Dr.Vikas Roshan
Nutrition is so basic that most of the times it is just taken for granted or completely overlooked. Nutrition in cancer is very important and its role is getting defined but still considered as new science. I am sure in coming future it will open the new dimensions in life of cancer patients. We are still studying the impact of malnutrition in radipdly evolving oncology. Day by day research started mounting evidences but still its application remains inconclusive. Moreover in our daily clinical practice we won’t discuss much about it but I believe it could be a game changer if acknowledged properly. Recently I was going through the literature for writing this article and I came to know that there are two principles that have proven beyond doubt that nutrition can sustain the patient and it has a supportive role in the treatment of cancer. Personally and experimentally I feel that it helps patients in handling the stress of treatment, it can reduce side effect, improve tolerances to treatment and it plays a significant role in improving quality of life. Proper and balanced nutrition helps in fighting cancer and recovery from side effects. There is no special diet that will replace the treatment but no doubt nutrition along with treatment can do wonders. Literature reveal that there is better chance of recovery from surgery, chemotherapy and radiotherapy when patient is taking adequate calories. It improves the immunity and make you less susceptible to infections. Patients who eat balance of protein, fat and carbohydrates are better at maintaining strength. It preserves the muscle mass and repairs the treatment induced injuries. When you are not eating proper food, body breaks down the fats and own muscle protein to release energy in body and consequently muscle mass of patient decreases. Moreover with cancer patients there is always anorexia (loss of appetite) associated and they don’t feel like eating food which in turn leads to weight loss. Cancer generally improves metabolism (means break food too fast) and burns the calories quickly and so the intake should be increase but what happens, is exactly opposite to this. The chronology is first malnutrition sets in and then there is weight loss. The signs and symptoms associated with malnutrition are so subtle and difficult to pick early. Generally patients complain of altered taste and even digestion is not good sometimes. Simple way to improve nutrition is to add different colored foods (use red ,yellow, green colored (traffic light colours- easy to remember) because it contains different vitamins and minerals, Arrange the favourite foods for the patients and table decoration can be changed as traditional occasions like festivals. These measures will increase appetite and maintain nutrition. Meals should be served to patients at dining table and not in isolation, those days when patients are feeling good (up days) should take more food and gain nutrition momentum so that body stores can be replenished and used later on. And if you are living alone keep your cupboard stocked with easy to make foods. It is good to avoid raw food when patients are on active treatment.
There is option of giving intravenous nutrition. All these invasive types of nutrition have certain limitations attached to it and physician consultation is required before starting it. So good balanced diet, small frequent meals as per need, 10-15min physical exercise or yoga will help the patients to continue their cancer journey well.
There are certain things that we can do to increase calories or make food nutritionally dense • Use Peanut butter, butter or margarine with soups, vegetables, breads • Add cheese to vegetables, pulses, salads • Cream can be used in soups, coffee, tea • Porridge, vermicelli, Kheer, Daliya etc • Gravies and sauces with butter • Nutritional/protein bars • Keep nuts, raisins and locally available dry fruits. • Use brown sugar, honey, chocolate syrups in hot drinks • Use sunflower, pumpkin or sesame seeds into cereals or baked goods. There are side effects associated with cancer treatment like taste changes and loss of appetite, nausea vomiting, diarrhea, abdomen cramps, constipation, mucositis, heartburn, sometimes weight gain because of fluid retention. There are sometimes features of fullness of tummy and remedy for this is to switch to high carbohydrate diet like toast and juices and avoids fatty foods. It is good to take small frequent meals. It is important to weigh the nutritional content of food as compared to bulk of food. Avoid nausea by maintaining electrolyte by taking adequate salts. Sweet carbonated water can be taken for nausea but if it persists that contact doctor. For proper patient care you can maintain chart at home, taking care of proportions of carbohydrates/fats/proteins. We also ask patients to meet nutritionist/dietician to prepare diet charts from them. Oncology patient should take roughly 6 to 11 meals per day. Attendants should take care of hygiene while preparing food. Rich sources of vitamin B are cereal, rice, beans, breads etc that helps in maintaining metabolism. Fruits and vegetables are rich source of vitamin A which maintains mucous membranes during radiation therapy. Milk can be fortified with dry milk and can be used for sauces and gravies that provide dense food to provide energy and calcium. Use of energy dense foods like fats gives more calories in body(almost double) as compare to protein and carbohydrate. So if intake is less we can add butter and ghee to food. Sometimes patient are unable to take orally and on nasal tube feeding (ryle tube) through nose. It is common myth that feed is not possible through this tube but if patients are explained properly and counseled well to use grinder to grind food and make it to fluid like consistency and can be taken 10 to 12 servings a day. Sometime tubes can be placed directly in stomach/part of intestine to maintain nutrition and sustain health. There is option of giving intravenous nutrition. All these invasive types of nutrition have certain limitations attached to it and physician consultation is required before starting it. So good balanced diet, small frequent meals as per need, 10-15min physical exercise or yoga will help the patients to continue their cancer journey well.
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Author Consultant Radiation Oncology.
