Proper nutrition of the body, i.e. providing it with all the necessary ingredientsóThe provision of the nutrients in the right quantities and proportions needed for proper functioning is not always easy for people who are not able to meet their nutritional needs.ób healthy, let alone when the body is struggling with an illness. Its needs at this time can significantlywhatchange and, at the same time, there may be ailments or symptoms thatówhich make it even more difficult to eatów, such as decreased appetite or taste disorders. The gastrointestinal tract of oncology patients may not function properly as a result of treatment or the presence of cancer. Therefore, it is important to know how to take care of it in order to minimise discomfort and support its work.
What happens to the digestive system in oncological disease?
In the treatment of patients with cancer, various therapeutic methods are used - from surgery to systemic treatment (chemotherapy, immunotherapy, molecularly targeted therapy) and radiotherapy. The vast majority of cancers use a combination of the above treatment methods with each other in different sequences - this is known as combination treatment. One of the common problems associated with therapy is gastrointestinal complaints, which can lead to malnutrition and adversely affect the entire treatment process.
The presence of a tumour can affect the function (motility) of the gastrointestinal tract, causing backlogging of digestive contents and impairing nutrient absorption. This is most often the case with ovarian, gastric or pancreatic cancer. As a result of treatment (chemotherapy or radiotherapy), inflammation of the mucous membranes of the gastrointestinal tract may occur, which is also the cause of such troublesome symptoms as dry mouth, diarrhoea or constipation, nausea, vomiting, inflammation of the liver or pancreas, which in turn further interferes with food intake and nutrient absorption.
It is also worth remembering that cancer, especially in its disseminated stage, is a disease with an often chronic course, associated with a generalised inflammatory reaction. The development of inflammation in the body, resulting from the presence and progression of the cancer, contributes to an increase in metabolic rate (energy requirements), usually accompanied by a decrease in appetite, a decrease in food intake, which leads to an impaired protein-energy supply and, consequently, to the development of nutritional deficiencies. In such a situation, the patient's body begins to cope with the deficiency in a different way - it uses available components, mainly muscle tissue-building protein, to produce energy. As a consequence, this leads to a decrease in muscle mass and body weight, a reduction in regeneration capacity, and patients develop feelings of fatigue, lack of strength - explains Dr Manuela Las-Jankowska, clinical oncologist at the Professor Franciszek Łukaszczyk Oncology Centre in Bydgoszcz.
During an oncological illness, the body's requirement for protein increases up to twofold (up to 1.5 g/kg bw/day), and the need for energy also increases. For this reason, the oncology patient's diet should additionally include increased amounts of both the aforementioned macronutrient and energy.
How to stimulate the digestive system to function properly during illness?
In oncology patients with gastrointestinal complaints, it is advisable to implement an easily digestible diet. It is based on the exclusion of products that remain in the stomach for a long time, which are bloating and cause digestive discomfort (e.g. products high in fat and fibre, spicy products), and the inclusion in the diet of cooked, stewed and baked dishes with a small amount of fat, which have a sparing effect on the intestinal mucosa.
Some patients also develop temporary lactose intolerance, e.g. after radiotherapy to the pelvic region or after treatment with 5-fluorouracil preparations, so it is worth observing how the body reacts to dairy products (especially milk) and, if complaints arise, use lactose-free products.
Sometimes, however, it can be difficult to eat the necessary amount of nutrients with a traditional diet, with a reduced appetite and malaise associated with illness. Therefore, doctors may recommend the implementation of medical nutrition to support the body in the therapy process, thereby supporting gastrointestinal function. - Specialised medical nutrition (Food for Special Medical Purposes, FSMP), contains large amounts of energy, protein and other essential nutrients in a small volume and liquid form, and therefore in a form that is easy for patients to consume. It can be used as preparation for the start of treatment, i.e. for chemotherapy, radiotherapy and surgery, as well as being used during ongoing therapy and during the recovery period. Specialised medical nutrition is intended for malnourished patients, but also for those at risk of malnutrition. In the case of oncology patients, high-protein formulas are most often recommended, but other types of medical nutrition are also available for those for whom an increased protein supply is not indicated - these are always selected by the doctor based on knowledge of the patient's condition and ongoing treatment, often with the assistance of a clinical dietitian. - says Dr Manuela Las-Jankowska.
The digestive system needs regularity
Providing the body, struggling with illness, with the right amount of nutrients is vital. However, there is more to it than that. - Equally important and significantly affecting the nutritional status of the body is the regularity of the use of medical nutrition. We do not take breaks of several days, or even days, from eating, so there should not be either when using specialised nutritional supplements. Doctors often recommend consuming them systematically for at least two weeks. According to studies[1], the implementation and regular intake of medical nutrition 14 days before surgery can reduce the number and severity of postoperative complications. Patients in the study group who did not receive additional nutritional support in the form of oral nutritional supplements before surgery had a higher number of postoperative infectious complications, mainly wound infections - explains the expert.
[1] Kabata P. et al. , 'Preoperative nutritional support in cancer patients with no clinical signs of malnutrition-prospective randomised controlled trial', Support Care Cancer (2015) 23:365-370