The most common symptom that patients with esophageal cancer experience is difficulty swallowing, which in turn leads to inadequate nutritional intake. The tumor in turn leads to altered body metabolism and increased energy expenditure, so severe malnutrition often occurs.
Rational nutritional support therapy can improve malnutrition and improve quality of life. In this article, we will use a case study to explain how nutritional support therapy can help patients with advanced disease.
Brief medical history
Mr. Li was 68 years old when he came in. He had locally progressive esophageal cancer detected 3 years ago and was treated with surgical resection and postoperative adjuvant radiation therapy.
In the last month, he again had difficulty swallowing, lost his appetite, ate 2/3 less than usual, and lost 3 kg of weight in 1 month.
Blood tests at the hospital suggested hypoproteinemia. The internist determined that his esophageal cancer had recurred and metastasized, was clinically advanced, and his nutritional status was poor, which could affect subsequent treatment.
Severe malnutrition, what to do?
To improve his nutritional status, Mr. Li came to the nutrition clinic. After taking a detailed medical history, the dietitian conducted a 24-hour dietary survey.
Specifically, the dietitian asked, and combined with a food model, to investigate the patient’s dietary intake over a 24 hour period, including all foods, types of nutritional supplements, and intake.
Subsequently, Mr. Li was diagnosed as “severely malnourished” after undergoing blood biochemistry, routine blood tests, and body composition tests (bioelectrical resistance to protein, fat, calcium, etc.).
Nutritional support therapy, how does it work?
The dietitian suggests that you should be careful about what you do.
The dietitian recommends 1 to 2 weeks of nutritional support before moving on to the next step in treatment.
Nutritional support is based on a “3+3” regimen, which is 3 regular meals in the form of a semi-liquid diet, with 3 additional meals between regular meals, supplemented by oral “foods for special The patient was given oral foods for special medical purposes (FSMP) for nutritional supplementation and intravenous infusion of amino acids, fatty milk and glucose for parenteral nutrition support.
Foods for special medical purposes (FSMP) are specially processed and formulated to meet the special needs of some people for nutrients or diets.
After 1 week of nutritional support, Mr. Li’s physical and nutritional status had improved significantly. He then received 6 cycles of chemotherapy, which resulted in significant tumor shrinkage and significant improvement in symptoms such as poor appetite and difficulty swallowing.
After chemotherapy, the dietitian performed regular nutritional assessments and adjusted his nutritional support regimen at any time. The specialized palliative care team also managed the pain and other discomfort.
Six months later, due to multiple metastases throughout his tumor, Mr. Li’s health took a sharp turn for the worse within a week or two, and he eventually passed away quietly but without pain.
How does nutritional intervention help patients with advanced disease?
Patients with progressive tumors have a life expectancy ranging from months to years and may be accompanied by a range of symptoms such as anorexia, pain, bloating, and fatigue, leading to reduced eating and weight loss, which affects quality of life. Many large esophageal cancer centers have formed multidisciplinary teams of medical and surgical oncologists, dieticians, psychiatrists, and others to work together to implement palliative care for patients with advanced disease.
Nutritional screening and intervention is an important part of the process.
Some primary care hospitals may not have a dedicated nutrition department, so it is recommended that you be able to visit a regular major hospital or consult with the dietitian at the hospital you visit. If local medical care is not available, you can also do self-nutrition screening at home, with family members to help monitor weight and diet changes to determine if you are at nutritional risk.
The criteria for evaluation are: recent diet loss of 1/3 or more, or weight loss of more than 5% in 3 months, or more than 1 to 2 kg in a week.
Severe nutritional risk can also be initially determined if a blood test reveals a lower than normal serum albumin or hemoglobin.
What kind of nutritional support do patients with advanced disease need?
1. Patients with a life expectancy of months or years
The goals of nutritional therapy are to ensure adequate energy and protein intake, to reduce metabolic disturbances, to maintain an adequate physical status, to be moderately active, and to have a satisfactory quality of life. Specific tools include: dietary guidance, oral nutritional supplementation, enteral nutrition tube feeding or parenteral nutrition support.
Dietary principles: Balanced diet, food diversity, no need to overly avoid food. Eat more fresh fruits and vegetables, whole grains, fish, poultry, eggs, milk and legumes, limit red meat, and try not to eat processed meat. If symptoms such as early satiety and reduced food intake exist, small, frequent meals and less soup with meals are recommended; you can hydrate between meals.
If you have a biochemical or clinical deficiency of a particular nutrient, it is recommended that you use “special medical foods” or nutrient supplements under the guidance of a physician or dietitian, but it is not recommended that you take them blindly.
2. People with a life expectancy of a few weeks or less than 2 months
Oral nutritional supplementation or moderate rehydration therapy, based primarily on the person’s desire to eat autonomously. At this point, nutritional compliance is no longer the primary goal; improving symptoms, preventing dehydration, and keeping you comfortable are the most important. Invasive intravenous nutritional support and massive rehydration therapy are not recommended.
Dietary principles: Small, frequent meals, light, digestible food, orally supplemented with 100-200 ml of “special medical food” between meals, 3 times daily.
3. Terminally ill patients
Patients who are terminally ill can usually only eat a semi-liquid or liquid diet, and a very small amount of diet is sufficient to meet their needs. At this time, nutritional support is mainly to relieve hunger and thirst.
The following foods are available:
- Staple foods, such as rotten noodles, pasta, bread, ravioli, fish fillet porridge, pumpkin porridge, vegetable rice paste;
- Protein category, such as egg custard, tofu brains, mashed meatballs, fishballs;
- Vegetables and fruits, such as young leafy vegetables (bean seedlings, spinach, baby vegetables, etc.), squash and fruit vegetables (zucchini, pumpkin, winter squash, tomatoes, etc.), freshly squeezed fruit and vegetable juices, etc.