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Weight loss and lack of appetite in bowel cancer

Question

Hello, My 71 year old mother is currently 5 1/2 stone and has lost approximately 3 stone in one year. She has rectal cancer.. a large tumour. It has not spread to other parts of the body but has gone beyond the bowel wall. She has had radiotherapy back in june but they could not operate as it is stuck to the bone. She is undergoing chemo (5fu folifox I believe) and due for her 3rd round. If this is successful it is still hoped an operation will take place. She is currently in hospital due to DVT which is being treated. She is hardly eating.. finds it difficult to swallow. The team seem reluctant to feed her with an NG tube but I am very concerned as she is continuing to loose weight. I have been advised by a friend who is a nurse that she should have had a malnutrition screening.. I feel the staff are not focusing enough on these problems. She has calogen 3 x per day and 1 Complan (she does not like ensure even though I am aware this has more calories in). I also feel her problem is also psychological and have mentioned this to the dietician but with no response. Any advice of what route to take would be much appreciated. Surely she is at great risk if she loses even more weight? Best Wishes, Jacqui Attwood

Answer

Malnutrition screening tools have been implemented by many hospital trusts. Screening tools are used to identify patients who are malnourished, or at risk of becoming malnourished on admission to hospital. Tools are usually completed by the nursing staff on the ward, and include management guidelines which can be used to develop a nutrition care plan, for example; offering additional snacks, starting nutritional supplement drinks, and ultimately referring the patient to the dietitian. I realise that your mum is being seen by the hospital dietitian and it is possible that this has been initiated as a result of malnutrition screening.Loss of appetite is one of the most common problems experienced by people with cancer and side effects of treatment, such as radiotherapy and chemotherapy can further impair a persons desire to eat.

You may find it helpful to know what your mum's nutritional requirements are currently, for example, how many calories/grams of protein does she need to take in order to keep well nourished? The dietitian will be able to advise you on this.  Keeping a record of all the food and drink your mum consumes over a period of 2-3 days will enable the dietitian to work out exactly how much your mum is currently taking, and calculate the shortfall. If there is a deficit between your mum's nutritional requirements and what she is currently taking, the following suggestions may help to bridge the gap and are usually available at ward level: 

  • Energy dense meals. These are often indicated on the hospital menu. Softer options may be easier to manage if your mum has difficulty swallowing.
  • Additional snacks e.g. thick and creamy yoghurts, soft cake
  • Nourishing fluids e.g. milk, milky drinks and fruit juice
  • Encouraging your mum to eat ‘little and often' i.e. small amounts every two to three hours will be easier for her to take when her appetite is poor

 Oral nutritional supplements can be helpful too. There are lots of different products available, and the dietitian will be able to advise your mum which ones are available in the hospital. You mention that your mum is currently taking Complan and Calogen. Ask the dietitian to explain exactly how many your mum needs to take in order to meet her nutritional requirements. I can understand that you are very concerned about your mum's nutritional status, and you are right in thinking that keeping her well nourished will help her to tolerate her cancer treatment better. Bearing in mind the concerns that you have expressed, I would recommend that you ask to speak to the Consultant in charge of her care who will invariably be more than happy to discuss these matters with you. It may be helpful to make a note of your questions or concerns in anticipation of your meeting.