Nutritional management for late complications of radiotherapy

Abstract

Late complications of radiotherapy can include a variety of issues, such as xerostomia, dysphagia, taste changes, digestive and absorption dysfunction. These late complications can seriously impact the nutritional status and quality of life of patients following radiotherapy, and may even adversely affect tumor control and patient survival. Comprehensive nutritional management strategies should be implemented to address these late complications. For radiation-induced xerostomia, salivary stimulant drugs, saliva substitutes, and hyperbaric oxygen therapy have demonstrated efficacy in alleviating dry mouth symptoms. The management of post-radiation trismus remains challenging, with functional training, including active jaw exercises, passive motor devices, and splints, being the primary interventions. In the case of radiation-induced dysphagia, a multidisciplinary team approach is recommended, incorporating malnutrition risk assessment, personalized nutritional treatment, nursing care, rehabilitation training, and patient education. Protecting normal organs, such as the tongue and oral cavity, during radiotherapy planning can help prevent and mitigate taste changes, which can be further managed with zinc supplements, oral care, and lactoferrin supplementation. For post-radiation digestive and absorption dysfunction, a comprehensive assessment of the patient's nutritional status, site of gastrointestinal injury, and potential complications (e.g., bleeding, perforation) is crucial in guiding the selection of appropriate nutritional support, ranging from enteral nutrition as the first-line approach to supplemental or even exclusive parenteral nutrition. Surgical intervention may be necessary in some cases. By implementing these multifaceted nutritional management strategies, healthcare professionals can optimize the care of cancer patients undergoing radiotherapy and mitigate the adverse impact of late radiation complications on their overall well-being and treatment outcomes.