February 2017- Question #1
As part of an initial assessment for a patient recently diagnosed with lung cancer, what are types of pertinent information would you want to collect? This patient is having surgery to remove her a tumor in her right upper lobe in three weeks. What education would you provide to her in pre-operation and for recovery post-operation?
posted by Unknown @ 4:47 PM
29 comments
29 Comments:
As you would assessing other patients, you would want to collect the patients usual diet intake, %EER meeting per day, weight history, appetite, any functional changes affecting nutrition such as chewing or swallowing. You would want to know how their bowels are and their level of knowledge related to nutrition. You would also want to perform a nutrition focused physical exam to identify any malnutrition. As you mentioned earlier we are nutrition experts and it is our jobs as Dietitians to educate our patients and provide them with the tools they need to prevent malnutrition, heal and live healthy lives before and after surgery. Surgery poses catabolic stress on the body leading to inflammation and depleted nutrients. Therefore, meeting nutrient needs can prevent infection and post-op complications. It can also speed up recovery time. Educating patients before surgery is just as important as educating patients after surgery. Before surgery it is important that the patient is well hydrated and eats adequate amounts of calories and protein. It is also important your patient is confident in their eating habits and confident they can continue to maintain proper nutrition after surgery. Even though it can be difficult for patients, after surgery nutrient needs should be met to help the body heal/repair and prevent any muscle or fat depletion.
As remarked by Moriah, determining the patients risk for malnutrition and development of malnutrition is a primary goal in nutrition assessment. In addition to subjective measures mentioned, biochemical data to review may include anemia profiles, glucose, and c-reactive protein value. Nutrition education for this patient may include intake of adequate energy and protein prior and following surgery. The liberalizing of dietary restrictions to allow for increased intakes may be beneficial. Further discussion of strategies to increase intake related to decreased appetite or exhaustion.
In assessing this patient, information I would like to collect would be the information necessary to determines the patients risk for malnutrition, or if the patient is in fact currently malnourished. Such information would include: PO intake history, unintentional weight loss, if patient is experiencing weakness that is effecting his/her ADL's, etc.
The information I would provide to this lung cancer patient for pre/post operation is to assure they are eating adequate protein and to consider an oral nutrition supplement if patient has a poor appetite. Overall, I would stress with the patient the importance in adequate intake for successful recovery and develop strategies for the patient to increase calories and protein throughout the day. Additionally, the specific nutrients I would want to focus on are L-arginine and fish oil. Many research shows L-arginine and fish oil are beneficial in wound healing and infection prevention. During my internship, I became aware that both Abbott and Nestle are currently developing a pre/post operative supplement high in both these nutrients specifically intended for surgical patients.
As with any patient a clinical dietitian would see, gathering information regarding usual weight as well as current weight is crucial. Gathering a diet history and if there are any taste aversion the patient is experiencing, so the RD can help strategize with the patient on foods to include in their diet to replace what the patient is unwilling to consume. With that said, if the patient is having an aversion to meat, finding other ways to increase protein in the patient’s diet so they can tolerate is a priority to prevent muscle wasting/unintentional weight loss.
I would want to educate the patient on the importance of consuming enough energy and protein to aid in a speedier recovery. I would also want to touch upon safe food handling post-surgery. Having the patient as well as the family present while educating on safe food preparation and storage can help overall in ensuring the patient is consuming foods that pose a low risk for infection while they are recovering from their surgery.
Moriah, I like that you touched upon the importance of confidence. While dietitians are focused on the food side of things, we have the responsibility to promote positive change and that starts with the patient. Strategizing with them and using the information gathered to motivate them to eat and consume adequate nutrients is so important during this time; giving them control and confidence, being their “cheerleader.”
I would also collect information about the patient's weight history, eating habits, changes in appetite, pertinent lab results. I would also like to conduct a nutrition-focused physical exam to determine if any signs of malnutrition are present. If the information is available, I would also access her recent meal orders and % meals eaten to determine whether she is eating adequately for her condition.
Nutrition education for pre/post surgery should focus on adequate energy and protein intake. How the patient has been eating recently, results from the physical exam, and any recent weight fluctuations would determine how I would approach this topic with the patient. It may be appropriate to recommend a nutrition supplement to insure she is taking in enough nutrients to promote wound healing. I would suggest the patient fast for as little length as possible pre and post surgery. If in an appropriate environment, I would also support Early Recovery After Surgery (ERAS) protocol.
