient outcomes can be achieved with early and proactive nutrition intervention.^1-3 Cancer treatment can cause adverse events that impact nutritional intake even if the patient is not diagnosed with malnutrition. These side effects include, but are not limited to, taste alterations, fatigue, oral mucositis, nausea, and vomiting. Experiencing one or more adverse events takes an additional toll on patients and caregivers, impacting quality of life. The purpose of this article is to provide nutrition tips that will help educate patients and caregivers when managing common side effects during treatment.

The Table details many of the symptoms or adverse events that can impact nutritional intake. Nearly all patients will experience side effects that impact nutrition throughout their care. Patients with head, neck, or gastrointestinal cancers have a higher incidence and more severe effects. If these side effects are unaddressed, a significant decline in nutritional status can cause weakness and an inability to tolerate treatment.

Many people experience not just one but multiple adverse events throughout their treatment. Here are a few tips that you can share with patients and caregivers to encourage and support proper nutritional intake throughout care when they are experiencing some of the common side effects.

Fatigue

Fatigue is the symptom that is experienced most commonly by oncology patients.⁴ Persistent fatigue experienced by patients impacts all aspects of daily life and can often decrease the desire to eat. Feeling tired makes it hard to cook and clean, even further decreasing the likelihood of eating. Fatigue is commonly underreported by patients because of the thought that there are no treatment options for it. Common treatments may include exercise, anemia correction, and correction of involuntary weight loss.⁵ Here are a few nutrition tips to help patients increase calorie and protein intake to increase energy.

• Keep favorite and convenient foods well stocked.
• Have easy-to-prepare foods available, such as frozen entrees, bars, and shakes.
• Eat small, frequent meals throughout the day.
• Prepare extra food on days you feel well, and accept gifts of food from friends and family.
• Use disposable plates and utensils to minimize cleanup.

Taste Alterations

Radiation and chemotherapy treatments can change taste and smell sensations.⁵ Chemotherapy may cause sensitivity to bitter taste and may increase tolerance of sweets. It also may cause an unpleasant and often metallic taste in the mouth. Radiation may reduce the number of taste buds, leading to a general loss of taste, especially following treatment to the head and neck. Taste and smell sensitivities may change throughout treatment, with most being restored up to a year following treatment. Alterations in taste can lead to food aversions, which may decrease food intake and lead to weight loss. Below are a few tips to help people manage food intake through taste and smell changes.

• Cleanse the mouth with salted water, water with lemon, or water with baking soda before meals. Use gum, mints, or lemon drops after meals.
• To lessen tastes or smells, serve food cold or at room temperature.
• To help with a metallic taste, eat flavorful, tart foods such as citrus fruit or pickles. Try using plastic utensils.
• Use seasoning, sauces, and spices to help with decreased sensitivity to salt and sugar. Marinate meats in flavorful sweet and sour sauces.

Oral Mucositis

Mucositis is inflammation in the mouth caused by direct damage to the mucosal epithelial cells from radiation or chemotherapy. Oral mucositis pre­sents as ulcers or red, burnlike sores in the mouth. These sores can make eating painful and unenjoyable, leading to decreased food intake. Open sores also leave patients more susceptible to infection. Here are a few tips to help patients.

• Help prevent infection by brushing teeth and rinsing the mouth regularly.
• Use numbing sprays and lozenges to relieve pain.
• Prepare and eat soft, mild foods such as frozen yogurt, eggs, and mashed potatoes that are easy to chew and swallow.
• Avoid foods that are dry or rough or citrus fruits, which may irritate the mouth.

Good nutrition involves eating a variety of foods every day to get the nutrients (protein, carbohydrates, fat, fluid, vitamins, and minerals) needed to maintain weight and to encourage healing. Through cancer treatment, getting the right nutrition can be challenging due to appetite loss, fatigue, and other painful side effects. Educating patients on the small changes they can make to their daily eating routine can help alleviate or manage some of these adverse events. If patients experience unintentional weight loss or if the nutrition-related side effects become unmanageable, refer the patient to a registered dietitian or nutritionist for additional support. Addressing nutrition issues and needs can impact quality of life for patients and caregivers throughout treatment.

References
1. Marín Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007;26(3):289-301.
2. Aapro M, Arends J, Bozzetti F, et al. Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol. 2014;25(8):1492-1499.
3. Baldwin C, Spiro A, Ahern R, et al. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst. 2012;104(5):371-385.
4. The National Comprehensive Cancer Network Clinical Practice Guidelines. http://www.nccn.org/
patients/resources/life_with_cancer/fatigue.aspx2015. Accessed June 1, 2015.
5. Leser M, Ledesma N, Bergerson S, et al, eds. Oncology Nutrition for Clinical Practice. Chicago, IL; Oncology Nutrition Dietetic Practice Group; 2013.