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From A Registered Dietitian: Are We Talking Too Much, Too Soon?

By Margaret Martin, RD, MS, LDN, CDCES August 13, 2014Pearls of Wisdom Blog

This summer an oncologist referred a head and neck cancer survivor and her spouse to PearlPoint’s Nutrition Education services. The survivor also had the possibility of metastasis to her stomach, but test results were still pending. As I usually do, I began the nutrition consultation by sharing information on the possible side effects of her cancer treatment. I talked about how the right food and eating choices could help. As I began talking about how, in her future treatment, good nutrition choices could potentially also include tube feeding, the couple quickly interrupted me. And when they spoke, both the survivor and her husband said something that I had never heard from a client. They asked, “Why are you telling us about these side effects of cancer treatments? The doctor and hospital staff all told us what the side effects may be. Now you are bringing up side effects again. We don’t want to know so soon, or again and again, about what side effects may happen. And, we certainly do not want to hear now about the possibility of a tube feeding.”

This made me stop and think.

As health care professionals, are we able to truly gauge the survivor’s level of acceptance of their cancer diagnosis?

How well do we assess the survivor’s current knowledge about their cancer, treatment options, benefits, and possible side effects?

Are we listening to what the cancer survivor is saying?

Certainly, we can overload survivors with information on the possible side effects and complications from cancer treatment. On the other hand, we are bound by ethics and treatment protocols to disclose both the benefits as well as the possible side effects of each treatment, medication, and therapy even if the cancer survivor is not ready to hear the information.

How can we achieve a balance between what the survivor is ready to hear, and what she needs to hear to choose the best treatment plan?

To answer that question, let’s focus on a single possibility (and one that I know has caused anxiety before!): tube feeding as part of a treatment plan.

Frequently the cancer survivors I work with share that they initially don’t want a tube feeding. Of course, no one really wants to have a feeding tube, especially when you first are diagnosed with cancer. But despite possible resistance to the tube feeding option, a feeding tube or alternative nutrition support can be a priceless bridge to better treatment outcomes when you are not able to nourish yourself. This is especially true in the treatment of head and neck cancers. Many survivors may not know of anyone who has had a tube feeding, or even what a feeding tube is or how it works, so it may be a new concept in their treatment discussion. So new, in fact, that it may be difficult to hear about or to discuss with the health care team.

To overcome resistance to tube feedings, I now take a fresh approach to how I communicate. I begin by bringing up the possibility of a tube feeding in a kinder, gentler way. I may start with the benefits of good nutrition and hydration and how they contribute to successful outcomes for cancer treatment. For instance, survivors who receive early nutrition medical therapy and adequate nourishment have fewer complications and hospitalizations during cancer treatment. This then leads into the topic of the feeding tube naturally, and hopefully with less fear and misunderstanding for the survivor and family.

So my new plan is to always focus first on sharing information and news that gives hope. Hope helps all of us to be better listeners. And listening may be a key tool in managing cancer side effects.

Let us know what you think of this article in the comments section below.

More information about tube feeding or other side effect management strategies.

Margaret Martin, RD, MS, LDN, CDCES

Author Margaret Martin, RD, MS, LDN, CDCES

Nutrition Educator Margaret Martin is a Licensed Dietitian and Nutritionist in the State of Tennessee as well as a Certified Diabetes Educator. Margaret graduated from the University of Alabama with a Bachelor of Science in Dietetics and received her Master’s Degree in Nutrition Science & Public Health from the University of Tennessee. With more than 10 years of experience in Clinical Nutrition, Margaret has also worked in the insurance industry with WellPoint Inc. and Blue Cross Blue Shield providing telephonic nutrition consultations, service assistance, and web-based nutrition education. In her free time Margaret volunteers with the American Lung Association’s annual “Lung Force Walk" in Middle Tennessee. She belongs to the Oncology Nutrition & Diabetes Care and Education Dietetic Practice Groups of the Academy of Nutrition and Dietetics.

More posts by Margaret Martin, RD, MS, LDN, CDCES

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