Did you know that one in three hospitalized patients are malnourished? Malnutrition is a major contributor to increased morbidity and mortality, decreased function and quality of life, and increased frequency and length of hospital stay. In addition, when patients are malnourished, they may not be candidates for necessary surgical or chemotherapy treatments, or they may have to receive a much lower, potentially sub-optimal chemotherapy dose.
Malnutrition doesn’t only occur in underweight individuals. Even an overweight or obese individual who develops a severe illness or experiences a major traumatic event is at risk for malnutrition and frequently needs and benefits from intense nutrition intervention.
Defining malnutrition
The Academy of Nutrition and Dietetics notes that two or more of these characteristics can define adult malnutrition:
- Insufficient energy intake
- Weight loss (unintentional)
- Loss of muscle mass
- Loss of subcutaneous fat
- Localized or generalized fluid accumulation that may sometimes mask weight loss
- Diminished functional status as measured by hand-grip strength
A large percentage of cancer patients lose weight because of multiple factors, which include:
- Anorexia
- Cachexia (caused by the cancer itself )
- Complications from cancer and its treatment:
- Mucositis
- Taste dysfunction
- Early satiety
- Dysphagia
- Nausea and vomiting
- Partial bowel obstruction
- Gastroparesis
- Unaddressed depression
Monitoring nutrition status early
Unfortunately, weight loss may not be adequately addressed in many cancer patients, which is why we assess and oversee our patients’ nutrition status from the moment they walk in the door. When a clinician assesses that a patient is malnourished, the patient is referred to the metabolic support team, which is comprised of registered dietitians, gastroenterologists, nurses and care managers. This team may recommend appropriate treatments, such as:
- Diet education, which teaches patients what to eat and how to eat most efficiently
- Medication management, for improving appetite, finding different routes of administration, if necessary, and discontinuing drugs that cause gastrointestinal distress and other issues
- Possible enteral nutrition, including PEG or PEJ tube
- Parenteral nutrition (PN), via peripheral or central access
When patients are supported nutritionally, they are better able to stay on course with treatment and enhance their quality of life, which may be important for improving survival. Malnutrition is a disease in itself and must be prevented or reversed to help fight cancer and reduce further complications. It is important for all medical practitioners to take the initiative to consider this and make the appropriate referral.
