Cancer definition

nausea and vomiting

Cause of nausea and vomiting in Cancer patients include;

• Chemotherapy
•  Radiation
• Analgesics
•  Odor(including food orders, performs)
•  delayed gastric emptying

• Nausea and vomiting associated with atrophy can be classified as acute delayed or anticipatory.

• Acute nausea and vomiting occur within 24 hours of administration of chemotherapy

• Delayed nausea and vomiting usually within 24 hours administration of chemotherapy has been administered and may last up to a week.

• Anticipatory nausea and vomiting most commonly occur before the initiation of chemotherapy but may also occur during or after the initiation of chemotherapy.

• Nausea and vomiting related to radiation therapy are dependent on the field being irradiated.

• Almost 100% of patients undergoing total body irradiation (TBI) during bone marrow transplantation experience emesis ,while radiation of the cranium only is a considered low risk (about 10% to 30% of patients experience emesis).

• Upper and mid- abdominal RT can also result in nausea and vomiting starting one to two hours after treatment and resisting for several hours.

• Patients who are experiencing nausea and vomiting due to certain odors are encouraged to take precautions in avoiding such odors.
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• A common cause of nausea and vomiting is the use of narcotic analgesics(morphine, codeine, fentanyl) which are prescribed for many cancer patients for chronic pain.
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• Other medication known to cause nausea and vomiting include antibiotics, digoxin, and anticholinergic agents.

      Intervention

• The patient should be advised to eat only a small low - fat meal the morning of the first treatment and to avoid fried, greasy and favorite foods for several days following the statement.

• A clear liquid diet for the first few days after therapy may be indicated.

• To provides calories and maintains hydration consumption of electrolyte- fortified beverages, nutritional fruit beverages and non acidic fruits drink (apple and grapes juice,  nectars) should be encouraged.

• One important intervention is to encourage patients to take their antiemetics as instructed by their physician.

• To encourage adequate intake and maximal control of nausea and vomiting, antiemetic should be take at least 30-40 minutes before a meal is consumed.

• Patients should be encouraged to take their antiemetics even if they do not feel nauseated at the time, especially while actively receiving treatment.

• It is important for the patients with early satiety to eat small, frequent meals that are nutrient dense.

• Beverage should also contain nutrient and should be consumed between meals rather than with meals so as not to add to the feeling of fullness.

• Consumption of RAW vegetables, such as salads and other high - fiber foods should be avoided.
• Prokinetics medication that increase gastric emptying may be useful.

     Mucositis;

• Mucositis also known as a stomatitis  irritation and inflammation of the epithelial cells of the cells of the membrane lining the gastro-intestinal tract that can occur at any point in the GI tract

• The patients with oral mucositis  should have a thorough and systematic assessment of mouth.

• Chemotherapy-induced mucositis commonly occur 5 to 7 days after chemotherapy is initiated and may continue until the patient recover from the immunosuppression.

    Intervention;

• Patients with oral mucositis may need nutrition education to provide guideline for eating until the mucositis resolves.

• The patient should be encouraged to eat only soft, non-fibrous and non- acidic foods.

• What food should be avoided as they can burn the already tender, fragile mucosa.

• Liquids should be encouraged to prevent dehydration, non- acidic juices such as lectors may be helpful.

• High- Kcal high protein milk shakes or nutritional supplement may be beneficial at this time.

     Diarrhea;

• Antineoplastic agents target those cells that have the highest replication rate, they often cause diarrhea.

• When mucositis is present in the oral mucosa, it can be assumed that it may also be present in the stomach and in the small and large intestine resulting in diarrhea, which may at times becomes severe.

    Intervention;

• The patients with diarrhea should be encouraged to drink small amount of fluids frequently throughout the day.

• Large amount of fruit juice should be avoided as excessive fructose can exacerbate diarrhea.

• Patients should be encouraged to use the antidiarrheal Tube Mate medication as prescribed by their physician.

• Instructing the patient to increase their intake of food high in soluble fiber may help with the treatment of diarrhea; however، often these patients have a poor appetite and may have a difficult time increasing their intake of food in general.

