Gastrointestinal Care During Cancer Treatment: From Nutrition to Gut Health
From dietary principles to gut health repair, helping Hong Kong patients improve treatment tolerance and quality of life.
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In Hong Kong, many cancer patients undergoing chemotherapy or radiotherapy face treatment courses that last for several months. While chemotherapy is effective in killing cancer cells, it also brings a series of gastrointestinal side effects, including nausea, vomiting, diarrhea, stomach pain, bloating, and constipation (National Cancer Institute, 2022). Malnutrition can lead to treatment interruption or increase the risk of infection. Therefore, maintaining gut health and nutritional status is critical to whether patients can successfully complete their treatment (Arends et al., 2021).
Introduction: Why is gastrointestinal care so important in cancer treatment?
How does malnutrition affect treatment?
Research shows that cancer patients with malnutrition may experience weakened immunity, weight loss, leukopenia, and even treatment interruption or reduced therapeutic efficacy (Muscaritoli et al., 2021). In Hong Kong’s clinical practice, physicians often emphasize that beyond the “frontline battle” of cancer elimination (chemotherapy, radiotherapy, surgery), there must also be “logistical support”—nutrition and physical strength—to sustain the fight.
Prevention is better than rescue: Early nutritional intervention
Local medical societies recommend that if a cancer patient has experienced weight loss before treatment, nutritional intervention should begin immediately, rather than waiting until severe loss of appetite occurs (Hong Kong Society of Clinical Oncology, 2021). In fact, about 20–40% of cancer patients do not die from the tumor itself but from malnutrition and cachexia (Fearon et al., 2012).
Dietary principles during chemotherapy: The right concept of “food as medicine”
- High protein, high calorie: To support cell repair and immunity. High-quality proteins include fish, eggs, chicken, beef, and soy products (Prado et al., 2020).
- Avoid high-sugar foods: Excess refined sugar exacerbates inflammation and metabolic burden (Khalid et al., 2022).
- Small, frequent meals: Reduce gastrointestinal burden and help avoid nausea and bloating.
- Capitalize on morning appetite: Patients usually eat better in the morning, so this should be the “golden nutrition window” to take in the main nutrients.
Patient experience insight: During chemotherapy, making breakfast the “nutrition golden hour” and prioritizing protein and small amounts of nutritional formulas is more effective than forcing a heavy lunch.
The triple “gut-nourishing” strategy: Improving common chemotherapy side effects
Chemotherapy and stress damage the intestinal barrier, leading to diarrhea, stomach pain, and bloating. Studies suggest a three-in-one approach:
- Glutamine: Repairs intestinal mucosal cells, reduces diarrhea and oral mucositis (Wischmeyer et al., 2020).
- Digestive enzymes: Aid nutrient absorption and improve indigestion (Martinsen et al., 2021).
- Probiotics (e.g., Bifidobacterium, Lactobacillus): Improve microbiome imbalance and reduce chemotherapy-induced diarrhea (Redman et al., 2022).
Clinical studies confirm probiotics are safe for most cancer patients, but should be paused when white blood cell counts are critically low (<1500/μL) (Redman et al., 2022).
Common side effects and dietary adjustment strategies
- Loss of appetite: Small, frequent meals; main meals should emphasize high-protein foods; supplement with liquid nutrition in between (NCCN, 2022).
- Taste changes: Use lemon juice, tomato sauce, or herbs to enhance flavor; avoid fishy-smelling ingredients (Ravasco et al., 2020).
- Oral mucositis: Choose soft, cold foods such as pudding or steamed egg; avoid spicy and acidic foods (Lalla et al., 2020).
- Nausea and vomiting: Small, bland meals; avoid greasy, strong-smelling foods; take antiemetics as prescribed (Hesketh, 2020).
- Diarrhea: Replenish electrolytes, follow a low-fiber diet, and consider probiotics (Redman et al., 2022).
- Constipation: Drink plenty of water, eat high-fiber foods, exercise, and use stool softeners if needed (NCCN, 2022).
- Bloating: Avoid carbonated drinks, beans, and coarse fibers; eat smaller meals and take light walks.
Conclusion
For cancer patients in Hong Kong, gastrointestinal care is not just an adjunct but an essential anti-cancer strategy. Through proper nutrition and gut-health support, patients can increase treatment tolerance, reduce side effects, and improve quality of life. By establishing a nutrition plan early, patients can significantly improve their odds of completing therapy successfully.
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References
- Arends, J., Baracos, V., Bertz, H., Bozzetti, F., Calder, P. C., Deutz, N. E., … & Weimann, A. (2021). ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical Nutrition, 40(5), 2898-2913.
- Fearon, K., Strasser, F., Anker, S. D., Bosaeus, I., Bruera, E., Fainsinger, R. L., … & Baracos, V. E. (2012). Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology, 12(5), 489-495.
- Hesketh, P. J. (2020). Chemotherapy-induced nausea and vomiting. New England Journal of Medicine, 373(14), 1356-1367.
- Hong Kong Society of Clinical Oncology. (2021). Nutrition care guidelines for cancer patients in Hong Kong.
- Khalid, U., Spiro, A., Baldwin, C., Sharma, B., & Andreyev, H. J. (2022). Nutrition in cancer care. BMJ, 376, e063801.
- Lalla, R. V., Bowen, J., Barasch, A., Elting, L., Epstein, J., Keefe, D. M., … & Peterson, D. E. (2020). MASCC/ISOO clinical practice guidelines for mucositis secondary to cancer therapy. Cancer, 126(19), 4423-4431.
- Martinsen, T. C., Berstad, A., & Sandvik, A. K. (2021). Enzyme supplementation in gastrointestinal diseases. Scandinavian Journal of Gastroenterology, 56(5), 525-532.
- Muscaritoli, M., Arends, J., & Bachmann, P. (2021). Nutrition and cancer: evidence-based recommendations. Nutrition and Cancer, 73(5), 663-676.
- National Cancer Institute. (2022). Nutrition in Cancer Care (PDQ®). NCI.
- National Comprehensive Cancer Network (NCCN). (2022). NCCN Clinical Practice Guidelines in Oncology: Supportive Care.
- Prado, C. M., Purcell, S. A., & Laviano, A. (2020). Nutrition interventions to treat low muscle mass in cancer. Journal of Cachexia, Sarcopenia and Muscle, 11(2), 366-380.
- Ravasco, P., Monteiro-Grillo, I., & Camilo, M. (2020). Individualized nutrition intervention improves chemotherapy tolerance and outcomes. Nutrition, 36, 30-37.
- Redman, M. G., Ward, E. J., & Phillips, R. S. (2022). The efficacy and safety of probiotics in people with cancer. Annals of Oncology, 33(4), 386-397.
- Wischmeyer, P. E., Dhaliwal, R., McCall, M., & Ziegler, T. R. (2020). Glutamine supplementation in critical illness and cancer therapy. Critical Care, 24(1), 1-11.