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Nutrition in Cancer Care (PDQ®)

Patient Version
Last Modified: 12/28/2011

Nutrition in Advanced Cancer

Key Points for This Section


Palliative care helps relieve symptoms that bother the patient and helps improve the patient's quality of life.

The goal of palliative care is to improve the quality of life of patients who have a serious or life-threatening disease. Palliative care is meant to prevent or treat symptoms, side effects, and psychological, social, and spiritual problems caused by a disease or its treatment.

Palliative care for patients with advanced cancer includes nutrition therapy (see the Treatment of Symptoms 1 section) and/or drug therapy.

Nutrition needs are different for patients with advanced cancer.

It is common for patients with advanced cancer to want less food. Patients usually prefer soft foods and clear liquids. Those who have problems swallowing may do better with thick liquids than with thin liquids. Patients often do not feel much hunger at all and may need very little food.

In patients with advanced cancer, most foods are allowed. During this time, eating can be focused on pleasure rather than getting enough nutrients. Patients usually cannot eat enough of any food that might cause a problem. However, some patients may need to stay on a special diet. For example, patients with cancer that affects the abdomen may need a soft diet to keep the bowel from getting blocked.

The benefits and harms of nutrition support are different for each patient.

Answering the following questions may help to make decisions about using nutrition support:

  • What are the wishes and needs of the patient and family?
  • Will the patient's quality of life be improved?
  • Do the possible benefits outweigh the risks and costs?
  • Is there an advance directive? An advance directive is a legal document that states the treatment or care a person wishes to receive or not receive if he or she becomes unable to make medical decisions. One type of advance directive is a living will.

Cancer patients and their caregivers have the right to make informed decisions. The healthcare team and a registered dietitian can explain the benefits and risks of using nutrition support for patients with advanced cancer. In most cases, there are more harms than benefits, especially with parenteral nutrition support. However, for someone who still has good quality of life but is unable to get enough food and water by mouth, enteral feedings may be best. The benefits and risks of enteral nutrition during advanced cancer include the following:

Benefits

  • May make the patient more alert.
  • May be a comfort to the family.
  • May relieve nausea.
  • May make the patient feel more hopeful.

Harms



Glossary Terms

abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
advance directive (ad-VANS duh-REK-tiv)
A legal document that states the treatment or care a person wishes to receive or not receive if he or she becomes unable to make medical decisions (for example, due to being unconscious or in a coma). Some types of advance directives are living wills and do-not-resuscitate (DNR) orders.
advanced cancer (ad-VANST KAN-ser)
Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.
bowel (BOW-ul)
The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
caregiver (KAYR-gih-ver)
A person who gives care to people who need help taking care of themselves. Examples include children, the elderly, or patients who have chronic illnesses or are disabled. Caregivers may be health professionals, family members, friends, social workers, or members of the clergy. They may give care at home or in a hospital or other health care setting.
constipation (KON-stih-PAY-shun)
A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.
diarrhea (dy-uh-REE-uh)
Frequent and watery bowel movements.
diet (DY-et)
The things a person eats and drinks.
drug therapy (… THAYR-uh-pee)
Treatment with any substance, other than food, that is used to prevent, diagnose, treat, or relieve symptoms of a disease or abnormal condition.
enteral nutrition (EN-teh-rul noo-TRIH-shun)
A form of nutrition that is delivered into the digestive system as a liquid. Drinking nutrition beverages or formulas and tubefeeding are forms of enteral nutrition. People who are unable to meet their needs with food and beverages alone, and who do not have vomiting or uncontrollable diarrhea may be given tubefeedings. Tubefeeding can be used to add to what a person is able to eat or can be the only source of nutrition. A small feeding tube may be placed through the nose into the stomach or the small intestine, or it may be surgically placed into the stomach or the intestinal tract through an opening made on the outside of the abdomen, depending on how long it will be used.
infection (in-FEK-shun)
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
living will (LIH-ving wil)
A type of legal advance directive in which a person describes specific treatment guidelines that are to be followed by health care providers if he or she becomes terminally ill and cannot communicate. A living will usually has instructions about whether to use aggressive medical treatment to keep a person alive (such as CPR, artificial nutrition, use of a respirator).
nausea (NAW-zee-uh)
A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.
nutrient (NOO-tree-ent)
A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.
nutrition (noo-TRIH-shun)
The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.
nutrition therapy (noo-TRIH-shun THAYR-uh-pee)
Treatment based on nutrition. It includes checking a person’s nutrition status, and giving the right foods or nutrients to treat conditions such as those caused by diabetes, heart disease, and cancer. It may involve simple changes in a person’s diet, or intravenous or tube feeding. Nutrition therapy may help patients recover more quickly and spend less time in the hospital. Also called medical nutrition therapy.
palliative care (PA-lee-uh-tiv kayr)
Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.
parenteral nutrition (puh-REN-teh-rul noo-TRIH-shun)
A form of nutrition that is delivered into a vein. Parenteral nutrition does not use the digestive system. It may be given to people who are unable to absorb nutrients through the intestinal tract because of vomiting that won't stop, severe diarrhea, or intestinal disease. It may also be given to those undergoing high-dose chemotherapy or radiation and bone marrow transplantation. It is possible to give all of the protein, calories, vitamins and minerals a person needs using parenteral nutrition. Also called hyperalimentation, total parenteral nutrition, and TPN.
pneumonia (noo-MOH-nyuh)
A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.
psychological (SY-koh-LAH-jih-kul)
Having to do with how the mind works and how thoughts and feelings affect behavior.
quality of life (KWAH-lih-tee ... life)
The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.
registered dietitian (...dy-eh-TIH-shun)
A health professional with special training in the use of diet and nutrition to keep the body healthy. A registered dietitian may help the medical team improve the nutritional health of a patient.
saliva (suh-LY-vuh)
The watery fluid in the mouth made by the salivary glands. Saliva moistens food to help digestion and it helps protect the mouth against infections.
side effect (side eh-FEKT)
A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.
soft diet (soft DY-et)
A diet consisting of bland foods that are softened by cooking, mashing, pureeing, or blending.
spirituality (SPEER-ih-choo-A-lih-tee)
Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others, and beliefs about the meaning of life.
surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
throat (throte)
The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The throat is about 5 inches long, depending on body size. Also called pharynx.

Table of Links

1http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/Patient/Page5#S
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