Dietitians will often prescribe oral nutritional supplement drinks. These can take the form of juices or milk shakes, or powder which can be sprinkled over other food. The supplements are calorie rich and also full of vitamins and are a good source of additional nutrition. It is important to note that they are supplements, not a replacement for meals. They should be taken with other food, not as a substitute for food.
If the weight loss is caused by malabsorption, and this can be very common in pancreatic and biliary tract cancers, then supplemental enzymes can sometimes be given. Most common of these is called Creon and it replaces the digestive enzymes produced in the pancreas. Patients who are lacking pancreatic digestive enzymes will often poorly absorb fats which can lead to unpleasant bloating and trapped wind and smelly yellow-coloured poo. By taking these enzyme replacements with each meal, more calories are absorbed, weight loss slows down, and the other horrible symptoms start to resolve. Other types of malabsorption include bile acid malabsorption, and this requires special tests to diagnose. Your oncologist will work closely with the dietitians and gastroenterologists in order to maximise nutrition and minimise any losses caused by malabsorption.
In situations where patients are unable to eat due to difficulty swallowing, or where the gut is not functioning properly there are other measures that can be taken to ensure nutrition can be delivered. Feeding can be delivered via a tube, often inserted through the nose and down into the stomach, or through the stomach into the jejunum, which is the first part of the small bowel. This method is often used if there is severe difficulty with swallowing, for example patients with oesophageal cancer. Because there is a physical block, rather than the gut not working, that block can be bypassed with a nasogastric or nasojejunal tube, and the patient can then be fed.
If this type of feeding is going to continue long term, then the nasal tube can be replaced with something a little more comfortable such as a gastrostomy or jejunostomy tube. These tubes are inserted through the skin, directly into the stomach or jejunum. This is a procedure which is often carried out either in the x-ray Department, or by endoscopy. They need to be flushed regularly to stop them from blocking and are easy to use at home. Patients are supplied with a feeding pump and will often feed themselves overnight whilst they are sleeping.
In situations where the gut itself is not working, for example bowel obstruction or severe malabsorption or advanced peritoneal disease, then feeding can be given directly into a central vein. This is done through a PICC line or a Port-A-Cath. Most commonly, this is done in the hospital setting. This type of feeding is called TPN (total parenteral nutrition). The decision to offer this type of feeding is done in consultation with specialist gastroenterologist and dietitians. There can be complications to having feeding directly into the veins, so this will only be done if there is no other viable solution.
TPN can be given at home, but there are huge logistics in setting this up, and it can often take several weeks.
