Nutrition in advanced cancer
People in the advanced stages of cancer may have been told that their cancer has spread, come back or perhaps that it cannot be cured. When cancer is not curable, treatment becomes palliative, i.e. focusing on the relief of symptoms rather than treating their cause. Patients may have palliative treatment (e.g. Radiotherapy or Chemotherapy) to help control their cancer symptoms and they will experience the same side effects and subsequent nutritional problems as someone undergoing curative treatment. Nutritional advice for palliative care patients is very similar to that offered to patients having curative treatment, but the goal of treatment will be aimed more at improving quality of life and providing relief from symptoms. Common symptoms experienced by patients with advanced cancer are anorexia (reduced appetite) and weight loss. Weight loss is often expressed as a concern by both patients and their families, as changes in appearance can serve as a constant reminder of the diagnosis of cancer. Patients with advanced cancer may develop cachexia. Cancer cachexia is the term used to describe a complex syndrome that is characterised by progressive, involuntary weight loss. You may also hear this called ‘wasting syndrome’. Both a reduction in food intake and a change in the body’s metabolism are thought to contribute to the development of the following symptoms:
- Weight loss, even in patients that are eating well
- The loss of fat and muscle mass (muscle wastage)
- Anorexia • Early satiety (feeling full after eating small amounts)
- Weakness and fatigue
Cachexia seems to be more common in people with lung cancer or with cancers in the digestive system. Nutrition related side effects might occur or become worse as cancer becomes more advanced. The following symptoms are some of those commonly experienced by people with progressive illness:
Some people may have particular eating problems caused by the local effects of their cancer e.g. swallowing difficulties resulting from oesophageal (gullet) cancer. Individual assessment of the patients’ dietary needs may be helpful here. Patients can ask their Hospital Doctor or GP to refer them to a Registered Dietitian who can offer specialist advice.
The psychological effect of having advanced cancer can be deeply worrying for patients and this may further impair their desire to eat or drink.
Many of these symptoms can be improved, and so it is essential that patients discuss them with their Doctor or Healthcare professional. Achieving good symptom control will benefit food intake.
When cancer is advanced, food should be encouraged as a source of enjoyment and it may be appropriate for any dietary restrictions (e.g. diabetic diets) to be stopped or relaxed. Any changes in diet need to be discussed with the patients’ medical team first who can offer advice, support and reassurance.
Advanced cancer and nutritional support page for practical suggestions.
Source: National Cancer Institute, Nutrition in cancer Editorial Board
