Nutrition in the Care of the Cancer Patient

Proper nutrition care is essential to help prevent or minimize the deleterious effects of cancer, namely malnutrition and cachexia, on nutrition status. When designing appropriate nutrition support, clinicians should consider a patient's history and clinical state including extent of the disease, expected survival, psychological status, and current lifestyle. Oral nutrition is often the preferred means of feeding, but may be limited by factors related to the cancer, the treatment, and the psychologic issues surrounding this disease. Several strategies have been recommended to help patients achieve an adequate oral intake in the presence of anorexia. However, for patients who are severely malnourished or unable to consistently consume more than 75% of their energy needs, enteral nutrition may be indicated. Parenteral nutrition is appropriate only for certain subsets of cancer patients. Numerous trials have shown that use of the enteral route gives comparable results to the parenteral route and is associated with fewer complications and lower costs in both cancer and noncancer patients. There has been much recent interest in the use of immunotherapy—arginine, essential fatty acids, and glutamine—to improve the nutritional status of patients with cancer.