I agree with Rachel that it may be more important to allow this patient a liberalized diet and focus on getting enough calories and protein. Also, providing information on certain nutrients, like Noel mentioned, might also be a great idea in promoting healthy, quick surgery recovery. Providing supplements with L-arginine and fish oil to the patient post-op would be ideal if available.
Nikki, I think you made a great point that it is important to teach and educate on safe food handling. As you mentioned, it is not only important for the patient but the family as well, as they will be the support system ! Great idea!
Important parts of this patient’s assessment will include usual body weight, current body weight, % REE currently eaten, appetite, and unintentional weight loss. Though this patient was recently diagnosed with lung cancer, understanding how the illness may have affected her body in the past 6 months to a year may be helpful to know for treatment and asking questions related to diet and weight history will be important focuses here. Evaluating malnutrition through a nutrition focused physical exam will also help to indicate whether the patient is suffering from signs of malnutrition and diagnosing this will be an important point when approaching their pre and post op education.
As the patient prepares to go into surgery, their education should be focused on achieving a successful surgery and healing post-surgery. If the patient shows signs of malnutrition, helping to make calorie, hydration and protein suggestions to improve that status will be important pre-op. Similarly, if a patient is in good health, an RD should be helping them to maintain that before surgery. If the patient is compliant with oral nutrition supplements, the ones from Abbott or Nestle that Noel mentioned may be good choices to increase nutrition status before surgery. Helping to encourage physical activity may also be beneficial to increasing the patients lean mass.
Following the surgery, continuing to encourage foods high in calories and protein to help feed the healing body will be beneficial. Surgery is high stress on the body, and getting adequate energy to compensate for the catabolism will be needed. Just as Nikki said, finding ways to educate the family and patient about the new dietary guidelines and food safety is important. Making this a team effort can raise morale for the patient and allow them to feel supported not only by the RD, but their family.
Like many have mentioned, I would begin by gathering typical assessment data to determine nutritional status and malnutrition risk including: usual PO intake (%EER), weight history (UBW, current, % weight loss), changes in appetite, applicable lab values, chewing/swallowing difficulties, functional status, etc. I would also conduct a nutrition-focused physical assessment to aid in determining nutritional status.
I would use the obtained assessment data and approach this case with my thoughts and actions organized into three objectives so-to-speak: 1) to figure out and understand the patient’s current dietary situation and any barriers or challenges to eating and consuming adequate energy, protein, etc. she may be experiencing considering her diagnosis and any prior medical treatments, 2) to identify how to take action now, pre-op, to ensure that she will be going into surgery with good nutritional status, and 3) to identify strategies to maintain and achieve adequate nutritional status post-op. I would use these objectives to guide my education and communicate with the patient so they understand the importance of nutrition during this time. Pre-op I would stress the importance of consuming adequate energy to maintain good nutritional status prior to undergoing surgery and initiating catabolic and inflammatory stress. With post-op education, the focus would be on much of the same – adequate intake of both energy and protein– but this time for different reasons, to reduce inflammation, infection, and risk of complications, and to promote healing and recovery. Post-op would include some additional assessment to identify any changes to appetite, ability to chew/swallow, taste preference, etc. and then to brainstorm and offer additional suggestions to maintain intake at an adequate level. This may involve a nutritional supplement or trying new foods to address aversions.
Additionally, I thought both Moriah and Nikki made good points about the importance of the patient’s personal feelings/confidence levels and their support system. It addition to actual biomarkers markers and nutritional needs, it is also important for the R.D. to consider these things when making recommendations as they play a significant role in patient success and outcomes.
In an initial assessment, I would first gather data from the patient’s medcial record including height, weight, BMI, weight history, current diagnosis, prior medical history, surgical procedures completed, recent diagnostic tests completed, bowel function, presence of edema, reported nausea/vomiting/diarrhea/constipation, medications, IVF, food allergies, presence of wounds, labs, recorded PO intake %, and nursing screen malnutrition screening tool score (if completed). Reviewing these details of the patient’s medical record would help me develop a relatively comprehensive view of their current health status. Following this detailed review, I would interview the patient and ask them about any recent weight changes (intentional vs unintentional weight changes), usual body weight, current appetite, usual appetite, usual PO intakes, current PO intakes, chewing/swallowing difficulty, and nausea/vomiting/diarrhea/constipation issues. A nutrition-focused physical exam would also be useful in detecting possible malnutrition, especially if unintentional weight loss history, decreased appetite, and decreased PO intakes suggest malnutrition.
