Case study – nutrition for a patient undergoing radiation and

Case Overview

At the start of radiation therapy (XRT), Mr. Allen’s weight was 171.5 lbs and his height was 5 feet 6.5 inches. His BMI, 27,
put him in the overweight classification. However, his usual body weight (prior to this condition) had been 183 lbs.
The primary goal of medical nutrition therapy is to identify nutritional risk and implement strategies to minimize the
impact of treatment side effects on food intake that may contribute to weight loss and nutrient deficiencies.
• On the 5th day of XRT, Mr. Allen complained of dysgeusia (decreased taste sensation).
• On the 19th day of XRT, he reported decreased appetite secondary to constipation. He was following a soft diet
that included the oral supplement Boost plus TID. His weight loss was a total of 3.5 lbs. He began stool softeners
and was started on Megace, an appetite stimulant.
• On the 23rd day of XRT, the patient reported that he chokes on plain water but not oral supplements. His weight
was stable since day 19, indicating no further weight loss.
• On the 28th day of XRT, the patient complained of increased pain with swallowing, continued taste change, and
decreased PO intake. He also lost an additional 3 lbs. He was instructed to increase the frequency of liquid
codeine to ease the pain of swallowing.
• By day 38 of XRT, the patient had been treated for dehydration twice. His soft diet continues with thickened
juices and oral supplements. His weight has decreased another pound since day 28. His total weight loss since
the beginning of XRT was 7.5 lbs. His weight at the end of XRT was 164 lbs. and his BMI was 26.

Questions

S. Allen is an 86-year-old gentleman undergoing 40 days of radiation treatment (XRT) for squamous cell carcinoma T4NOMO of the base of tongue (BOT). He is receiving concurrent chemotherapy. He presented with a sore throat as well as swallowing difficulties and discomfort. These symptoms had become progressively worse over the past year.

1. Beginning with dysgeusia, list the issues that contributed to Mr. Allen’s decreased food intake.
2. For each issue from #1, list possible interventions that you would recommend to minimize the negative effects
on his food intake.
3. What is the most meaningful way to evaluate his weight loss? Do the necessary calculations: consider his UBW
and his weight at the beginning and end of his 8 weeks of treatment. How would you classify his nutritional
status based on his weight loss?