Chapter 12: Symptom Management of Cancer Therapies

Question 1

Common Nutrition Impact Symptoms of people going through cancer treatment?

Answer 1

anorexia, poor appetite, early satiety, constipation, diarrhea, malabsorption, dysphagia, mucositis, esophagitis, oral candidiasis, xerostomia, thick saliva, taste and smell changes, or fatigue.

Question 2

What is Anorexia?

Answer 2

the loss of appetite or desire to eat

Question 3

What are potential nutritional outcomes of anorexia?

Answer 3

weight loss, nutrient insufficiencies & deficiencies, dehydration

Question 4

Nutrition Interventions for anorexia.

Answer 4

small, frequent meals of calorie-dense foods and fluids, eat in pleasant surroundings, avoiding stress or conflict at meals, eat by the clock rather than waiting for appetite or hunger cues, view eating as part of treatment, use medical nutritional beverages when eating is too hard, use easy to prepare foods, engage in light activity to stimulate appetite.

Question 5

Other considerations for anorexia?

Answer 5

Look for other conditions that may depress appetite (constipation or depression), and look for medications that may depress appetite (meds that manage constipation, nausea, or pain)

Question 6

Nutrition interventions for Early Satiety?

Answer 6

choose calorie dense foods or medical nutritional beverages, maximize intake when most hungry, eat small frequent meals/snacks, eat by the clock, eat by the clock rather than hunger cues, consume liquids between meals instead of with meals.

Question 7

Other considerations for early satiety?

Answer 7

Evaluate for conditions that may slow gastric emptying (GERD, diabetes, gastroparesis, obstruction), evaluate for use of medications that may slow gastric emptying (opioids, H2 receptor antagonists, proton pump inhibitors, sucralfate, interferon, levadopa)

Question 8

What is Constipation?

Answer 8

The decrease in frequency of bowel movements and or hard to pass stools that may be due to dehydration, medication or mechanical changes from anticancer therapy.

Question 9

Potential nutrition outcomes of constipation?

Answer 9

infrequent or hard to pass stools, pain, early satiety, nausea, vomiting

Question 10

Nutrition diagnosis of constipation?

Answer 10

altered GI function related to inadequate food, fluid and/or fiber intake or medications.

Question 11

Nutrition interventions for constipation?

Answer 11

Education pt on importance of adequate hydration, fiber intake, and total food intake on bowel regularity.
Aim for 64 oz fluid per day and a slow increase to 25-35 grams of fiber per day as tolerated.
Encouraged use of hot beverages, hot cereal or high fiber food to stimulate bowel movements.
Incorporate probiotics and/or other supplements that help regular bowel movements. Engage in light activity to stimulate bowel regularity. Discuss meds that may effect bowel movements, schedule adequate bathroom time.

Question 12

What is Diarrhea?

Answer 12

An increase of three or more stools per day as compared to usual or an increase in liquidity of bowel movements possibly caused by diet, emotional stress, inflammation or irritation of the mucosa of the intestines, medications or cancer treatment or lactose intolerance.

Question 13

Nutrition diagnosis for Diarrhea?

Answer 13

Altered GI function related to inability to digest/absorb certain foods, anticancer treatment, and or medications.

Question 14

Potential nutrition outcomes of Diarrhea?

Answer 14

Frequent stools, dehydration, electrolyte imbalances, weight loss, fatigue, nutrient insufficiencies and deficiencies, malnutrition.

Question 15

Nutrition interventions of Diarrhea?

Answer 15

Identify problem foods or eating habits via food/symptom log, encourage low fat, low fiber, and or low lactose diet, avoid gas producing foods, caffeine and alcohol. Consider the use of bulking agents (soluble fiber) to control diarrhea. Avoid sugar alcohols.

Question 16

What is Dysphagia?

Answer 16

Pain or difficulty swallowing that leads to decrease intake.

Question 17

Possible causes of Dysphagia?

Answer 17

extrinsic compression of the esophagus, mechanical obstruction, neurological dysfunction, oral or esophageal candidasis, or sever mucositis, or esophageal radiation

Question 18

Nutrition diagnosis of Dysphagia?

