Gastric cancer is a tumor that severely affects the nutritional status of patients, and many gastric cancer patients will suffer from malnutrition and other manifestations. So, how do gastric cancer patients get nutritional support after treatment is over?
Principles of nutritional support
Patients with gastric cancer, in terms of diet, need to follow the principles of gradual progress, small meals, chewing slowly, balanced diet, and reasonable nutrition.
- After surgery, patients should eat gradually. Initially, the total energy consumption is calculated as 35kcal per kg of body weight per day, and the total daily energy consumption increases gradually as the body and eating recover and the activity increases.
- After discharge from the hospital, patients can resume eating with their families. They should eat less and more often, chew and swallow slowly, and eat at a pace that suits them. The amount of food eaten is usually based on one’s subjective feeling, and if there is a feeling of fullness or bloating, one should stop eating.
- Based on a balanced diet and reasonable nutrition, pay attention to the diversity of food types to achieve the best nutritional effect. The patient’s energy supply is usually 50% to 70% from sugars (mainly supplied by plant foods, such as wheat, millet, fruits and vegetables, etc.) and 30% to 50% from lipids (mainly supplied by animal fatty tissues, such as eggs, milk, etc.), while ensuring appropriate daily intake of minerals (electrolytes and trace elements), vitamins, etc.
Patients with gastric cancer, especially after surgery, generally have varying degrees of weight loss compared to preoperative times, and usually do not need to overeat in a hurry to quickly regain their original weight, and should avoid overeating. A balanced daily intake of porridge or rice, meat and eggs, milk, vegetables, and fruits is important to restore immunity and maintain body weight.
Steps for postoperative dietary recovery
After a major gastrectomy or total gastrectomy for gastric cancer patients, they need to eat less at each meal because the stomach volume becomes smaller or the intestine replaces the stomach, which affects the function of holding food and digestion. The following steps can be followed to resume the diet.
- 3 to 4 days after surgery, eat a clear liquid diet, such as water, rice soup, light juice, enteral nutrition solution, etc.
- About 1 week after surgery, eat a liquid diet, such as rice porridge, low-fat broth, lotus root powder, rice paste, sour milk, fruit and vegetable juice, etc.;
- About 10 days after surgery, eat semi-liquid food, such as lump soup, dragon’s beard noodles, egg custard, pureed meat, pureed fruits and vegetables;
- About 1 month after surgery, eat soft food, such as rice, noodles, steamed buns, bread, lean meatballs, meat stew, fish and shrimp, rolls, boiled eggs, less crumbly vegetables, fruits, etc.
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Adjust the type of food according to the eating situation to ensure nutrition and energy supply.
Considerations for the intertreatment or home recovery period
- In between treatments (radiation therapy, chemotherapy, surgery) for gastric cancer and during home recovery after treatment, it is important to get into the habit of taking oral nutrients for nutritional therapy to maintain an ideal weight that is not below the lower limit of the normal range. There is a wide variety of oral nutrients, such as micronutrients and vitamins, and in various dosage forms, which can be oral liquids, powders, tablets, softgels, etc.
- Weighing should be done and recorded every 2 weeks at regular intervals (after waking up in the morning and having a bowel movement, on an empty stomach). Any unexplained (involuntary) weight loss of not less than 2% should be promptly followed up with a return visit to the hospital.
- Value outpatient nutrition counseling at least once every 3 months.
Nutritional support options for patients with gastric cancer at different stages of treatment
Neoadjuvant chemotherapy (radiotherapy), that is, chemotherapy (radiotherapy) administered before surgery. If a patient with locally progressive gastric cancer undergoing neoadjuvant chemotherapy is able to eat and does not have complete obstruction, but the intake cannot meet current needs, oral nutrient supplementation is usually preferred; if the needs are still not met, the doctor will usually recommend tube feeding nutrition with a jejunal nutrition tube as soon as possible, and enteral nutrition support therapy can be used at home after the doctor’s guidance; if enteral nutrition still cannot meet the needs, the patient should return to the hospital for follow-up. If the need for enteral nutrition still cannot be met, it is necessary to return to the hospital for follow-up. Patients with postoperative adjuvant chemotherapy for gastric cancer should get into the habit of taking oral nutrients for nutrition during the home recovery period; if they cannot meet 60% of their target needs for more than 60 days, they need supplemental parenteral nutrition support (i.e., intravenous rehydration); patients with poor gastric emptying (known as gastroparesis) are usually recommended to have a jejunal nutrition tube for tube feeding as soon as possible, and can be treated at home after physician guidance. The patient can be treated at home with enteral nutrition support after doctor’s guidance. For patients with inoperable locally progressive gastric cancer and metastatic gastric cancer undergoing palliative chemotherapy (radiotherapy) who can eat a liquid diet, oral nutrient supplementation is preferred to maintain ideal body weight and keep weight stable to improve patients’ treatment tolerance. If the intake does not meet the patient’s target needs, and there is a gradual loss of weight, or if there is significant abdominal distention and vomiting after eating, the doctor will usually recommend the early placement of a jejunal nutrition tube for tube feeding nutrition, and after the doctor’s guidance, enteral nutrition support therapy can be used at home. Patients with end-stage gastric cancer near the end of life no longer require any form of nutritional therapy, only appropriate water and food to reduce hunger. Nutritional therapy for patients with end-stage cancer is a complex issue. Given that the disease is irreversible and the patient does not benefit from it, and that nutritional therapy may have some complications, foreign guidelines do not recommend nutritional therapy. However, in China, influenced by traditional beliefs and culture, nutrition therapy for patients with end-stage cancer is largely no longer a matter of evidence-based medicine or health resources, but a complex ethical and emotional issue, and physicians’ decisions often take into account the demands of patients’ families. For patients with end-stage gastric cancer, physicians will individualize their assessment, develop a rational plan, and select the appropriate nutritional formulas and pathways. Patients with home gastric cancer should follow a gradual, small, frequent, chewy, balanced, and rational diet; have their weight measured regularly every 2 weeks and recorded; and visit the hospital outpatient clinic for nutritional counseling every 3 months. When the intake is not enough to meet the target needs, oral nutrient supplementation is preferred; when the needs are still not met, you can talk to your doctor and choose to supplement parenteral nutrition or enteral nutrition. Please listen to your doctor’s professional advice on how to choose. (Contributed by Peng Deng, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)
Table Correction factors for energy demand
Factors
Correction amount
Age
≥ 70 years old
-10%
Degree of malnutrition
Moderate
+5%
Severe
+10%
Activity
Free Activities
+30%
Stress
Fever >37°C per 1°C
+10%
uncontrolled severe pain (pain score ≥ 7)
+10%
minor surgery
+0%~10%
Long bone fracture
+15%~30%
Malignant tumors
+10%~30%
peritonitis/sepsis
+10%~30%
Severe infection/polytrauma
+20%~40%
Multi-organ failure syndrome
+20%~40%
Burn injury
+20%~200%
Patients with locally progressive gastric cancer undergoing neoadjuvant chemotherapy (radiotherapy)
Patients with postoperative adjuvant chemotherapy for gastric cancer
Patients with inoperable locally progressive gastric cancer and metastatic gastric cancer undergoing palliative chemotherapy
Patients with end-stage gastric cancer
Summary