A substance that, in the presence of a drug, speeds up or improves the effectiveness of the medicine. The term is also used to identify a substance that is added to a vaccine so that a smaller dose of the vaccine is needed to induce an antibody response (i.e. an immune system response). The adjuvant accomplishes this by (1) preventing antigens from leaving the area where the immune response is occurring, and (2) by increasing the rate of multiplication of the lymphocytes.

Symptom and Description Taste changes refer to changes in the way foods taste. Taste changes are commonly experienced by patients receiving therapy for cancer. Common types of taste changes include a loss of taste or having foods taste different than they used to. Sweet, bitter, and salty tastes can seem very different. Sometimes a metallic taste in the mouth will be present. Changes in the sense of taste can lead to food aversions (or dislikes), decreased intake of food, and weight loss.

Prevention/Management Making sure that you are able to eat properly and maintain weight during cancer treatment is very important. Being aware of issues with food intake and nutrition is important from the time you are first diagnosed.
If foods taste good, eat them. If foods don’t taste right anymore, avoid them.
Eliminate odors that may affect taste. This can be done by using a kitchen fan when cooking, using an outdoor barbecue grill to cook, using boiling bags, covered pots, or microwave ovens.
Cold foods are usually better tolerated than warm or hot foods. Try deviled eggs, chicken, ham, egg salad, ice cream, milk shakes, puddings, custard, or cheese.
If a metallic taste is present, you can avoid preparing foods in metal pots and pans—use glass cookware. The use of plastic eating utensils can also be helpful. With some types of cancer therapy, the metallic taste can be stimulated by the utensils used, not the food.
Chewing gum or sucking on hard candy such as Lifesavers can be helpful in minimizing a metallic taste.
Sometimes meats don’t taste good anymore. If this happens, poultry, fish, eggs, peanut butter, cooked dried beans and peas, and dairy products can be used as substitute sources of protein.
Marinate meat, chicken, or fish in sweet fruit juices, wines, salad dressing, or barbecue sauce to help improve the taste.
Use herbs and spices such as oregano, rosemary, tarragon, and lemon juice to enhance the taste of foods.
Try new and attractively prepared foods to help make the meal more appetiz-ing. It is a good idea not to try new foods before a treatment.
Sugar can be used to tone down salty foods. Try adding sugar to grapefruit juice or tomato sauce.
The flavor of starchy foods, such as rice or pasta, may be improved if they are not prepared with butter or margarine.
Tart foods such as orange juice, pickles, lemonade, vinegar, and lemon juice may be used to enhance flavor.

Follow-up You should notify your doctor or nurse if:
Taste changes prevent you from being able to maintain your food intake.
You experience other symptoms such as nausea or vomiting that interfere with your ability to eat or drink.
You lose weight unintentionally.

This guide will help you with the additional tube feedings you need to boost your nutrition. The feedings can help you by providing more nutrients and calories.

Symptom and Description When weight loss or lack of appetite become severe, nutrition supplements can be given. These supplements provide protein, vitamins, and other nutrients your body needs for energy. If you are unable to take these supplements by mouth, special tubes can be placed that allow you to receive the necessary nutrients without eating or drinking. The types of special tubes are:

Nasogastric tube: A tube that goes from the nose down the esophagus to the stomach. This tube is usually used for short-term(a few days to weeks) nutrition support.

Gastrostomy tube: A tube that is placed by the surgeon into the stomach through a small hole outside the stomach wall.

Jejunostomy tube: A tube that is placed into the upper part of the intestine (jejunum), just beyond the stomach. The tube is placed by the surgeon through a small hole in the abdomen. Both the gastrostomy and jejunostomy tubes are used to provide nutritional support for longer-term feeding (usually several weeks).

Insertion of the tubes is relatively simple and can be done in the outpatient setting.