Answer 18

Inadequate oral intake related to swallowing difficulty

Question 19

Potential nutrition outcomes of Dysphagia?

Answer 19

Dehydration, coughing, choking, feeling of “food getting stuck”, pain while swallowing, weight loss, nutrient insufficiencies and deficiencies, dehydration, malnutrition.

Question 20

Nutrition interventions of Dysphagia?

Answer 20

Use of good posture when eating to prevent aspiration, avoid distractions and limit talking while eating, encouraged double swallows to assure food clears, encourage verbalization after drinks to assure liquids have cleared, choose moist foods of a similar texture, consider using thickeners in liquids to slow flow and allow safe swallow, avoid straws, alter food texture as needed for safe swallow.

Question 21

What is oral candidiasis?

Answer 21

May be an opportunistic infection seen as red or white patches in the mouth due to treatment or a depressed immune status, causing taste alterations, sore mouth, and coated tongue.

Question 22

Nutrition Diagnosis of candidiasis?

Answer 22

Inadequate food and beverage intake related to infection, taste alterations, and a sore mouth.

Question 23

Potential Outcomes of Candidiasis?

Answer 23

sore mouth and throat, decrease in food intake, weight loss, malnutrition

Question 24

Nutrition interventions for Candidiasis?

Answer 24

practice good oral hygiene, choose soft textured, low acid foods, avoid sugar and yeast-derived foods

Question 25

What is Fatigue?

Answer 25

Lack of energy, tiredness, and mental fuzziness

Question 26

Possible causes of Fatigue?

Answer 26

anemia, inadequate energy and/or protein intake, weight loss, pain, medications, acticancer treatment, dehydration, and/or sleep disturbances.

Question 27

Nutrition diagnosis of Fatigue?

Answer 27

inadequate food and beverage intake or involuntary weight loss related to inadequate energy or protein intake, fatigue, pain or medications.

Question 28

Potential outcomes of Fatigue?

Answer 28

poor oral intake, weight loss, weight gain, depression

Question 29

Nutrition interventions for Fatigue?

Answer 29

Review food/fluid intake for adequacy, monitor weight and adjust calories as needed, encourage easy to prepare foods, advise use of non-perishable snacks (trail mix), consume soft, easy-to-chew foods, small frequent meals, eat well when appetite is best (morning), encouraged light ADL

Question 30

Other considerations for Fatigue?

Answer 30

evaluate for anemia as a cause of lack of energy. Pt may need mvi

Question 31

What is Malabsorption?

Answer 31

decreases in the ability to digest and absorb nutrients.

Question 32

Possible causes of Malabsorption?

Answer 32

chemotherapy, surgery, medications, medical conditions, or infections

Question 33

Possible symptoms of Malabsorption?

Answer 33

gas, bloating, gastrointestinal pain and/or diarrhea

Question 34

Nutrition diagnosis of Malabsorption?

Answer 34

altered GI function related to disease process, infection, surgery, medications, chemotherapy, or radiation

Question 35

Potential nutrition outcomes of Malabsorption?

Answer 35

abnormal digestive enzyme studies, cachexia, steatorrhea, weight loss, dehydration, fatigue, nutrient insufficiencies and deficiencies, malnutrition

Question 36

Nutrition interventions for bloating and gas?

Answer 36

avoid cruciferous vegetables and limit swallowed air by avoiding use of straws, carbonated beverages and chewing gum and by eating slowly with mouth closed

Question 37

Nutrition intervention for bloating, cramping, and gas from milk products?

Answer 37

eat low lactose diet and use lactase treated dairy products or lactase pills or drops

Question 38

Nutrition intervention for gas from beans and legumes

Answer 38

avoid these foods and use Beno drops

Question 39

Nutrition intervention for chronic diarrhea?

Answer 39

try a low insoluble fiber, low fat, low lactose diet

Question 40

Nutrition intervention for bulky, foul smelling stools?

