Attention to nutrition is an important aspect of the care of the cancer patient. The amount of dietary guidance needed will vary with the individual and his condition, but it is useful to appraise the food practices of each individual patient. Marginal nutrient intakes which have sufficed in health may not meet the stress of disease. In addition, loss of appetite, sometimes aggravated by fear, may further reduce the amount of food eaten and limit the types of food that will be accepted. The mechanics of normal eating may be temporarily or permanently altered; absorption and utilization of nutrients may be impaired. Any of these factors can be a serious obstacle to maintaining good nutrition. The nurse who has knowledge of her patient's past and present food practices will be better prepared to help him meet dietary problems as they arise. It is a well-recognized fact that patients in good nutritional status respond more favorably to therapy.

The nutritional needs of the cancer patient are often greatly increased. Diets high in protein and calories are frequently ordered to help meet these needs. The nurse will do well to arm herself with suggestions for ways of adding protein to the diet, emphasizing such foods as milk, meat, and eggs because of their high biologic value. Many foods that the patient enjoys can be fortified with protein. It should be remembered that for best utilization of protein, calories must also be adequate.

Patients receiving special therapies as radiation or chemotherapy may have specific nutritional problems related to the therapy they are receiving. For example, many chemotherapeutic agents produce gastrointestinal conditions which affect nutrient intake. The cells which line the intestinal tract have a rapid turnover and so are very subject to toxic affects of drugs. Nausea, vomiting, and diarrhea may occur, reducing food intake and absorption. Frequent small feedings of foods that appeal to the patient and that are nonirritating to tender mucous membranes are indicated.

Since there are many reasons for impaired nutrition, a variety of potential problem areas may have to be considered if nutritional needs are to be met. For example, a patient or his family may not have sufficient knowledge about food values to select foods wisely or to make dietary modifications; he may have the knowledge but lack the appetite or interest; he may not have the money to purchase adequate kinds and amounts of food, or the facilities or energy to prepare it. In addition, some patients must make drastic changes in eating habits; this may be difficult.

Diet orders from the physician will give guidelines within which to work, but the nurse must adapt these orders to the home situation. In complicated cases she may wish to seek consultation from a nutrition specialist such as a hospital dietitian or a nutritionist from a local or State health department or a voluntary agency. Home management specialists in county extension units may be able to make suggestions for the homemaker who needs to reorganize her work to reduce energy expenditure or adapt to handicapping conditions.