Nutritional Support

Many cancer patients will require some form of nutritional support during the course of their illness (Table 1). When patients have an eating difficulty, the first course of action is to assess their oral intake. If patients are able to eat, then they should be given appropriate advice to maximize their oral intake. If patients are unable to swallow enough nourishment to maintain their weight, an enteral tube feed should be considered. The type of tube placed will depend on the following:

1. The anticipated length of time the feed will be required.

2. The physical state of the patient; for example, a nasogastric tube or percutaneous endoscopically placed gastrostomy tube may not be suitable for patients with complete oesophageal obstruction. A jejunostomy tube may be preferred following upper gastrointestinal tract surgery.

3. The wishes of the patient concerning the physical appearance of different tubes and the invasive-ness of the procedure required to place them.

Table 1 Methods of nutritional support

Method

Route

Oral feeding

Oral feeding can be facilitated by

Altering the consistency or timing of food

or drink

Fortifying food and drinks with protein and

energy

Altering the flavoring added to food

Using sip feeds and dietary supplements

Enteral tube

Nasogastric or nasojejunal tube Gastrostomy

feeding

Percutaneous endoscopically guided

Gastrostomy

Radiologically inserted gastrostomy

Percutaneous gastrostomy with a jejunal

extension

Jejunostomy

Parenteral

Central line

nutrition

Peripheral line

Numerous brands of enteral feeds are available. Most cancer patients will require complete, whole protein feeds providing 4-6kJml-1 (1-1.5kcalml-1). Only in cases of severe malabsorption, gastrointestinal fistula, or pancreatic insufficiency may elemental, peptide, or low-fat feeds be necessary.

The choice of feeding regimen will depend on the patient's mobility and activity during the day and on the volume of feed tolerated. It may be administered in the following ways: pump feeding overnight and/ or during the day; gravity feeding, which is usually provides a faster rate of feeding that does not require the precision of a pump; and bolus feeding.

Parenteral nutrition is required where the gastrointestinal tract cannot be used, such as in patients with complete bowel obstruction or severe malabsorption.

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