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Will A Tube Feeding Help?

Laurie Beebe
 


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If you or a loved one has been diagnosed with cancer, there's a chance you may have experienced a great deal of weight loss. Some types of cancer are evident by causing 20-30 pounds of weight loss in just a few months. Others affect a person's taste or appetite so they aren't able to eat as much as they need. Sometimes it's the treatment that causes inability to eat, either due to pain or nausea. In some cases your doctor or dietitian may have suggested you consider a tube feeding to help give you the nutrition you need.

Often, people with cancer aren't able to eat enough to support themselves for one of the aforementioned reasons. They take a few bites at each meal and mumble something about eating later, or the food not tasting good, or feeling nauseated all the time. If a large amount of weight loss occurs (more than 10% of the person's weight over a three month period, or 5% in just 1 month) it becomes vital to not only gain some weight back, but to stop the process before it's too late. The longer a person goes without gaining weight back the more difficult it becomes. Even if a person was overweight to begin with, the weight loss is an indicator that not enough of other nutrients have been ingested either. A person may seem to have some extra fat stores, but there are no stores of protein in the body: that will be taken from existing tissue such as muscle and vital organs. That means every day that a person does not eat enough, there will be more tissue lost from their heart and lungs, making it difficult to breathe, and more lost from their muscle, making it difficult to even get out of bed to stand up.

So once it has been determined that a person is not able (or willing) to eat an adequate amount of food, with or without supplements (such as Boost, Ensure, or other fortified drinks and puddings) the decision becomes what type of feeding to choose. There are normally two types of tube feedings to choose between. One is a nasogastric (NG) tube which is inserted in through the nose and the tip gently moved down into the stomach. It's done while the person is awake, is uncomfortable but not painful, and has little potential for complications. After it is confirmed that the tube is in place (often by x-ray-it must be certain that the tip of the tube is not in the lung or the formula will be delivered there!) a feeding is usually started off slowly and dripped in from a bag similar to an IV bag, with a pump. This method can deliver over 3000 Calories a day, once the person's system adjusts over a few days, and can totally support even a large person who is able to eat nothing. This type of tube feeding is reserved for short-term use, as over time the tube can migrate up into the esophagus and risk formula ending up in the lungs, causing pneumonia. It can also cause sinus infections if left in place over a period of weeks.

A preferred tube placement for longer term is a G tube (gastrostomy) which is placed directly into the stomach through the skin. Sometimes done at bedside, there is a local anesthesia involved for this procedure. This type of tube can stay in place almost indefinitely (sometimes they are replaced after many months of use because of cracking or some other tubing problem). Again, feedings can be delivered to meet the person's total nutritional needs. A benefit of this tube placement is that the tube is not in the person's face, allowing him to eat if he likes. It is also not visible if the patient is able to get out and about and would like to be able to go places out of the house.

Either type of tube feeding can be given either around the clock, or in certain amounts several times a day (bolus), or formula can be run in at night, and the person can be free during the day to walk around without a pump attached.

Sometimes people just need the tube to get them through a certain period of time, like chemotherapy or radiation treatment. Other times it is helpful to nourish and build a person's strength back so they can go through a surgical procedure. Most of the time it is a life saving measure that allows a person who cannot eat adequately to receive the nourishment they need to get well. Nutrition cannot cure any disease, including cancer, but it can help make an ill person as strong as they can be, allowing them to fight back, move around more comfortably because they are stronger, and keep them from losing weight and getting weaker. Always discuss the options with your health care team, and be ready to acknowledge when you can use some help getting adequate nutrition.

Laurie Beebe is a registered dietitian certified in nutrition support. Laurie has transitioned into life coaching to help people implement changes in their environment. Coaching helps dramatically by allowing people to set their own goals and design their own action plans to start their path to success. Please visit Laurie's website, “Shaping Your Future" at http://www.mycoachlaurie.com for diet tips, links to great books and websites, to sign up for a free monthly newsletter, or for more information on coaching.

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