A practical guide for lung cancer nutritional care including a lung cancer nutritional care pathway is available to assist the multidisciplinary team involved in the management of patients with lung cancer. The document aims to assist with assessing and monitoring the nutritional status of patients with lung cancer in order to maximise treatment outcomes and improve patient experience. A nutrition starter information pack for patients has also been developed in conjunction with the National Lung Cancer Forum for Nurses (NLCFN) and the Roy Castle Lung Cancer Foundation (RCLCF) to support the guide.
The guide ‘A Practical Guide for Lung Cancer Nutritional Care’ has been developed by a multi-professional team and is supported/endorsed by the Roy Castle Lung Foundation and ten key professional organisations including BAPEN(1). Centred around the patient pathway, the document includes a pathway to assist healthcare professionals in optimising the nutritional status of patients with lung cancer using clinical experience and the evidence base, alongside accepted best practice in order to maximise treatment outcomes and patient experience throughout their cancer journey.
The emergence of highly specialised treatments and new developments in different therapies to treat lung cancer contribute towards more patients having the opportunity to be treated with potentially curative therapies(2). However the impact of treatment together with unintentional weight loss, pain, changes in appetite and breathlessness, along with the potential side effects of cancer treatment, all add to the decline in the nutritional status of patients with lung cancer.
Disease-related malnutrition occurs frequently in patients with cancer and is a major cause of morbidity and mortality(3). The consequences of malnutrition in cancer patients include the impairment of immune function, performance status, muscle function and associated debilitating morbidities such as depression and fatigue(3). The major consequence of progressive weight loss and decline in nutritional status is reduced survival(3).
Early nutrition screening can help to identify malnutrition risk and any problems that may affect how well the patient’s body can deal with the impact of the subsequent cancer treatment(4).
The mainstay of nutritional interventions can include dietary advice, oral nutritional supplements (ONS), and in some instances enteral tube feeding (ETF). Nutritional intervention with ONS can improved quality of life in patients who are malnourished and may also result in cost savings(5-8).
‘A Practical Guide for Lung Cancer Nutritional Care’ includes:
- An overview of the clinical consequences of malnutrition in cancer
- Information on the importance of nutritional screening and support for lung cancer patients
- Guidance on offering dietary advice and oral nutritional supplements to patients with lung cancer
- A practical Lung Cancer Nutritional Care Pathway which covers patients at low, medium and high risk of malnutrition as well as those requiring active supportive care
The three supporting patient leaflets produced in conjunction with the NLCFN and the RCLCF are:
- Living with Lung Cancer – Practical Tips for Eating – gives tips on what to do if you have lost your appetite and how to fortify everyday foods and drinks
- Living with Lung Cancer – Practical Tips for Using Oral Nutritional Supplements – including information on when and how to take Oral Nutritional Supplements (ONS) as well as heating, freezing and storing ONS
- Living with Lung Cancer – Practical Tips for Managing Common Symptoms – covering issues such as breathlessness, dry or sore mouth or throat and feeling tired
1. The document has been supported by the Roy Castle Lung Foundation and ten key professional associations:
- British Association for Parenteral and Enteral Nutrition (BAPEN)
- British Dietetic Association (BDA)/The Oncology Group of the BDA
- British Thoracic Oncology Group (BTOG)
- British Oncology Pharmacy Association (BOPA)
- British Pharmaceutical Nutrition Group (BPNG)
- National Lung Cancer Forum for Nurses (NLCFN)
- National Nurses Nutrition Group (NNNG)
- Royal College of General Practitioners (RCGP)
- Royal College of Nursing (RCN)
- Royal Pharmaceutical Society (RPS)
2. Bennett A and White J. Improving care and quality of life for patients with lung cancer. Nursing Standard. 2013;28 (9): 50-58.
3. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. European Journal of Oncology Nursing 2005;9:S51-S63. Suppl 2:S51-63
4. Arrieta O, Ortega RMM, Vilanueva-Rodriguez G et al. Association of nutritional status and serum albumin levels with development of toxicity in patients with advance non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer 2010;10:50
5. Baldwin C, Spiro A, Ahern R et al. Oral Nutritional interventions in malnourished patients with cancer; a systematic review and meta-analysis. Journal of National Cancer Institute 2012;104(5):371-385
6. Lee H, Havrilla C, Bravo V et al. Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma. Support Cancer Care 2008;16(3):285-289.
7. Isenring EA, Bauer JD, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. Journal of American Dietetic Association 2007;107(3):404-412.
8. Elia M (ed). The cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults. A report by BAPEN. 2005.