     Dysgeusia;

• Dysgeusia, or alteration in taste, can have a profound effect on patient's ability to guest and adequate amount of  nutrition
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• Test change that occur include a metallic taste (usually due to the chemotherapy agent) no taste sensation (aguesia) a heightening of certain tastes (especially sweets )or to force the patients like to eat in the past.
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• Patients who experience a metallic taste in their mouth should be advised to avoid metal utensils and instead use plastic utensils.
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• Needs are often not tolerated .for To ensure adequate protein in to take the patient should be encouraged to incorporate  other high protein food into the diet, including peanut butter, cottage cheese, poultry and soya meats substitutes.
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• Patients with the dysgeusia should be encouraged to use more highly spiced and flavor food, such as marinated foods.
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• Sweet foods often teste to sweet to individual undergoing cancer therapy.
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• Many homemade drinks and nutritional beverages may be too sweet for these patients.

   Xerostomia;

• Xerostomia, video salwar production, is a common side effect of head and neck radiation and chemotherapy.

• The seriety of xerostomia is correlated with the severity of oral  discomfort, dysgeusia, dysphagia and dysphonia.

• Drugs used to treat cancer can make silver saliva thicker, causing the mouth to feel dry.

• Treatment of xerostomia may include use of artificial saliva and/or mouth moisturizers.

• Chewing gum is more effective than artificial saliva for the treatment of radiation -induced xerostomia.

• Denture wearers may not be able to chew gum for the treatment of xerostomia.

    Anorexia;

• Lack of appetite, or anorexia, is challenging problem for both patient and clinical dietitians.

• Nutrition therapy for the treatment of anorexia is helpful for some patients, improvement required intensive counselling and motivation by the patients.

• Exercise may be help to increase appetite, but many patients may be unable to increase their physical activities for a variety of reason, including profound fatigue, severe thrombocytopenia, severe lmmunosupersession, and side effects from therapy, such as nausea and vomiting 🤮,or diarrhea.

• Exercise, on the other hand, may actually relieve fatigue, prevent muscle wasting, and improve the ability to perform activities of daily living by improving endurance levels.

    General instruction;

     Eating smaller, more frequent meals.

• Maximize your intake when appetite is most normal.

• Limit fluid with meals to avoid feeling of fullness.

• Keep favorite foods readily available at all times.

• Mild exercise, as tolerated ( check with physician).

• Eat meals in pleasant environment.

• Avoid noxious odors, ventilate eating area.

• Try relaxation exercises before meals times.

• Consider pharmacologic agent/appetite stimulants.

    Nutrition support of cancer ♋

• Nutrition support is considered an aggressive form of therapy and should be utilized only when other aggressive medical approaches (i.e chemotherapy, surgery, radiation) are also being used to treat the cancer ♋.

• Nutrition support is inappropriate for most terminal. cancer ♋ patients with a poor prognosis for whom all medical anticancer therapies have been exhausted.

   Guidelines;

• The practice guidelines for nutrition support of adults with cancer ♋ of the American 🏈 Society for Parenteral and Enteral Nutrition (ASPEN) include the following:

• Patients with cancer are nutritionally at risk and should undergo nutrition screening to identify those who required formal nutritional assessment with the development of nutrition care plan.

• Nutrition support therapy should not be used routinely in patients undergoing major cancer operations.

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• Perioperative nutrition support therapy may be beneficial in moderately or severely malnourished patients if administered for 7-14 days preoperatively, but the potential risks of the nutrition support therapy it self and of delaying the operation.

• Nutrition sports therapy should not be used routinely as an adjunct to chemotherapy.

• Nutrition supports therapy appropriate in patients receiving active anti cancer treatment who are malnourished and who are anticipated to be unable to ingest and or absorb adequate nutrient for a prolonged period of time.

• The use of nutrition nutrition support therapy in terminally ill cancer patient is rarely indicated..

• Patient should not use therapeutic diet to treat cancer.

  How to manage with the side effects of chemotherapy and radiation therapy?

  How to deal with nausea/ vomiting in cancer?

  How to deal with dysgeusia and xerostomia in cancer?

Cancer definition

Nutritional manifestation of cancer