Books


Understanding How to Manage Changes in Eating

Introduction

Consult with the patient's physician before changing the diet to an alternative diet, such as macrobiotic diet. Some diets may not provide the type of nutrients that the patient needs for energy requirements.

Loss of appetite and progressive decrease in food intake are among the most frequent and distressing symptoms encountered by advanced cancer patients and their family members.

There is a very strong association between eating and family members' expression of love and concern. When patients change their usual eating patterns, family members become very upset and fear that death is approaching.

Decline in eating is expected in advanced cancer patients.

Increased food or fluid intake may not make patients feel better or live longer.

Physical assessment and history may reveal treatable conditions that have resulted in changes in eating patterns.

Family members may need support and information about why their loved one is unable to eat. Some family members interpret the lack of eating as rejection of their efforts to comfort the patient.


Assessment

  • Assess and treat any of the following:
  • Pain or discomfort
  • Nausea
  • Vomiting
  • Altered taste
  • Fever, infection
  • Oral candidiasis
  • Depression
  • Constipation, bowel obstruction
  • Dry mouth
  • Treatment related causes (chemotherapy, radiation)
  • Gastritis or peptic ulcers

Intervention

  • The following suggestions may be helpful:
  • Assist patient with routine mouth care
  • Assist patient to find comfortable position for swallowing
  • Offer small portions of favorite foods frequently
  • Offer foods that are moist, and easy to swallow
  • Serve food moderately warm or at room temperature
  • Avoid foods with strong, spicy flavors and aromas
  • Offer high protein/high calorie foods (Sustacal, Megacal)
  • Make eating time a pleasant social experience
  • Do not display anger if patient is unable to eat
  • Do not force-feed
  • Ask MD if appetite stimulating medication is appropriate (Megace)
  • Family caregivers need information about patients' inability to swallow as decline in function is demonstrated at end of life.

References

Holden, C. (1993). Nutrition and hydration in the terminally ill cancer patient: The nurse's role in helping patients and families cope. The Hospice Journal, 9(2-3), 15-35.

Kaye, P. (1990). Symptom Control in Hospice and Palliative Care. Essex, CT: Hospice Education Institute.

National Cancer Institute. (1986). Eating Hints. NCI Publication No. 86-2079, Bethesda, MD: National Cancer Institute, U.S. Department of Health & Human Services, Public Health Service.

Nelson, K.A., Walsh, D., & Sheehan, F.A. (1994). The cancer anorexia-cachexia syndrome. Journal of Clinical Oncology, 12(1), 213-225.

Storey, P. (1994). Primer of Palliative Care. The Academy of Hospice Physicians, Gainesville, FL, pp. 21-23.





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