Weight management for cancer patient’s

Israthunisha S

Clinical dietitian, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

Abstract

Effective Nutritional management is critical for enhancing treatment tolerance and prognosis in oncology patients, but managing malnutrition alongside comorbidities is complex. Unintentional weight loss(cachexia) often negatively impacts outcomes and survival.

Key words: Patient-Generated Subjective Global Assessment (PG-SGA); Oral nutritional supplement (ONS); Colon cancer.

A 64-year-old man with a history of diabetes mellitus and colon cancer presenting with significant weight loss and newly diagnosed chronic obstructive pulmonary disease. Following a comprehensive nutritional assessment using the Patient-Generated Subjective Global Assessment (PG-SGA), an individualized, multidisciplinary nutritional support plan was initiated. This plan involved a high-protein, high-calorie oral nutritional supplement (ONS) regimen, combined with dietary counseling. Following the intervention, the patient demonstrated a clinically significant weight gain, an increase in lean body mass, and improved functional status scores. His tolerance to ongoing chemotherapy improved, and breathing difficulties related to muscle weakness were alleviated. This case demonstrates that proactive and personalized nutritional interventions can effectively reverse unintentional weight loss, even in complex oncology patients with multiple comorbidities like COPD and DM. A multidisciplinary approach to nutritional optimization is essential to improve physical parameters, enhance treatment tolerance, and ultimately improve the patient’s quality of life and overall prognosis.

Introduction

Colon cancer, also known as colorectal cancer, is the development of cancer from the inner lining of the colon or rectum (parts of the large intestine). It is a significant global health concern, ranking as the third most common cancer and the second leading cause of cancer-related deaths worldwide. This disease typically begins as small, noncancerous clumps of cells called polyps that form on the inner wall of the colon. Over time, some of these polyps can become malignant, or cancerous, acquiring the ability to invade nearby healthy tissue and spread to other parts of the body, such as the liver and lungs, a process called metastasis.

Key Aspects of Colon Cancer

  • Progression and Symptoms:Colon cancer often develops slowly over several years and may not cause noticeable symptoms in its early stages. When symptoms do appear, they can be non-specific and depend on the cancer’s size and location within the large intestine, including changes in bowel habits (diarrhea or constipation), blood in the stool, persistent abdominal discomfort, unexplained weight loss, and fatigue.
  • Risk Factors:The development of colon cancer is multifactorial, involving a mix of genetic and environmental influences.
  • Non-modifiable factorsinclude increasing age (most cases occur in people over 50), a personal or family history of colorectal cancer or polyps, and inherited genetic syndromes like Lynch syndrome and familial adenomatous polyposis (FAP).
  • Modifiable factorsare related to lifestyle and can be managed to reduce risk, such as a diet high in processed and red meats and low in fiber, physical inactivity, obesity, smoking, and heavy alcohol consumption.
  • Prevention and Screening:Early detection is crucial for improving prognosis and survival rates, as treatment is more effective when the cancer is caught in its localized stages. Regular screening, often recommended to begin around age 45 for individuals with average risk, involves methods such as colonoscopies and stool-based tests which can detect precancerous polyps before they turn into cancer.
  • Ongoing research continues to advance the understanding of the molecular and genetic mechanisms underlying the disease, leading to newer, more targeted therapies and personalized treatment plans aimed at improving patient outcomes and quality of life.

A 64-year-aged man with 57kg of weight and 165cm of height was admitted with the following medial history.

NameXXX
Age64Yrs/ Male
LifestyleSedentary
Past historyDiabetes Mellitus, Hypertension , Carcinoma – Colon, Weight Loss
DiagnosisObstructive Airway Disease Lower Respiratory Tract Infection (Sputum C/S – Klebsiella Pneumonia)
Present complaintsBreathing Difficulty
D.O.A22.08.2025
D.O.D01.09.2025

Course in the hospital

A 64year old male admitted in hospital with the complaints of breathing difficulty and diagnosed as COPD. He had a past history of Diabetes Mellitus, Hypertension, Carcinoma.

