Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

Abstract

Background: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. Methods: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. Results: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. Conclusions: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.

Current and future targeted alpha particle therapies for osteosarcoma: Radium-223, actinium-225, and thorium-227

“…ifosfamide, ifosfamide with or without etoposide is often the 2 nd line therapy of choice (31-34). When ifosfamide is given with mesna as a continuous infusion, thrombocytopenia, encephalopathy, and renal toxicity are seen less often (33)(34)(35)(36)(37)63). We have also demonstrated that outpatient continuous infusion of ifosfamide + mesna was associated with fewer transfusions and episodes of fever and neutropenia (63).…”

“…Tyrosine kinase inhibitors including regorafenib ( 2 , 64 ) and cabozantinib ( 3 ) have efficacy against osteosarcoma. Although a dose adjustment of TKI is sometimes needed to limit skin or GI toxicity, we have found the use of glutamine-disaccharide (Healios) can be helpful in ameliorating GI side effects and helping in eating and nutrition while on these agents ( 35 ).…”

“…Thus liposomal doxorubicin has high patient acceptance among relapsed osteosarcoma patients. Cold packs on hands, feet, and the use of glutamine + disaccharide (Healios) can be used to limit hand/foot erythroderma and mucositis/esophagitis, respectively ( 35 ). Liposomal doxorubicin is probably most suitable in relapsed osteosarcoma patients who had an initial excellent response to MAP chemotherapy.…”

Preventive Effect of Probiotics on Oral Mucositis Induced by Cancer Treatment: A Systematic Review and Meta-Analysis

“…The incidence of oral mucositis is approximately 20–40% in patients undergoing chemotherapy, 60–85% in patients receiving HSCT, and up to 90% in patients with head and neck cancer undergoing chemoradiotherapy [ 3 ]. Oral mucositis is a painful condition that can cause poor oral hygiene, difficulty eating and swallowing, altered nutritional intake, and decreased quality of life [ 4 , 5 ]. Severe oral mucositis can lead to a reduction or discontinuation of cancer treatment, resulting in a poor prognosis [ 5 , 6 ].…”

Editorial of Special Issue “Diet and Nutrition during Chemotherapy and Radiotherapy”

“…lymphocyte counts as studied by Tang et al [13], intermittent fasting using 12-15 h instead of 48 h time periods may be more practical for a family-centered care approach [2]. Overall, the 13 papers included in this Special Issue highlight numerous state-of the art scientific contributions and the importance of diet and nutrition during chemotherapy and radiation.…”