Before surgery, I would focus on encouraging adequate nutrition status via sufficient intakes as well as good hydration status. I would stress the importance of weight maintenance before surgery and the necessity of avoiding weight loss leading up to surgery. After surgery, I would focus on encouraging the patient to eat small, frequent meals throughout the day that include nutrient and energy dense foods. I would suggest oral supplements if the patient was undernourished and/or has poor PO intakes. Pain medications that may be prescribed after surgery may cause constipation, I would suggest eating fiber-rich foods and drinking lots of fluids.
Rachel's point about liberalizing diet restrictions is excellent! Patients on specific diet restrictions for certain health conditions may benefit greatly from liberalizing of the diet to promote intakes. If this can be safely done for the patient, it might make the difference of several hundred calories and a significant amount of protein in a day. Noel's comment about the product development of pre/post surgery supplements was very interesting. I have not previously heard about these products and they seem like they have promising application in the clinical setting. Nikki made very thoughtful points about considering taste aversions and safe food handling. These are things that can have significant impacts on the patient's health status, especially if they are undergoing chemotherapy. Taste aversion is a common side effect of chemo and chemo suppresses the immune system, making food safety extremely important. Finally, Jenni's suggestion to take action now (several weeks before surgery) to ensure adequate nutrition status going in to surgery was appropriate. Improved health status before the stress of surgery can positively affect recovery and prognosis. Specific strategies mentioned by others could aid in achieving this good nutrition status pre-surgery.
As many others have noted, I would begin with a physical assessment to determine any symptoms that relate to malnutrition. Diagnosis of malnutrition is commonly seen in oncology patients due to side effects of chemotherapy or radiation (loss of appetite, mouth sores, dry mouth, nausea etc…) I would directly ask the patient if they have had any recent weight loss or changes in appetite. After just learning about the Nutrition Focused Physical Assessment in MNT, I believe that this is essential for the RD to perform. I would look specifically at the periorbital and temporal areas of the face, and also the chest and triceps. After that, I would collect data on the patient's current weight, height, BMI, diet history, and any chewing or swallowing difficulties. Also mentioned above, it is important to know how much the patient has been eating (%EER) in previous days to determine if they are meeting daily needs. Along with that, I agree with Rachel that any diet restrictions should be liberalized in order for the patient to obtain adequate nutrition, especially after a surgical procedure where nutrition demands increase.
Before the surgery, I think it is important to educate this patient about the increased nutrition needs that will be imperative post op. I would encourage the patient to try to increase oral intake with adequate protein as well as maintain optimal hydration in order to accelerate healing. During post-op education I would continue to encourage oral intake and high energy. If the patient is suffering from a loss of appetite I would promote small frequent meals, and recommend nutrient dense foods that will supply lots of energy. At this point, I would not be extremely strict on healthy dieting. In order to improve the patient’s quality of life, I would encourage intake of anything they would like or could tolerate. If the patient does have an appetite or is overweight, I would recommend a more wholesome diet.
As everyone has discussed, assessment of the patient should include EER, protein needs, % PO intake, usual body weight, current body weight, appetite, as well as pertinent lab values indicative of nutrient deficiencies. As Kristen discussed, additional details such as current diagnosis, presence of edema, reported nausea/vomiting/diarrhea/constipation, medications, and so on should be included in the assessment to get a full picture of the patient. A nutrition-focused physical exam can expose risk of extent of malnutrition
The patient should be well nourished and hydrated before going into surgery as well as post-surgery to aid recovery. I would emphasize the importance of consuming adequate energy and come up with strategies with the patient to achieve this. If appetite is poor or their taste has been altered, I would suggest the patient take oral supplements to ensure nutritional needs will be met. I love Nikki’s idea of gathering a diet history and asking about taste aversions the patient is experiencing, since we know cancer treatments can significantly alter taste which in turn affects consumption. As Nikki explained, gathering this information can allow for the RD to negate malnourishment and/or unintended weight loss by providing suggestions more tailored for the patient. I agree with others’ ideas that the patient as well as their family or caretakers should receive nutrition education. Support in all areas of recovery are extremely important. I also agree that the patient’s feelings and confidence should be inquired and that overall the patient should be motivated and supported.
It sounds like the main consensus is to collect all of the relevant information regarding anthropometrics, biochemical data, subjective history (including diet recall and weight history). In addition, due the high prevalence of cancer cachexia and malnutrition in general, NFPAs are the RD-specific way to document muscle and subcutaneous fats losses based upon evidence-based research.
