RADIOTHERAPY NUTRITION MANAGEMENT

Transcription

1 RADIOTHERAPY NUTRITION MANAGEMENT IN COLLABORATION WITH HIRSLANDEN PRIVATE HOSPITAL GROUP, SWITZERLAND.

2 It is important not to diet during radiotherapy so that you don t lose weight. Your radiotherapy plan is specific to your size and shape. If your weight changes a lot your radiotherapy plan may need to be done again. If you are able to eat normal foods it is important to eat high energy and protein foods, such as: Meat Fish Eggs Cheese Full fat milk Pulses (peas and beans) If you don t have much appetite you can add extra energy and protein to your diet, without actually having to eat more food. You can have high energy drinks as milkshakes or soups. And you can add high protein powders (beneprotein) to your normal food. Your doctor or dietitian can prescribe these for you. It is important to drink plenty of fluids, about three litres a day if possible. Keeping well hydrated helps the body to heal the radiotherapy damage. Tips for eating well If you are having problems eating, it can help to: Have small snacks through the day rather than large meals eat little and often Have a soft or liquid diet if swallowing is difficult (check the high calories high protein ideas). The soft food texture includes moist foods which are either naturally soft or require minimal cutting. The addition of sauce or gravy may be required to increase the moisture content

3 Side effects during treatment The main side effects of radiotherapy treatment include: Tiredness and weakness Sore skin Loss of hair in the treatment area Tiredness and weakness Most people feel tired while they are having radiotherapy, particularly if they are having treatment over several weeks. This is because the body is repairing the damage to healthy cells. Or tiredness can be due to low levels of red blood cells (anaemia). Radiation therapy is one of the most common treatments for cancer. It uses high-energy particles or waves, to destroy or damage cancer cells. Other names for radiation therapy are radiotherapy, irradiation, or x-ray therapy. Radiation can be given alone or used with other treatments, such as surgery or chemotherapy. Radiotherapy destroys cancer cells in the area of the body it is aimed at. The treatment also affects some of the normal cells nearby. Radiotherapy affects people in different ways, so it s difficult to predict exactly how you will react. Some people have only mild side effects but for others the side effects are more severe. Before you start your treatment, talk about any likely side effects with the staff in your radiotherapy team. Knowing about the side effects can help you to prepare and to manage any problems. Rest if you need to and try to exercise a little when you can. This can help to reduce the tiredness. Sore skin Some people get sore skin in the area being treated. The skin may look reddened or darker than usual. It may also get dry and itchy. The skin may break or small blisters can start to form in the area. The staff in the radiotherapy department can advise you on the best way of coping with this. Loss of hair in the treatment area Radiotherapy makes the hair fall out in the treatment area. Hair in other parts of the body is not affected. The hair should begin to grow back again a few weeks after the treatment ends. What to eat and drink You need to have as healthy a diet as possible during radiotherapy. Your body needs protein to heal itself and you need plenty of calories. Your medical team will arrange for you to see a dietician if you are having problems with eating.

4 Fruit Dairy foods Desserts Fluids All stewed or canned fruit in small pieces Soft, peeled fresh fruit (without seeds) Berries with small seeds, e.g. strawberries All except whose in the avoid list All except whose in the avoid list The inclusion of fluids will depend on the patient s diagnosis. Fluids are often not indicated in patients with dysphagia Dried fruit, fruit leather, fruit peel Stingy fruit, e.g. pineapple Large/round pieces of fruit, e.g. grapes Yogurt with nuts, seeds or hard pieces Hard cheese or crispy cooked cheese Dry cakes and biscuits Anything with nuts and seeds, dried fruit, coconut or pineapple Chewy lollies, e.g. toffee

5 Check below table for soft food: Food groups Meats and protein Vegetables Soups Breakfast cereals Carbohydrates Recommended foods Minced meat or chicken Tender casseroles and stews Moist fish dishes (easily broken up with fork) Scrambled and boiled egg Well-cooked legumes Soft tofu (should crumble) Well cooked, non-fibrous vegetables served in small pieces or soft enough to be easily mashed with fork Soft canned vegetables, e.g. peas Soups not indicated for dysphagia patients, who are not allowed fluids. For those who are allowed fluids: All soups, except those listed as Foods to avoid All well moistened cereals Soft sandwiches (no crust) with moist fillings, e.g. egg and mayonnaise Well-cooked rice and other grains Soft pasta and noodles Foods to avoid Tough, gristly, or dry meats Dry fish or fish with bones Fried eggs Dishes with nuts Hard or fibrous legumes Hard, fibrous or stringy vegetables, e.g. corn, broccoli stalks All raw vegetables (including chopped and shredded) Soups that have large pieces of meat or vegetables Soup with pieces of corn Coarse or dry cereals, e.g. All Bran Cereals with nuts or dried fruit Dry or crusty breads Sandwiches which are not thoroughly moist Bread with seeds or dried fruit Rice, grains, pasta and noodles which is not wellcooked Toast, crackers, pizza