Answer 40

eat a low fat diet and use pancreatic enzymes

Question 41

Nutrition intervention for fatty stools

Answer 41

try a low fat diet and use pancreatic enzymes

Question 42

What is Mucositis/Esophagitis

Answer 42

The inflammation of the mouth or espophagus, usually described as a painful, irritated throat or the feeling of a lump in the throat.

Question 43

What are some symptoms of Mucositis/Esophagitis?

Answer 43

indigestion, esophageal reflux, belching, feeling of fullness, and early satiety

Question 44

Nutrition diagnosis of Mucositis/Esophagitis?

Answer 44

Inadequate energy intake related to disease process or treatment that produces pain when swallowing

Question 45

Potential Outcomes of Mucositis/Esophagitis?

Answer 45

weight loss, nutrient insufficiencies and deficiencies, malnutrition

Question 46

Nutrition intervention for Mucositis/Esophagitis?

Answer 46

lower acidity foods, low spice foods, soft texture foods with added moisture (gravy, etc), creamy soups, mashed potatoes, etc, cool/room temp foods, smoothies with low acid fruits and tofu, avoid alcohol and tobacco

Question 47

What are some causes of Nausea/Vomiting?

Answer 47

chemotherapy, radiation, immunotherapy, pain, dysguesia (change in sense of taste), fatigue, mucous drainage, flu, constipation, psychological factors and or medications such as antibiotics and narcotics

Question 48

Nutrition diagnosis for Nausea/Vomiting?

Answer 48

Inadequate oral food/beverage intake and altered GI function related to disease process or treatment

Question 49

Potential outcomes of Nausea/Vomiting?

Answer 49

dehydration, electrolyte imbalances, weight loss, nutrient insufficiencies and deficiencies

Question 50

Nutrition interventions of Nausea/Vomiting?

Answer 50

5-6 small meals/day, limit exposure to food smells, cool, light foods, avoid high fat foods, consume liquids between meals, avoid strong smelling soaps, perfumes, etc, rest with head elevated for 30 min after eating, if taking pain meds, take with crackers or light food.

Question 51

Other considerations for Nausea/Vomiting?

Answer 51

consider use of complementary therapies such as ginger tea, ginger ale, acupressure bracelet, relaxation techniques

Question 52

Symptoms of changes to taste and smell?

Answer 52

Caused by radiation and chemotherapy, characterized by having little or no sense of taste and smell or heightened sense of metallic, bitter, salty or sweet taste (normal taste may take up to a year to return)

Question 53

Nutrition diagnosis of taste and smell?

Answer 53

Inadequate food and beverage intake related to taste and smell changes

Question 54

Potential outcomes of taste and smell?

Answer 54

decreased intake, nutrient insufficiencies and deficiencies, weight loss

Question 55

Nutrition interventions when foods have no taste?

Answer 55

choose fruit marinades for meats, use lemon, herbs an spices, pickles or hot sauce to flavor foods

Question 56

Nutrition interventions when food has an "off" taste?

Answer 56

fruity or salty flavors are often well accepted and taste correctly. Suggest sugar-free lemon drops, gum, or mints

Question 57

Nutrition interventions for bitter or metallic taste?

Answer 57

use spices or seasonings like onion, garlic or chili powder, suck on lemon drops or mints, use plastic utensils, flavor water with lemon or other fruit flavors

Question 58

Nutrition interventions when meat tastes "bitter" or strange?

Answer 58

add fruit-based marinades, or sweet and sour sauce to meats, chose alternative protein sources like eggs, beans, tofu or dairy

Question 59

Nutrition interventions when smells are bothersome?

Answer 59

avoid cooking ares during meal prep, eat foods that aren't cooked such as smoothies, cold sandwiches, crackers, cheese, yogurt, and fruit, use a cup with a lid and straw to mask food oders, avoid microwave as it can spread food odors

Question 60

What is Xerostomia?

Answer 60

the abnormal dryness of the mouth that causes difficulty eating and talking, taste alterations, and or thick saliva and ropy saliva

Question 61

Nutrition diagnosis for Xerostomia?

Answer 61

inadequate food and beverage intake related to difficulty eating

Question 62

Potential outcomes of Xerostomia?

