Nutrition support and cachexia management

Overview

• Pancreatic cancer is the disease where nutrition support starts with enzymes. Pancreatic Cancer UK's starting doses are at least 50,000 to 75,000 units with a main meal and 25,000 to 50,000 with a snack or milky drink, half with the first mouthfuls and half spread through the meal, swallowed with a cool drink, more for larger or fattier meals, and reviewed regularly; the UK consensus (Phillips 2021) sets the same starting point.
• A population-based study (Roberts 2019) found people with pancreatic cancer prescribed enzyme replacement lived longer than those who were not; NICE NG85 says offer enteric-coated pancreatin in unresectable disease and consider it before and after resection.
• Bowel cancer: Macmillan says to eat at regular times, to try several small meals rather than one or two large ones, to include high-protein foods to help healing, to follow a low-fibre diet for the first few days after surgery and to keep a diary of what you eat and how it affects you. Cancer Research UK says the foods most likely to cause problems are very high fibre fruit and vegetables, onions, brussels sprouts and cabbage, pulses, fizzy drinks, beer and lager, and very rich or fatty foods, and that a food can be tried again after a few weeks.
• Lung cancer: eating is harder when breathing is hard. Macmillan advises sitting up at a table so breathing feels less restricted, smaller meals on a smaller plate, avoiding chewy food, eating slowly with smaller mouthfuls, adding sauces or gravies, sipping fluid often, and using ready meals on difficult days; it says high-protein powders and high-calorie drinks can be prescribed by a GP or dietitian. Cancer Research UK adds that you lose a lot of fluid through your breath, especially breathing through your mouth, and that dehydration makes saliva and phlegm sticky and harder to swallow.