Malnutrition in Cancer

Mrs Artika Datta

Mrs Artika Datta

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