Answer 62

decreased oral intake, nutrient insufficiencies and deficiencies, weight loss

Question 63

Nutrition interventions of Xerostomia?

Answer 63

small frequent meals, alternate bites and sips at meals, add broth, gravy and sauces to meals and dunk dry foods in liquids, sip fluids throughout the day (aim for 8-10 cups/day), chew on carrots/celery, swish and spit using club soda or carbonated water, use a humidifier at home to moisten the air, good oral hygiene, suck on hard candies, avoid alcohol

Question 64

Pharmacologic interventions for anorexia and early satiety.

Answer 64

``` Periactin Decadron Solu-medrol Provera Megase Reglan ```

Question 65

Pharmacologic intervention for constipation (Bulking agents).

Answer 65

Bran, flaxseed or wheat germ Citrucel (methycellulose) Konsyl

Question 66

Pharmacologic intervention for constipation (stool softener/surfactant).

Answer 66

Colase (docusate) | Mineral oil

Question 67

Pharmacologic intervention for constipation (osmotic laxative).

Answer 67

MiraLAX (polyethylene glycol) Lactulose MOM

Question 68

Pharmacologic intervention for constipation (stimulant laxative).

Answer 68

Carter’s pills (bisacodyl) | Senocot (senna)

Question 69

Pharmacologic intervention for constipation (herbals).

Answer 69

Probiotics Slippery elm Aloe juice

Question 70

Pharmacologic intervention for diarrhea (opoid receptor agonist).

Answer 70

Imodium AD Lomotil Sandostatin Timcture of opium

Question 71

Pharmacologic intervention for diarrhea (anti-inflammatory, anti-diarrheal).

Answer 71

Pepto-Bismol | Kaopectate

Question 72

Pharmacologic intervention for diarrhea (bile acid sequestrant).

Answer 72

Questran (cholestyramine)

Question 73

Pharmacologic intervention for diarrhea (anticholinergic).

Answer 73

Benadryl (diphenhydramine)

Question 74

Pharmacologic intervention for diarrhea (herbal).

Answer 74

Probiotics

Question 75

Pharmacologic intervention for dysphasia (topical spray).

Answer 75

Xylocaine (lidocaine spray)

Question 76

Pharmacologic intervention for dysphagia (thickeners).

Answer 76

Thick It Thicken up Thicken Right Thick and Easy

Question 77

Pharmacologic intervention for oral candidasis.

Answer 77

Polyenes such as nystatin Azoles such as Diflucan Chlorhexidine

Question 78

Pharmacologic intervention for fatigue.

Answer 78

Blood transfusions | Erythropoietin given as Epogen, Procrit

Question 79

Pharmacologic intervention for malabsorption to reduce gas.

Answer 79

Gas-X | Probiotics

Question 80

Pharmacologic intervention for lactose malabsorption.

Answer 80

Lactaid | Probiotics

Question 81

Pharmacologic intervention for malabsorption of beans and vegetable starches.

Answer 81

Beano | Probiotics

Question 82

Pharmacologic intervention for fat malabsorption.

Answer 82

Pancreatic enzymes

Question 83

Pharmacologic intervention for mucositis/esophagitis.

Answer 83

Anticeptic gels containing lidocaine Gargle made of salt and baking soda Glutamine rinces 5 g 3x/day

Question 84

Pharmacologic intervention for acute nausea and vomiting.

Answer 84

Zofran (ondansetron) Anzemet (dolasetron) Kytril (granisetron) Aloxi (palonosetron)

Question 85

Pharmacologic intervention for delayed nausea and vomiting.

Answer 85

``` Dopamine antagonis: compazine, phenergan Reglan Marinol (dronabinol) of Cesamet (nabilone) Ativan or valium Decadron or Prednisone ```

Question 86

Pharmacologic intervention for change in taste and smell.

Answer 86

zinc supplements (50 mg of elemental zinc)

Question 87

Pharmacologic intervention for xerostomia thick saliva.

Answer 87

``` accupuncture Biotene (gel, liquid, spray) BioXtra (gel, tablets, spray) Caphosol Glandosane Salivart Xero-Lube MouthKote ```