Nutrition support therapy is the delivery of complete nutrition to a patient other than by mouth. A variety of conditions and circumstances could preclude eating normally. They include severe nausea, post-surgical recovery requiring the need for bowel rest, partial bowel obstruction or preparation for radiation or chemotherapy. Nutrition support can be required temporarily or as a longer-term source of sustenance in advanced disease. In most cases, nutrition support therapy would be initiated one to two weeks after a patient is without oral nutritional intake.
The following are three options available for nutrition support therapy and sometimes require daily homecare nursing. They are listed in order of preference, safety and by the advancement of disease:
1. Enteral Feeding - requires a tube to be inserted through the abdomen, into the stomach and ending in the small intestine. The insertion is usually performed under local anesthesia by a radiologist. By inserting the tube further into the digestive tract, it can avoid nausea and vomiting but is not always successful depending on the volume and presence of ascites or tumour encroachment. This procedure is relatively common with feeding easily managed at home.
The patient is encouraged to rest at a 45 degree angle during feeding. If the patient is suffering from partial bowel obstruction, a low fiber formula can be given. Otherwise, the formula is developed on a per patient basis to maximize nutrition and bowel regularity.
Enteral feeding is the only method of gaining nutrition recommended for periods of more than 30 days.
2. Nasogastric Feeding – the tube in inserted through the nose, into the stomach and on into the small intestine. It avoids any involvement of ascites or tumour interference but is more uncomfortable. It too is easily managed at home with various formulas depending on the patient’s needs. Complications with this method include tube dislodgement, clogging and nasal trauma, to name a few.
3. TPN (Total Parenteral Nutrition) line or PICC (Peripherally Inserted Central Catheter) line – is inserted into a vein either in the neck region (TPN) or in the arm (PICC) and then advanced until it reaches a large vein above the heart. These procedures are performed under anesthesia. More complications could arise with these two methods because of the risk of infection, occlusion (blockage) and possible blood clots.
Once again, special formulas are developed based on the patient’s needs and stage of disease progression.
A patient is unable to directly help themselves in these instances and must accept assistance from nursing staff or a capable family member. It is very frustrating not to be able to enjoy regular meals and drinks but if the formulas are properly prepared and given in a timely fashion, you do not suffer from hunger or a desire to eat otherwise. I was on TPN post-surgically for ten days and even though others were eating very tasty meals alongside of me, I was completely satisfied.
Patients have a dry mouth as a result of these feeding methods and are encouraged to suck on ice chips or use mouth swabs. Proper oral hygiene needs to be maintained as well.
There is a certain fear associated with returning to whole foods when you have been on nutrition support – especially post-surgically. This is normal and should be addressed when discussing your meal plans with a qualified cancer dietician or your doctor.
We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.