Practice Consideration
Many symptoms interfere with the patient's desire or ability to eat, digest or metabolize food. These impediments to nutrition intake are termed nutrition impact symptoms (NIS). Common NIS in the clinical-care setting include:
Gastrointestinal System
» Abdominal pain
» Ageusia (altered sense of smell)
» Constipation
» Diarrhea
» Dysphagia (difficulty or discomfort in swallowing)
» Dysgeusia (altered sense of taste)
» Mucositis
» Nausea
» Vomiting
Respiratory System
» Dyspnea (difficult or labored breathing)
Other
» Anxiety
» Fatigue
» Sleep problems
» Weakness
Dietitians address NIS in their appraisal of the patient's nutrition focused physical findings during Nutrition Assessment. They also use malnutrition screening tools which include NIS to classify the patient's nutrition state. Despite the obvious impact of NIS in the clinical setting, researchers have yet to achieve consensus on screening and treatment. It is understood that the greater the number of NIS, the greater the likelihood of reduced dietary intake, weight loss and reduced functional capacity.(1)
The ESPEN guidelines on nutrition in cancer patients (2) state,
"We recommend nutritional intervention to increase oral intake in cancer patients who are able to eat but are malnourished or at risk of malnutrition. This includes dietary advice, the treatment of symptoms and derangements impairing food intake (nutrition impact symptoms), and offering oral nutrition supplements."
References
1. Kubrak C, Olson K, Jha N, Jensen L, McCargar LSH, Harris J, Scrimger R, Parliament M, Baracos VE. Nutrition impact symptoms: Key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck. 2009; 32: 290–300.
2. Muscaritoli, M, Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2021;40(5):2892-2913.