6 give you mouthwashes and a mouth care routine to follow. This helps keep your mouth healthy during your treatment. It is important to keep your mouth clean and as healthy as possible. It s best to use a small soft toothbrush to clean your teeth. And you may need to clean them more than twice a day. Smoking Smoking might make the soreness worse. You can try to cut down on smoking. Or you could talk to the radiotherapy staff about nicotine replacement treatments. Mouth ulceration Sometimes the delicate lining inside your mouth can break down (ulcerate) during radiotherapy. If this happens, the radiotherapy staff can give you painkillers to help you cope with it. You might need to have a fine feeding tube into your nose if your mouth is very sore, because it will be painful to eat or drink. The tube is called a nasogastric tube. Or you may have a tube put directly into the stomach through the skin and muscle of the abdomen. The tube is called a percutaneous endoscopic gastrostomy tube (PEG tube). You may have tube feeding if you: Are malnourished before starting chemotherapy or radiotherapy Have problems with swallowing due to a cancer in the head or neck area Have holes (fistulas) or an abscess in the oesophagus or stomach Can t eat or drink for five days or more after an operation or other types of treatment Have a severely sore mouth or throat You may have liquid feeding: Through a drip directly into the bloodstream (intravenously) or Through a tube into the stomach or bowel Giving food directly into a vein This is called parenteral nutrition (PN). This means being fed directly into your bloodstream through a drip into a vein. The feeds don t go through your normal digestive system. You have PN through a central line or a PICC line. A PICC line goes up a blood vessel in your arm and into a chest vein. Other types of central lines go into the chest and directly into a major blood vessel, as this diagram shows: Collar bone Point where central line enters body Heart Connection for drips or syringes Cancer Research UK

7 Avoid strong alcohol it can aggravate a sore mouth or a sensitive digestion Avoid spicy foods if your mouth or throat are sore Ask staff about potential problems and how to try to prevent them before you start your treatment if possible Tell the radiotherapy staff about any problems you have with eating or drinking they can arrange for you to talk to a dietician In case your daily intake does not cover your requirements, you may need oral supplements such as: Ensure, Ensure plus, Glucerna SR, Forticare, Resource diabetic, Resource optimum, Beneprotein If you have problems If you are having difficulty eating enough, you can eat high fat foods. There are more calories in fat than in protein or carbohydrate. Remember that you may lose a little weight during radiotherapy. But if you are having any problems with eating tell the staff involved in your treatment. Alcohol during radiotherapy Usually it is fine to have small or moderate amounts of alcohol during your treatment. But strong spirits can inflame a sore mouth or throat if you are having radiotherapy to your head or neck area. Radiotherapy can make you feel tired and alcohol can make you feel even more tired. It is important not to drive or operate machinery if you feel tired or dizzy. If you are not sure whether you can drink alcohol ask your doctor or radiographer Head and neck radiotherapy Having a sore mouth The cells lining your mouth are sensitive to radiation. So radiotherapy to your mouth is likely to make it sore. This is called oral mucositis. The soreness usually only lasts while you are having treatment and for a few weeks afterwards. While your mouth is sore you may find that some foods or drinks are too strong for you to cope with. These include highly flavoured or spiced foods, and strong alcohol. It is best to avoid these while having treatment. You may have to eat a bland or soft diet for a while (check soft food list). Dry foods can hurt and scratch your mouth. You may also find that hot foods or drinks make your mouth sorer. Try eating your food when it is just warm. Mouth care A dry, sore mouth is more prone to infection. So your doctor or nurse may

8 sedation. Then they put a tube with a camera on the end through your mouth, down your food pipe and into your stomach. They can then see where to place the PEG tube, which is put in through the skin of your abdomen. This type of tube is used for people who have long term problems with eating and swallowing - for example, with cancer of the head and neck or cancer of the oesophagus. The feeds usually run for most of the day through a pump, with a break of a few hours to give the stomach a rest. But sometimes feeds can go in over 24 hours at a low rate. If you are having feeds at home, your dietician will guide you about how much feed you need and the timings. Oesophagus Stomach PEG feeding tube Cancer Research UK Stomach Skin PEG feeding tube Oesophagus Stomach Jejunostomy feeding tube Cancer Research UK Tube feeding at home Some people may need to go on using these methods of feeding after they leave hospital. This may seem very scary at first but people usually get the hang of it quite quickly, so try not to worry too much about it. Your nurses will show you and your medical team how to run the feeds before you leave hospital. Your doctors will monitor you closely at regular follow up appointments. And your nurses will give you the telephone numbers of people to contact for help if you need it. Dry mouth Your treatment might affect the salivary glands so that they produce less, or no, saliva. It can be uncomfortable to chew or swallow. In the early days of the treatment your saliva may become very thick and difficult to swallow. Cancer Research UK