Many of you bring up very valid points regarding pre- and post- surgical nutritional needs. Noel notes that there is new research emerging regarding L-arginine and fish oil for wound healing and recovery. This leads to an interesting point that (unfortunately) tends to occur in oncology patients. There are many articles/blogs/books that introduce more holistic means of cancer treatment-- many of which include unbalanced diets or extreme supplementation.
What if the patient in the original scenario admits to using some supplements? How would you address supplementation of things like echinacea or garlic? Check out this article for some statistics on supplement usage and chemotherapy: http://cancer.northwestern.edu/press_releases/2011/07_july/herbal.cfm.
As part of an initial assessment for a patient recently diagnosed with lung cancer, what are types of pertinent information would you want to collect? This patient is having surgery to remove her a tumor in her right upper lobe in three weeks. What education would you provide to her in pre-operation and for recovery post-operation?
A physical assessment of the patient would be the first indication of malnutrition. Although the patient was recently diagnosed with cancer, it is important to note what stage of cancer the patient has been diagnosed with. I'm late to the party here but I agree with everyone that the typical nutritional needs assessments such as anthropometrics and nutritional labs should be reviewed to understand the patients current nutritional status. A validated tool such ast the malnutrition screening tool is a strong recommendation according to the journal article.
Before meeting with the patient to discuss education, I would meet with the health care team to make sure we are all on the same page. After this initial discussion, I would speak with the patient and work on increasing her nutritional status before her operation if there is time. Studies have shown that near optimal levels of nutrition status before an operation have reduced the patient's hospital stay and readmission. The same goes for nutrition after the operation. The patient's tastes will change and she may find foods less desirable, but it is important to work with her to find what foods she can tolerate. Studies also show that food over supplementation show great reductions in the time it takes to heal as well as reduce readmission.
I would assess her current weight/BMI, UBW, IBW, current labs, and eating habits/diet log. I would also assess her current knowledge of nutrition.
In pre-operation education, I would go over the need to go into the operation with full strength, so she will need to consume adequate calories, and nutrition beforehand. She should also be adequately hydrated. Going into surgery with appropriate nutrition and hydration status yields better post-operative results.
For post-operation education, I would mention the importance of adequate nutrition/calories and protein on healing after surgery, and how this may speed up her recovery period. If she needs help planning meals in order to get adequate nutrition and protein, I would help her make sample meal plans.
I would want to complete the MST on the patient. If the patient triggers for being at risk for malnutrition, then, as with any assessment I would want to find out about the person’s weight history, eating patterns, if they have any difficulty eating, or suffering from n/v/c/d. Additionally, lab work identifying the patient’s biomarker status and a nutrition focused physical exam would also be beneficial.
The patient should be provided with personalized recommendations and education designed to prevent the loss of lean muscle mass, maintain weight, minimize anorexia, and reduce the risks for malnutrition that are associated with the patient’s treatment plan. The specific education may include ways to increase kcal and protein intakes, suggestions on food flavorings to improve taste, and prevent anorexia. If warranted, education of supplements should also be included.
As mentioned above, it would be important to compare the patient's REE to his/her daily energy intake in conjunction with a malnutrition screening. It would also be important to discuss with the patient changes in taste, appetite, and lung cancer symptoms that could impact intake (SOB, coughing, etc.).
As for pre-op education, I think Moriah makes an excellent point about ensuring that the patient is confident in his/her eating habits. Additionally, I would try to make sure that the patient is aware that he/she will have elevated energy and protein needs after the surgery, and that meeting these needs may seem difficult at times with decreased appetite. As mentioned above, ensuring that the patient is hydrated and meeting basic protein and energy needs is very important before surgery.
After surgery, providing nutrition support (via supplementation if necessary) to maintain adequate energy and protein intake will be critical. Once a patient is able to eat fairly normally after surgery, I would educate the patient about a protective diet, focusing on citrus fruits, vegetables, and specific seeds and nuts. Fish oil as mentioned by Noelle would also fall into this category.
As everyone has mentioned you would want to collect the pt’s anthropometrics, past medical history, current signs and symptoms, and also assess the client’s current knowledge set on nutrition and how much the patient does or does not know about pre operation pre- and post-operation nutrition. Also, you would like to know if the pt is going to be receiving chemo and/or radiation. Wound healing education will be important – increased protein and caloric intake. Also, if the patient has a poor appetite (especially if they are/will be receiving chemo), appetite stimulants may also be beneficial.
