Question

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

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1. What may dietary recommendations be useful to help Lisa in counteracting nausea she experiences following chemotherapy? In managing her mouth sores?

Well, balanced nutrition plays an important role in the prevention of post-chemotherapy nutritional imbalance. High calorie, easily digestible foods are recommended. Avoidance of greasy foods reduces vomiting and nausea. The ready availability of nutritious foods helps in managing nutrition.

Foods containing high amounts of nutrients such as fibre, vitamins, and minerals must be consumed. Foods like single-serving packages of nuts, whole grain crackers, granola bars, and fruit can be stored for patients easy access.

Use small and frequent meals.

Avoid spicy foods

Minimize the use of junk foods

Use foods at room temperature

Increase the fluid intake if possible

Consume high-protein foods

2. What factors may be contributing to Lisa’s gain in weight?

Use of junk foods with increased appetite contribute to her problem.

3. What suggestions may help someone experiencing lethargy post-chemotherapy treatments to maintain healthy eating habits?

Use palatable foods rich in vitamins (B, C, A)

Minimized use of junk foods

Limit fatty food intake

High protein foods

Consume easily digestible high-calorie foods

Small and frequent meals

4. Are there any nutritional implications of taking epoetin (Epogen) or filgrastim (Neupogen)?

Epoetin Alpha is a drug helps in Hb production. It can be easily attained when more iron-containing foods are consumed. B vitamins will also play an important role in utilizing the iron stores in the body.

Nitrate containing foods should be minimized as it may block the effects of epoetin. The erythropoiesis suppression may occur due to dietary nitrate.

Vitamin A should be included in the diet.

Filgrastim has no evidence of interaction with foods. Any food allergy can be reported to the doctor before treatment. Well, balanced diet is the key to success of any substitutions. To counteract the effect of vomiting from the drug, use palatable foods which will not irritate the GI system