Manage Malnutrition’s Monstrous Consequences in Patients With Cancer
By Addi Watters, MSN, RN, AGPCNP-BC, OCN®, BMTCN®, and Zach Gossman, MS, RD
Nutritional status (https://link.springer.com/article/10.1007%2Fs00520-019-05042-2) is one aspect of cancer care that may often be overlooked. Patients, particularly those with esophageal, gastric, pancreatic, and non-small cell lung cancers, have increased nutritional requirements (https://cjon.ons.org/cjon/24/3/malnutrition-screening-interprofessional-approach-outpatient-oncology) because of their high resting energy expenditure. Treatment side effects further hinder a patient’s desire and ability to eat, creating a wider gap between energy intake and energy needs and placing patients with cancer at high risk for malnutrition (https://link.springer.com/article/10.1007%2Fs00520-019-05042-2).
Approximately 20% of cancer mortality rates (https://www.tandfonline.com/doi/abs/10.1080/01635581.2018.1539186?journalCode=hnuc20) are attributed to disease-related malnutrition, which may lead to (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668103/):
- Reduced muscle and tissue mass
- Decreased mobility
- Immune system dysfunction
- Diminished tolerability of chemotherapy
- Increased risk of developing refeeding syndrome (https://voice.ons.org/news-and-views/the-case-of-the-major-malnutrition-concerns)
Studies show that collaboration between nurses and dietitians benefits and supports (https://cjon.ons.org/cjon/22/1/cancer-anorexia-and-cachexia-screening-ambulatory-infusion-service-and-nutrition) patients with cancer. A multidisciplinary approach among dietitians, advanced practice providers, physicians, and nurses may help improve treatment tolerance and reverse unintended weight loss. Oncology nurses are crucial in facilitating interprofessional collaboration (https://www.ons.org/articles/malnutrition-screening-interprofessional-approach-outpatient-oncology), which can provide individualized interventions to improve nutritional status and manage factors contributing to malnutrition.
Patient and family education is a critical part of treatment for malnutrition. Oncology nurses should encourage (https://www.mskcc.org/news/nutrition-and-cancer-6-frequently-asked-questions) patients to:
- Eat five or six small meals or snacks throughout the day, rather than the typical three large meals.
- Consume protein-rich sources during each meal.
- Set timers and reminders to eat.
- Consume bland, less fatty foods after chemotherapy.
- Follow antinausea medication regimens to optimize their ability and desire to eat.
Almost half of dietitian referrals (https://link.springer.com/article/10.1007%2Fs00520-019-05042-2) occur only after malnutrition is diagnosed, but nurses can change that by recommending early nutrition services interventions such as dietitian consults and use of organization resources. Nurses can also use reputable websites to search for recipes (https://www.mskcc.org/experience/patient-support/nutrition-cancer) and educational resources for patients.
Nutritional status doesn’t have to be an overlooked factor in a patient’s treatment plan. Nursing interventions and interprofessional collaboration can decrease a patient’s risk for malnutrition and contribute to improved treatment outcomes (https://link.springer.com/article/10.1007%2Fs00520-019-05042-2).