I like Rachel’s idea of liberalizing the diet. In this pt scenario, wound healing and preventing weakness is extremely important. If liberalizing the diet will provide the pt more options they would prefer it should be done.
Holly, you mentioned that some pts may use supplements, herbal treatments, or strict diets to treat cancer. In these situations, I think it’s best to suggest what will provide the pt with the best outcome and explain any risks that might be associated with the choice homeopathic therapy. It’s also important to tell the pt to speak to the doctor about homeopathic therapy, as it may interact with the treatments.
Like everyone else, I would want to collect standard assessment data including current body weight, usual body weight, determine is she has had any unintentional weight loss, change in appetite, if she is able to still easily perform activities of daily living, look at corresponding lab values, ask about any food allergies, and ask the patient for a 24 hour recall to asses if her intake is meeting her energy and protein needs. I would calculate her BMI, % weight loss, ideal body weight, and her energy/protein/fluid needs. I would also conduct a nutrition focused physical exam to determine if the patient has become malnourished in conjunction with a validated malnutrition screening tool. This information will allow me to have a good overview of the patient and her health status. Now I am ready to have a proper session with the patient and hopefully her family to discuss education about her diet and address and concerns or questions she may have.
Pre-op education:
I would discuss with the patient that she needs to enter her surgery as healthy and full of energy as she can so it is important for her to consume her daily energy and protein needs. Better nutrition before surgery leads to better results. During our discussion I would try to find barriers that would prevent the patient from eating what she needs to. If she does not have much of an appetite or energy to make large meals, I would give suggestions about energy-dense snacks and foods that are easy to prepare.
Post-op
I will once again tell the patient it is important for her to meet her energy and protein needs to help speed and assist the healing process. I would explain that her body temporarily has higher needs than before. I would warn her that her taste preference may change and she may have swallowing/chewing difficulty. We would work together to find nutritionally balanced alternatives for her.
I also like how many of you have noted how important keeping the moral of the patient high and how this will help her stay positive and feel supported during this huge transition to her life.
The initial assessment of this patient should include a Nutrition Focused Physical Exam, current diet order, labs of interest, nutrition history (recent and usual), and EER along with %EER this patient is meeting per day. This information will give you a good indication of the patient’s nutritional status. Specifically in the data we collect, signs of malnutrition and weight loss should be assessed carefully.
Pre-operation nutrition education would consist of educating the patient on the importance of maintaining a healthy weight. We do not want to see this patient lose weight before a surgery because the surgery itself can put the body through catabolic stress which can lead to a depletion of nutrients. It is imperative that we meet kcal needs as well as protein needs beforehand in order to aid in a faster recovery.
Post-operative education would consist of education the pt. why she is on a higher kcal diet at the moment. Because of the surgery her body will be going through some metabolic stress. An increased kcal/PRO diet will ensure that her body is receiving the energy and vital nutrients it needs to aid in a speedy recovery. For this we will need to work with the patient in order to make sure meal time is comfortable and enjoyable. This may also call for supplementation in order to encourage easy kcal/PRO consumption throughout the day.
As many have already said, I would assess the pt's recent intakes and ability to meet their nutrition needs. I would assess any nausea or vomiting that could affect intakes. Assessing diarrhea and constipation could give insight into their health status. I would ask about any chewing or swallowing difficulties that could be hindering adequate nutrition. I would ask about their UBW and any recent wt changes. This would also be a time to assess any fat or muscle loss to possibly diagnose malnutrition as this can change the plan of action for this pt.
If the pt appears at risk for malnutrition I would discuss starting a nutrition supplement to boost nutrition prior to surgery. If the pt is not at risk, I would still discuss eating a healthy diet to prevent complications or risk of infection d/t the surgery.
I thought Kirsten and Elyse both had good points about the post-surgery diet. Kirsten mentioned that the pt could have issues with constipation d/t the pain medications. I agree that fluids and fiber should be encouraged, but if this is not enough the pt may need a suppository to promote bowel movements. Elyse mentioned a change in taste d/t medications which is a common problem. I would talk to the pt about ways to alter the food to be more palatable, and I would recommend supplements as needed. I also think a multivitamin would be beneficial. This could be initiated prior to surgery to ensure that the pt is meeting micronutrient needs, and this could help speed up the recovery time.