Anthropometric assessment

Height165cm
Weight57kg
BMI20.9kg/m2
Ideal body weight65kg

Biochemical assessment

Haemoglobin11.8g/dl
Total RBC count3.41ML
Total WBC count10900cells/cumm
Monocyte4.1%
Eosinophil0.3%
Basophil0.3%
Neutrophil92.6%
Platelet count67000/cumm
Total protein6.1g/dl
Albumin3.1g/dl
Urea46mg/dl
Creatinine0.72mg/dl
Sodium129mmol/L
Potassium3.32mmol/L

Clinical assessment

  • Fatigue
  • Weight Loss

Dietary assessment

  • 24hrs recall:
Timing Menu
Early morning Tea
Breakfast Idly with sambar
Mid-morning -
Lunch Rasam rice
Mid-evening Tea
Dinner Kanji
Bed-time -

Day – 1 – Soft Diet (In-house diet)

Timing Menu
Early morning Milk
Breakfast Idly with sambar & chutney
Mid-morning Veg soup
Lunch Rasam rice and curd rice with veggies
Mid-evening Fruit juice (liquid diet started)
Dinner Wheat kanji
Bed-time Milk

Day – 2

Patient was on NPO in the morning

Evening – RT Feed – Blendarised Feeding started

Day – 3

Fluids: 1000 + 400ml

Calories: 900kcal

Protein: 91.5g

Time Menu Amount
(ml)
Calories (k.cal) Protein
(gm)
7.00 A.MPentasure HP (2 Scps dil in 120 ml of lukewarm water)12011613.5
9.00 A.MPentasure HP (1 Scps dil in 120 ml of lukewarm water)60586.75
11.00 A.MEgg flip (2 nos)20016012
1.00 P.MPentasure HP (2 Scps dil in 120 ml of lukewarm water)12011613.5
3.00 P.MPentasure HP (2 Scps dil in 120 ml of lukewarm water)12011613.5
5.00 P.MEgg flip (2 nos)20016012
7.00 P.MPentasure HP (2 Scps dil in 120 ml of lukewarm water)12011613.5
9.00 PMPentasure HP (1 Scps dil in 120 ml of lukewarm water)60586.75

*(Before and After feeding 25 ml of free water)

Day – 4 & 5

Continuous as same

Day – 6

Shifted to ward & Feeding Continuous as same

Day – 7 – Liquid diet(orally) started

Liquid Diet (In-house diet)

Timing Menu – quantity – 200ml
07:00am Milk
09:00amMilk with Pentasure HP (2scoop)
11:00am Wheat Kanji
01:00pm Millet Kanji
03:00pm Milk with Pentasure HP (2scoop)
05:00pm Veg soup
07:00pmWheat Kanji
09:00pmMilk with Pentasure HP (2scoop)

Day – 8 –  Diabetic-Soft diet (In-house diet)

Timing Menu
Early morning Milk with Pentasure HP (2 scoop)
Breakfast Idly with sambar & chutney
Mid-morning Veg soup
Lunch Rasam rice and curd rice with veggies
Mid-evening Milk with Pentasure HP (2 scoop)
Dinner Idly with sambar & chutney
Bed-time Milk with Pentasure HP (2 scoop)

Day – 9 – Diabetic-Normal Diet (In-house diet)

Timing Menu
Early morning Milk with Pentasure HP (2 scoop)
Breakfast Wheat rava upma with sambar & chutney
Mid-morning Veg soup / cut fruit/ buttermilk
Lunch Rice with sambar, rasam, veggies, glv, buttermilk, cut fruit and boiled egg
Mid-evening Boiled pulses / cut fruit + milk with Pentasure HP (2s coop)
Dinner Wheat dosa with sambar & chutney
Bed-time Milk with Pentasure HP (2 scoop)

Day – 10 & 11

Continuous as same

Day- 11

Patient discharged on the day – 11.

Patients discharged with the three rotational therapeutic menu plan

Therapeutic diet

Timing Menu
Early morning Milk with Pentasure HP (2 scoop)
Breakfast Pesarattu / moong dhal dosa / pearl millet dosa with sambar & chutney + boiled egg - 1
Mid-morning Veg soup / cut fruit/ buttermilk
Lunch Rice with pulses curry / nv curry / green gram dhal curry, dhal rasam, veggies, buttermilk and boiled egg - 1
Mid-evening Nuts (almond & walnut)/ cut fruit + milk with
Pentasure HP(2scoop)
Dinner Wheat dosa / chapathi / wheat rava upma with panneer / soya chunks curry or chutney
Bed-time Milk with Pentasure HP (2 scoop)

Summary and conclusion

On the day of discharge, he was advised to visit Clinical Dietitian on review date. From Dietitian side, three rotational menu plan was given, which contains 80g of protein (approx), patient gained weight gradually.Now, he awared about protein intake and regularly he is visiting us on every review.

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