Impaired nutritional status can be a significant problem for people living with cancer and can affect response to treatment (e.g. healing after surgery). Someone with poor nutritional status is less able to withstand side effects of cancer treatments and side effects of treatment such as nausea and vomiting can impede nutritional status further. It is recommended that all patients are screened for nutritional problems each outpatient appointment, admission to hospital and/or in the community/primary care across the pathway (including during prehabilitation) with referral to a dietitian as indicated.
Nutritional assessment of the patient (where appropriate) from a dietitian at a registered, enhanced or advanced level may include:
- Review of current nutritional intake
- Current nutritional problems as a result of disease, symptoms or cancer treatment
- Degree of nutritional depletion and the likelihood of further nutritional depletion
- Nutritional implications of specific tumour types
- Physical state
- Current food and drink intake
- Anthropometric measurements (height, weight, waist etc.)
- Biochemistry
- Nutritional requirements (energy, protein, fluid, electrolytes, micronutrients, fibre) using validated assessment tools
The dietitian will devise an individualised nutritional care plan providing practical dietary advice tailored to the individual’s needs, prognosis, symptoms, and circumstances and ensure interventions are commenced, provide counselling on eating and drinking problems and perioperative feeding and provide on-going dietetic monitoring and support.
Some people with cancer will require supplementary oral nutrition or enteral/parenteral nutritional support (‘tube feeding’) to help improve quality of life. In these cases, the dietitian will plan and coordinate enteral feeding tube discharges and ensure referral to community services for continued support, provide education regarding feeding tube management and the administration of feed and advice on weaning from enteral tube feeding to oral diet.