Malnutrition in Cancer
By Mrs Artika Datta
Rama Foundation- Trustee and Treasurer
Artika Datta who has a B.Sc. Honours in Nutrition and an M.Sc. in Dietetics from King’s College, London works at Addenbrookes hospital at Cambridge. Artika specialises in Motor Neuron Disease and has a particular interest in palliative care in which she is actively involved.
The Statistics
- Malnutrition affects 40-80% of cancer patients (Ollenschlager et al, 1991; Kern & Norton, 1998)
- Prevalance of malnutrition depends on the tumour type, location, stage and treatment (Shike, 1996)
- Risk of malnutrition increases with multi-modality treatments
- Approx. 80% of patient’s in advanced stages have cancer cachexia (or wasting syndrome which is loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite) (Goo and Hill, 2003)
- Up to 85% of patient with gastro-intestinal tumours are malnourished (Stratton et al., 2003)
- In head and neck cancers the incidence of malnutrition can range from 40 to 58% (Connally, 2004; Grobbelaar et al., 2004)
- Between 46 and 61% of patients with lung cancer and mesothelioma experience weight loss before diagnosis and treatment (Brown and Radke, 1998)
- 75-80% of patients with head an neck cancers have significant weight loss (>10% of body weight) during treatment period (Hammerlid et al., 1998; Lopez et.al., 1994)
One of the Main Factors of Malnutrition Is Poor Appetite
- It is the most common cause of decreased food intake
- 1 in 4 people diagnosed with cancer have loss of appetite
- It can be caused by the cancer itself
- And / or caused by the treatments. Many people find that during treatment for cancer there are times when they are unable to eat and drink as normal
- Emotions such as fear or depression can also take away a person’s appetite
Consequences of Malnutrition
- Malnutrition affects both the quality of life and survival in patients with advanced disease
- Muscle wasting, weakness and fatigue
- Impaired immune function, increased infection rate
- Apathy, depression, self neglect, reduced will to recover
- Poor quality of life .Failure to complete chemotherapy
- Reduced respiratory function
- Delayed wound healing
- Poorer outcomes
- Readmission to hospital
- Immobility and social isolation
- Higher incidence of psychological and psychiatric disorders such as depression, causing a marked alteration of quality of life and a drastic reduction of performance status (Ottery 1995)
- Some evidence that weight-losing patients have a reduced global QoL (Dahele & Fearon 2004)
Dietary modifications to overcome reduced appetite
- Little & often eating pattern
- High protein / energy meal options
- Eating what the patient fancies
- Food fortification
- Food & fluids separately
- Nutritional Supplements
- Use of appetite stimulants which include
- Steroids – Can stimulate appetite, however side effects include fluid retention, muscle weakness, osteoporosis & skin fragility
- Megestrol Acetate – Shown to have beneficial effects on cancer related anorexia & weight loss
Ideas to Fortify Diet
- Aiming to use 1 pint (568ml) of full cream milk / day and adding it to soups and porridge (sweet Dalia)
- Using full cream milk to make dahi
- Grated khoya or paneer can be added to vegetable curries, soups
- Add evaporated milk to dahi and daal
- Add syrup to ice cream, or sugar and fruit puree to natural yogurt
- Add ghee or butter to daal and sabji,
Nourishing snacks
3 rusks – 123 Kcal – 3.9 G protein
200ml Whole milk – 132 Kcal – 6.5 G protein
1 Samosa (filled with potato and peas)- 308 Kcal – 4.67 G protein
193g Kheer – 282 Kcal – 8 G protein
2 Rasgullas – 304 Kcal – 8 G protein
Moong daal Dalia – 268 Kcal – 11 G protein
Oral Nutrition Supplements
- A simple, non-invasive method of increasing nutrient intake
- Most oral nutritional supplements are nutritionally complete
- Majority contain 1-1.5 kcal/ml, but also available as ‘concentrated’ feed (2kcal/ml)
- Protein content varies from 4 to 10g/100ml
Oral Nutritional Support
- Oral nutritional supplements (ONS) considered when nutritional intake is insufficient despite nutritional counseling.
- ONS used
- To supplement food intake if the patient is unable to eat enough
- To replace food
- Available in liquid form, soups, powders, and other consistencies such as puddings