9 Giving food directly into the stomach or bowel This is called enteral nutrition. This means being fed with specially prepared liquid feeds through a tube into your stomach or small intestine. Different formulas are available. Your dietician will choose the most appropriate one for you, depending on your own particular nutritional needs. Some people may need to take all their food and drink this way. But other people may take some food by eating normally. And then have the rest as liquid through the tube. Enteral feeding is only suitable for people whose digestive tract (stomach and intestines) is working normally. This is because the feeds still go through the usual path of digestion. It is not suitable if you have: A blockage in the bowel Severe diarrhoea or sickness The types of tubes for enteral feeding, including: Nasogastric tubes (NGT) Percutaneous endoscopic gastrostomy tubes (PEG tube) Nasogastric tubes A nasogastric tube is a thin tube that is put into your nose and down your throat into your stomach. This is normally put in by a nurse or a doctor. It is not pleasant but is a quick procedure. It is usually used if you need feeding for less than three weeks. Nasogastric tube Oesophagus Stomach Cancer Research UK A nasojejunal tube (NJT) may also be used. An NJT is like a nasogastric tube but the tip goes into the second part of the bowel (the jejunum). NJTs are used: When the stomach cannot empty properly To get past a blockage in the small bowel After pancreatic surgery Percutaneous endoscopic gastrostomy tubes (PEG tube) A percutaneous endoscopic gastrostomy tube (PEG tube) goes into your stomach through an opening made on the outside of your abdomen. To put a PEG tube in you have an endoscopy. Your doctor gives you

10 These effects might be temporary and gradually go back to normal after a few months when the treatment ends. But for some people the effects may be permanent. There are things you can do to help keep your weight up however. Coping with weight loss It s important to eat and drink as well as you can but don t worry too much if you can t eat a lot during the treatment period. Your doctor, specialist nurse or dietician can prescribe nutritional supplements, such as high calorie drinks, to keep up your calories until your mouth feels better. Remember to drink plenty of other fluids too. Ask the radiotherapy staff or the hospital dietician what you should eat and drink to stay as healthy as possible. Try not to drink alcohol (especially spirits) or smoke because this can make your mouth and throat very sore. You might need to have a liquid feed through a drip into a vein or a tube down your nose to your stomach or a feeding tube put into your stomach through the skin and muscle of the abdomen (called a percutaneous endoscopic gastrostomy PEG tube) Your radiotherapy doctor (clinical oncologist) might stop your treatment for a while to allow you to recover but this is rare. Swallowing problems during head and neck radiotherapy Radiotherapy treatment for cancer in the head or neck area can cause swelling and soreness in the throat. Your throat may be very sore and you may find it difficult to swallow solid foods. The amount of difficulty you have depends on the part of your head or neck being treated. It also depends on the dose of your treatment. Foods and drink tips A soft, plain diet may help. Foods Try different foods to find out which are easiest to swallow. Avoid foods that may irritate your throat. This includes: Dry foods Highly spiced foods Very hot foods or drinks Alcohol, particularly spirits Drinks You might need high calorie drinks to boost your calorie intake, such as: Ensure plus Forticare Glucerna SR Resource optimum Resource diabetic And you can check the high calories smoothies ideas Remember to drink plenty of other fluids too. The soreness usually gets better within a few weeks of your treatment ending, but this depends on how much treatment you ve had. References:

11 After the treatment ends it can take a long time (six months or more) for saliva production to get back to normal. If the radiotherapy treatment area included the salivary glands, you may have a permanently dry mouth afterwards. If you have a severely dry mouth, talk to your radiotherapy doctor (clinical oncologist) or radiographer. Some of the following tips may help: Clean your tongue with a liquid made from a teaspoonful of bicarbonate of soda in a litre of warm water Use moistened cotton wool or a soft toothbrush to clean your tongue Sip drinks often to keep your mouth moist Fizzy drinks can refresh your mouth Moisten your food with sauces, gravy, cream, custard or ice cream Chewing gum can make your salivary glands produce more saliva Get your doctor to prescribe boiled sweets that boost saliva production, lozenges, and artificial saliva sprays or gels Ask your doctor to prescribe medicines that stimulate saliva Don t eat chocolate and pastry, because they tend to make your mouth drier Use lip balm or Vaseline regularly if your lips are dry Moisten the inside of your mouth at night with a small amount of olive oil Taste changes Your taste buds might also be affected by radiotherapy to the head or neck area. You may notice changes in the way your food tastes. Some people say their food has a metallic taste. Others say that all foods taste the same. There are some tips on making food tastier. You might need to wait to try these until your mouth has recovered from the treatment and is not sore any more. You could try using more herbs and spices to flavour your food, as well as using strong tasting sauces like sweet and sour. Sharp tasting foods, such as fresh fruit and sharp boiled sweets can be refreshing but only use these after your mouth has healed. A glass of sherry before a meal can make food taste better. The radiotherapy staff can arrange for you to talk to a hospital dietician for advice about overcoming taste changes. Why you may lose weight Radiotherapy to your head and neck area can make you lose weight because you may have: A sore or dry mouth A poor appetite Taste changes due to treatment Difficulty swallowing due to soreness or swelling in your throat