Malnutrition
(Appetite & weight loss)

Maintaining good nutrition is a vital part of your cancer treatment. Having enough foods and fluid provides your body with the essential energy, protein, vitamins and minerals it needs to keep nourished. This can help you to feel more energised as well as help you to recover and heal more quickly from treatment side-effects. 

During radiation therapy your body needs more energy and protein than usual. If you are unable to eat and drink enough, you may lose weight unintentionally and be at risk of malnutrition. Maintaining your weight is particularly important during head and neck cancer radiation therapy. This is because the treatment mask is made to fit precisely to the shape of your face and neck. If you are losing weight during treatment, often the mask won’t fit as well, meaning that your radiation therapy may not be as precise as intended. If you lose a large amount of weight, the mask may need to be remade or your treatment replanned.

How to help prevent unintentional weight loss:

• Ensure all treatment side-effects are well managed.

• Talk to your dietitian about starting oral nutritional supplements

• Choose foods that are high in energy and protein. Eating a diet that is high in protein and energy will help you to maintain your weight and recover quicker from treatment side effects. “Energy” in food refers to the kilojoules or calories that your body uses as fuel, while “protein” is used to repair and maintain tissue in the body.

High protein - high energy eating examples:

• Meat – beef, pork, lamb, chicken, turkey

• Seafood – fish, shellfish, tuna, salmon, sardines

• Eggs

• Falafel, tofu, vegetarian “meats”

• Dairy – milk, milk powder, yoghurt, cheese, dairy desserts

• Dairy alternatives – soy products or coconut milk / yoghurt / cream

• Beans – lentils, legumes, chickpeas, hummus

• Nuts and seeds 

• Fats and oils – olive oil, avocado, margarine 

What to do if you are eating less than usual:

• Eat and drink high protein high energy foods and fluids first – make every mouthful count 

• Use nourishing drinks regularly including milk and milk alternatives 

• Don’t rely on your appetite – eat small frequent meals and snacks every few hours 

• Have a range of pre-made options on hand to reduce effort at mealtimes (e.g. soups, frozen meals, dairy desserts) 

• Check your weight weekly and notify your doctor, nurse or dietitian if you have lost weight without trying 

• Stay active to help your body repair and heal 

• Recognise that food is ‘fuel’ for your body and even though you may feel unwell, you need nutrition to ensure your body heals and repairs properly. 

• Talk to your dietitian about nutrition supplements to help increase your energy and protein intake. These are liquid or powder products that can be purchased through your local pharmacy. Your Dietitian can make recommendations on nutritional supplements that are suitable for you.

Tube feeding options:

Sometimes, treatment side effects can make it too difficult or unsafe to eat and drink enough through your mouth. Your doctor, dietitian or speech pathologist may talk with you about alternative feeding options called “tube feeding” or “enteral feeding”.

Enteral feeding enables you to receive nutrition, fluids and medications directly into your stomach. This can be a short, medium or long term option, depending on your individual needs.

• Nasogastric tube (NGT):
  This type of feeding tube is placed through your nose into your stomach. It can be placed in the outpatient area by nursing or medical staff and is designed for temporary, short term feeding for up to 4-6 weeks

• Gastrostomy tube (RIG or PEG):
  This type of feeding tube is surgically inserted directly into your stomach and requires an overnight admission to hospital. This tube is preferred if you are likely to need nutrition support for longer than 4-6 weeks.

Your doctor or dietitian can discuss which tube feeding option is most suitable for you. 

Once a feeding tube is inserted, the dietitian, dietitian assistant or nurse will teach you how to administer nutrition through the tube. The most common method is where a large syringe is connected directly to the feeding tube, and the nutrition supplement is gently pushed through. This process is repeated across the day, with each supplement acting as a “meal”. Your dietitian will make recommendations on nutritional supplements and a feeding plan that is suitable to you. 

If you are experiencing a loss of appetite or weight please speak to an Oncology Nurse to obtain a referral to a Dietitian.

Page reviewed 6th Sept 2021