I echo all of the pertinent information you guys have listed! It is important to know where our pt stands nutritionally before surgery throws a wrench in things. Someone mentioned that it would be helpful to know the stage of cancer our pt is dealing with. I also think it would be helpful to know the goal of treatment (most likely to control or cure the cancer in this case). Will CT or RT be utilized? That is probably something we would learn post-surgery. In the meantime, it is our job to thoroughly assess the pt and provide the necessary interventions. This could include counseling the pt on cancer in general (recent diagnosis), highlighting ways in which the body is affected by cancer, surgery, CT/RT, etc., and the emphasizing the positive impact that she can provide herself through nutrition. This ties in to what Erin and Reilly discussed- I think we can show the patient respect and come alongside them to provide support when we not only explain our “game-plan” (diet order and recommendations), but explain the reasons behind our specific prescriptions. Hopefully this helps the pt to be motivated to increase her nutritional status before her surgery, for example.
Remembering to ask if the patient is taking any kind of supplements, minerals, and herbs is important to remember as RDNs. This is important to do with every patient but especially with patient on chemotherapy. Many patients probably do not realize that these supplements can affect their course of treatment or have adverse effects to medications. The supplemental article that Holly posted gave a great overview of many different ways supplements could interfere with a patient’s chemotherapy treatment.
To answer Holly’s questions:
If a patient told me that they routine took garlic supplements as part of their own home remedy, I would tell the patient that there would likely be no adverse reactions to consuming garlic as part of meals. However, I would warn the patient that extended use of supplemental garlic could lead to excessive bleeding during surgery. I would then ask why the patient was taking the garlic as a supplement and if it was helping them. I would see if they were open to stopping the garlic supplement until any upcoming surgeries were over and hopefully talk them into stopping at least until their chemotherapy was over. I would see if I could find other less risky ways of fulfilling the patients’ needs than their garlic home remedy. I would make sure to not make the patient feel victimized by taking the supplement away. I want to keep communication open with the patient otherwise they might not tell me important information later.
Reilly brings up a good point of asking about herbal supplements and minerals while undergoing chemotherapy. This was something many patients had questions about while I was at the cancer center in Peoria. We always advised patients to discontinue their supplements, herbal remedies, etc. during chemotherapy as there is research suggesting such things may decrease the effectiveness of chemotherapy--however, the research is still to slim to come to an exact conclusion if it is safe or not so we just err on the side of caution.
In regards to Holly's inquiry about the patient using supplements and/or more holistic approaches, I feel that is when an RD's role is vital. As we are all aware, there is a plethora of information and "research" on holistic approaches and supplements. Unfortunately, these are typically posted by illegitimate sources that are not research-based. Like the article Holly linked to, some of these alternatives can have adverse affects to patients of chemotherapy. I think it is our jobs as RDs to stay up to date with evidence-based information and be ready and willing to discuss these concepts with our patients. I think the patient should be applauded for being cognizant of and dedicated to their health. Perhaps these patients would want to feel as though they have a more substantial role in their treatment. For that, I might work with them so that they feel I provide more guidance, support, and approval rather than just giving them a list of things to do.
Reily makes a good point about the importance of asking about additional supplements and herbs the patient may be taking. Also, determining the potential issues of swallowing difficulties as mentioned by Alyssa would be important in assessing this patient.
Reilly, I like the way you would approach a patient's use of herbs and supplements. It's a very understanding and communicative approach rather than accusatory. I agree with you that it's important to make the patient feel comfortable during these conversations or else they may not feel like they can tell us the truth, and that's the last thing we would want because that may impair their treatment and health!
Jamey, I like that you bring up the many different sources of information patients have access to. I think it's important to talk to patients about where their information is coming from and explain where we, as RDs, get our information. This way, they will hopefully be more responsive to what we have to say/are advising them to do.
To add to Reilly's point, I think it is important for RDs to ask not just what supplement a patient is taking, but also why they are taking a specific supplement. For example, perhaps a patient is taking ginko biloba supplements as a way to self-treat vertigo and/or migraines. The patient may be hesitant to discontinue this supplement due to fear of increased migraine frequency and severity. Thus, it would be important for the RD in conjunction with a physician to discuss with the patient ways to address these symptoms in an effective manner that would minimally disrupt chemotherapy.
Mike’s comment triggered “interdisciplinary approach” in my mind. I agree that it is important to work with the patient in conjunction with a doctor and even a pharmacist- discussing current medications, specific symptoms both in the past, current, and expected symptoms from any CT/RT medications. Herbs and supplements are a big piece of the discussion as well. Looking at, as Mike said, the reasons behind why they are choosing to take a particular supplement, will aid the doctor in determining alternative routes to take that can achieve the same results- and safely.
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