Dharamshila Narayana Superspeciality Hospital

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Nutritional Care Support Programme

Patients with head and neck cancer face unique challenges in maintaining adequate nutrition. Both the disease itself and the treatments, especially surgery and radiation therapy, have significant negative impact on upper digestive tract function and oral intake is often insufficient during and after therapy. Placement of gastrostomy tubes is the most common approach to ensuring safe delivery of adequate nutrition, but the optimal timing remains unclear. Prophylactic(pre-treatment) gastrostomy tube placement is commonplace, but there is a lack of evidence tosupport this practice for all patients. Much work has been done with respect to improvement offunctional recovery from dysphagia, which includes rigorous “exercise” programs that show greatpromise. A diverse and experienced patient care team is needed to produce the best outcomes.

The dietician will work closely with the other members of the healthcare team, including gastroenterologist and naturopathic clinician, throughout the treatment. Together, they will recommend supplements and other therapies to support optimal digestion and nutrition, and help the patient to manage side effects.

Basic Principles

  • Eat small frequent meals -- six to eight times per day.
  • Make every bite and sip count by eating calorie-dense foods and add calories to foods.
  • Limit foods and beverages low in calories.
  • Eat a variety of foods -- include various colors, textures and flavors. You need high calories and high protein diet but you still need a balanced diet with foods from all food groups. Continue to include fruits and vegetables in addition to high calorie foods.
  • Carry food with you at all times to enjoy while waiting for treatment, in the car, waiting to see the doctor, etc.
  • As side effects become worse, most patients must focus on liquids and soft foods to obtain adequate calories. Often liquids can provide more calories than solids.

Major Goals for Maintaining Good Nutrition during Treatment

  • Eat frequently. You may need to give up the idea of three main meals for the next two to three months. Instead, eat smaller amounts but frequently throughout the day. Try not to go for more than two to three hours without eating something.
  • Eat calorie-dense foods. Remember the goal is to maintain your weight and in order to do that you need to eat a lot of calories. You want to make sure that the foods and liquids you eat have a lot of calories in them. You may find that you are not able to eat the same quantities as before, so you need to get the calories in smaller amounts of high calorie foods.
  • No food is plain. Try to think of food in terms of "What can I add to this to give it more calories?"
  • Concentrate on liquids and soft foods. Many liquids -- see suggestions in the handout -- will provide a lot more calories than you will get by eating solid foods. They tend to be easier to swallow, take less time and are generally soothing the sore mouth and throat. As you move through treatment, you may find that you are having side effects that make it difficult to chew and swallow. All the more reason to use liquids to get the majority of your calories.
  • Just do it. Overall your treatment is over a short period of time. Although it may become difficult to eat, both physically and emotionally, you need to take a deep breath and do it. Your body and mind need it.

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