The nutritional care of the cancer patient

Nutrient substrates are needed in the human body in sufficient quantities to supply basal requirements and to support a state of nitrogen and nutritional equilibrium under a wide variety of conditions associated with catabolism. Ordinary requirements can be accentuated by trauma, sepsis, metabolic disorders and possibly malignancies. Increased metabolic demands have been postulated to occur in patients with malignant neoplasms for many years but have never been documented clearly. When cancer is diagnosed initially in today’s health environment, the patient is usually adequately nourished. However, the use of the various antineoplastic therapies often results in severe caloric deficits and produces marked weight loss and inanition. On the other hand, loss of body mass can be the initial clinical sign in patients with specific malignancies such as leukemia, lymphoma and oat-cell carcinoma of the lung. Tumor bulk in patients with these malignant disorders is often quite large before any symptoms are produced, and weight loss, in part, may reflect the increased nutritional demand imposed upon the patient by this tumor mass. In contradistinction, malignant melanoma, breast cancer, most soft tissue sarcomas and most gastrointestinal malignancies produce early signs and symptoms, such as a palpable mass or bleeding, while the tumor is relatively small and before any weight loss secondary to the caloric demands of the malignancy can be identified.