Nutrition Near the End of Life
What and how much to feed a patient nearing the end of life can be a dilemma, especially for family members. "People equate food with love," explains Dixon, "and sometimes push food too hard, especially if the patient has an enteral feeding tube. They want to keep feeding the dying patient. We need to educate caregivers and family members that a normal part of the dying process is for organs to shut down. Pushing fluids at that time can do more harm than good." Dixon emphasizes that it's very important to work with the hospice team to pick up clues about when nutrition should be dialed back; these may pertain to decreased activity, or signs of fluid overload. "Families need to know that the patient is not hungry near the end of life," says Dixon.
If the patient still has months to live, even if cachexic, continuing nutrition will help with strength and quality of life. "If early satiety is a problem, administer enteral feedings through the feeding tube at night, give them more slowly, and keep the head of the bed elevated to avoid reflux. Try to get some nourishment in without making the patient uncomfortably full." Generally, Dixon advocates that patients in palliative care should be kept as well-nourished as possible so they don't die of malnutrition before they would die of their tumor. When a patient reaches days to weeks to live, however, nutrition usually isn't helpful.
Rebecca Katz, who has experience working as a cook for patients with cancer, shares what she has learned about food at the end of life. "I once worked with a family whose dying mother requested French toast -- really good French toast. Her family went bananas and said, 'No, no -- it's not healthy, you can't have that.' So I made her a little piece of French toast so that she could just put it in her mouth to taste it. People have to remember that food is an emotional issue until the very end. Sometimes people just want to taste something wonderful -- maybe without even swallowing it. Taste buds, even when dulled, have a memory."
Food for Thought -- and Health
The success of cancer treatment depends on the patient's ability to tolerate it, which in turn depends on the patient's nutritional status before treatment begins. Nutritional screening is therefore critical to outcomes.
The role of nutrition throughout cancer treatment is also important, and often underestimated. Good nutrition can mitigate the side effects of treatment, improve quality of life, and raise the chances of survival. The nutritional issues that may be encountered in patients with cancer are vast, so early referral to a specialist in oncology nutrition provides the best chance of success. Consistent, evidence-based guidelines for nutrition in patients with cancer are urgently needed.
By providing the right tools to patients, they can experience feelings of empowerment as they take control of their nutritional health, which can only be advantageous to their treatment outcomes and quality of life.
Medscape Oncology © 2013 WebMD, LLC
Cite this: Extreme Nutrition: Can It Beat Cancer? - Medscape - Nov 20, 2013.