As my 2 month contract job has come to an end, I decided to make the most of my time and shadow at the very reputable cancer hospital near my house. I’ve recently become interested in this area of nutrition as I’ve found cancer cases are often complex, require nutrition support (feeding through a tube), and the patient population is younger and still often with much fight in them. I also find that they are keen to research the best diet for recovery and prevention whether it be vegan, Gerson therapy, or the keto diet which can be very confusing and have a big impact on their nutrition status.
The Christie is a tertiary hospital that provides specialists oncology services. I learned about a few of the very specialist procedures that people travel far and wide across the UK to have completed. One of the procedures is the Total Pelvic Clearance. This is done when organs in the pelvic area have been affected by cancer and thus need to be removed. The procedure involves removing the bladder, lower bowel and potentially the uterus, ovaries, prostate, rectum.
I also learned about the HIPEC (hyperthermic intraperitoneal chemotherapy) procedure during which the organs are removed from the abdomen and a highly concentrated chemo solution is directed at the cancerous cells for 90 minutes (rather than circulating the whole body as with standard chemotherapy). The solution is then drained and all the organs put back in their place. This technique is used with Pseudomyxoma Peritoneii (PMP), a rare tumor that causes a build up on the jelly like substance mucin in the abdomen.
What is common about these complex procedures is that they have a significant impact on nutrition status. After major procedures like these, the bowels need time to rest and recover. There is also increased risk of ileus (temporary lack of intestinal movement after surgeries which can lead to blockage and potential obstruction). Because of this, the majority of these patients require parenteral nutrition (intravenous nutrition) for at least 5-7 days before they can begin advancing their diet from “soup/sweets” to light meals, low fibre solids, and upwards. All patients can have sips of water immediately following surgery, however must otherwise refrain from eating or drinking nutrition by mouth; all their nutritional needs are met via PN.
During my visit, I shadowed dietitians covering the head & neck, esophageal, gynecology, and surgical wards, attended a ward round, spoke with the research dietitian about her role, and sat in on a meeting which discussed nutritionally complex patients. Much of the head and neck patients will require nasogastric feeding with some needing RIGs (radiologically inserted gastrostomys) instead of PEGs if their esophagus is too narrow to place the endoscope. RIGs are placed using barium in the stomach and with xray guidance.
The Christies uses PN bags from Baxters and we reviewed specifications for their standard bags including a starter bag for off hours and those at risk of refeeding, fluid restricted (often used for haematology patients who can become very oedematous), low fat, fat free, and electrolyte free when electrolytes such as potassium are running high.
I also got to discuss the patients on the critical care unit which is different than a typical critical care as there are no trauma patients, but cancer patients experiencing cardiovascular issues, AF, sepsis, and neutropenic fever often as a result of chemo.
Special thanks to Lorraine, Debbie, Kerrie, and Hannah.