The contribution of the dietitian and nutritionist to palliative medicine

Abstract

Nutritional management of patients receiving palliative care has not, until recently, been considered an explicit element of care( 1 ). The features of cachexia such as anorexia are often considered by health-care professionals as milestones of disease progression. Traditionally, the input from palliative care specialists relating to nutrition is one of ethics and centres on the withdrawal of food and fluids. Nevertheless, many patients present with and are distressed by the presence of symptoms that affect their ability to eat 'normally' i.e. dysphagia, taste changes, xerostomia, and dementia. The deterioration and alteration in nutritional intake which results promotes weight loss, is accompanied by fatigue and often a distressing alteration in body image.

The futility of approaches that merely seek to improve patients' nutritional intake (either enterally or parenterally) and replete body mass has redirected the focus of nutritional intervention to maintenance and symptom control. (see Chapter 10.3.2) Our improved understanding of the metabolic sequelae of disease and an appreciation of nutritional strategies that may be used to ameliorate or manage symptoms (see Table 4.7.1) has resulted in the recognition of nutrition as a component of holistic palliative care. Embedding nutritional care in palliative medicine must be paralleled by formal and rigorous evaluation (i.e. randomized controlled trials) ofpractice. To a large part this remains to be addressed and it would be nave not to appreciate the inherent difficulties of conducting nutritional research in the palliative-care environment. The challenge for practitioners is to strike a balance between the application of research evidence with the practical nutritional needs of the individual.