Question

Nutrition for Cancer

Lisa is a 31-year-old Caucasian female of Northern European descent. She is 5 feet 3 inches tall, has an average frame size, and weighs 162 pounds with a BMI of 28.7 (overweight). She lives with her husband and two children, and works as a surgical technician at a local community hospital.

Lisa was diagnosed with Hodgkin’s lymphoma six months ago after experiencing chest pain over a few days. Lisa is currently on a weekly chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine) regimen, which is administered in an outpatient center. Lisa is also taking epoetin (Epogen) with each treatment to maintain a hematocrit above 36%, and filgrastim (Neupogen) for five days after each treatment to stimulate the production of neutrophils.

Lisa reports to the nurse that the only nutritional counseling she has received since diagnosis is to avoid greasy and spicy foods for four to five days post-treatment. She did receive a booklet on what to eat if she has a decrease in appetite, which she reports she has not read.

Since starting chemotherapy, Lisa has gained seven pounds and reports that she actually has more of an appetite than before she started treatment, but prefers more “junk food.” Lisa attributes this to dexamethasone, a steroid she receives with each treatment. She did ask her physician to decrease the dose in order to decrease her appetite. However, when the medication was decreased, she reported feeling “terrible” and chose to return to the higher dose.

Lisa has had occasional problems with mouth sores, a common problem of chemotherapy patients, but states that she is currently able to drink orange juice without much irritation.

Lisa also reports that she experiences significant lethargy and nausea for about four days post-treatment. She has been prescribed Compazine for the nausea, but states she often avoids taking it because it makes her feel “jittery.” Instead she finds eating bland foods like corn flakes, grilled cheese, or chicken with rice helps the nausea. Lisa found the advice not to eat greasy, spicy foods for 4-5 days post-treatment to be helpful. She stated that sausage and pizza made her stomach hurt. This was followed by the statement, “I think eating is the key to getting through chemo.”

1. What dietary recommendations may be useful to help Lisa in counteracting the nausea she experiences following chemotherapy? In managing her mouth sores?
2. What factors may be contributing to Lisa’s gain in weight?
3. What suggestions may help someone experiencing lethargy post chemotherapy treatments to maintain healthful eating habits?
4. Are there any nutritional implications of taking epoetin (Epogen) or filgrastim (Neupogen)?

Answer 1

Q1.Dietary recommendations

*Fish: 2 servings of fish per week

It provides protein and omega 3 fatty acids

*bread or crackers

Eat them plain , they are typically easy to digest

also useful to replenish sodium lost through vomiting.

*broccoli

offers a significant amount of vitamin c

*almond and other nuts

they are powerful anti oxidants.

*oat meal

*avocado

*eggs

Q2.Factors contributing in weight gain;

1.disease condition

Studies show that patients with hodkins lymphoma may become overweight or obese.

2.treatment

Chemotherapy can lead to weight gain, by edema/fluid retention.

3.use of steroids

4.eating of junk food

5.fatigue and decreased physical activity

Q3.Chemo-Lethargy dietary plan

Eat

Egg

Fish

Vegetables

Broccoli

Nuts

Avocado

Oats

*eat mini meal

*stay hydrated

*keep food tasty

*avoid alcohol

*limit green tea

Nutritional implications of epogen and nupogen: these drugs may cause nausea and vomiting in the patients. But they cannot completely subsided by a dietary modification.