Preventing Problems Tube feeding is important in giving you the nutrients you need. When care is taken to give the tube feeding safely, many problems can be avoided.1.
To prevent regurgitation of the feeding:
•
Sit up to take feeding and for 1 hour following feeding.
• If your feeding is continuous, keep your head elevated on two or three pillows.
•

Before starting your feeding, check for residual food in your stomach. If you get back more than 50 ml or 2 ounces of residual food, do not take a feeding at that time. Try again in 1 hour.
• Check placement of tube before beginning your feedings.
• Do not begin feeding if you feel full or bloated.
2. To prevent diarrhea:
• Allow feeding solution to warm to room temperature before giving.
• Do not use feeding solution that has been opened and out for more than 6 to 8 hours.
• Do not use feeding solution left open in refrigerator longer than 24 hours.
• Wash your hands before handling tube or feeding solution.
• Keep feeding container clean and all of your feeding equipment clean.
3. Preventing constipation:
• Make sure you drink enough water.
• Ask about adding fiber to diet.
• Consider a stool softener/laxative if you are prone to constipation.
• Increase your physical activity as tolerated.
4. Preventung skin irritation:
• It is important to keep skin around tube clean and dry.
• Check for leakage around tube and report this immediately to your caregiver.
• Tape tube securely to prevent pulling.
• Change dressing daily.
• Apply skin protectant as needed.
5. Dehydration (loss of body fluids):
• Increase amount of water given in the tube between feedings.
• Observe for increased urination.
• Observe for signs of thirst, fever.
• Check with physician about changing formula.
6.
Prevent clogging of your feeding tube:
• Make sure there are no kinks in tube.
• Flush tube with 3 to 4 ounces warm water after meals.
• Dissolve all medications placed in the tube in at least 1 ounce water.
• Rinse your tube with water before and after medications.
• Rinse tube with cola or 1 part hydrogen peroxide in 3 parts water, if tube becomes sluggish.

Management Your tube feeding will be given on a schedule that best fits your needs for care and amount of calories required. The doctor, dietitian, or nurse will explain the schedule that is best for you. The choices of schedules are as follows:
Intermittent or bolus: The amount of tube feeding for the day will be divided up into smaller portions to be given at set times during the day over short periods. May be done by gravity or syringe.
Continuous tube feeding: The amount of tube feeding for the day will be given slowly over the 24-hour period. It is usually given by a pump to keep the rate steady.

It is important to make sure the tube is in the right place before starting each feeding.1.
Nasogastric tube:
• Wash your hands.
• Draw up 10 to 20 cc air into a syringe.
• Insert the tip of the syringe into the end of the feeding tube.
• Unclamp the tube.
• Put stethoscope into ears and place bell over abdominal area.
• Quickly push air into feeding tube. You should hear a ‘‘whoosh,’’ a bubbling, or a quick high-pitched gurgling sound.
• Do not give your feeding if you cannot hear this sound. Contact the doctor, nurse, or dietitian.
2. Gastrostomy or jejunostomy tube:
• Wash your hands.
• Measure the number of inches from the stomach wall to the end of the tube.
• If more than _____ inches, do not give feeding.
• Contact the doctor, nurse, or dietitian.

Report any of the following symptoms to your doctor:
Tube feeding into lungs (aspiration): Coughing or gagging, especially associated with fever.
Diarrhea: Loose, watery stools can occur alone or associated with other symptoms such as cramping, upset stomach, or dizziness.
Constipation: Hard, infrequent stools.
Skin irritation: Pain, redness, or bleeding around the tube.
Dehydration: Thirst, weight loss, dry mouth, lack of energy, extreme tiredness.
Tube clogging: Difficulty flushing tube with water or air.

Follow-up Should any of these problems happen, call your doctor:1.
If you feel your feedings are not working well for you, check with your doctor or dietitian about changing rate of feeding or method of feeding.
2. If the tube becomes dislodged or falls out, apply a dressing over the opening if the tube is in your stomach, and call your caregiver immediately.
3. Notify your caregiver if you have any of the following:
• temperature of 100.4°F (38°C) or more
• diarrhea
• nausea or vomiting
• constipation
• abdominal distention
• tube dislodgement
• clogging of the tube

Symptom and Description Pleural effusions are a common problem in cancer, although pleural effusions can arise in people with other illnesses. A pleural effusion occurs when fluid collects in the space around the lungs. When this happens, the lungs cannot fully expand, and breathing may become difficult and painful. Pain, shortness of breath, and lung infections can occur if an effusion increases in amount or is left untreated.

You should report any of these symptoms to your doctor or your nurse:

• Shortness of breath

• The need to breathe fast

• A dry cough

• Chest pain, which may be slight or severe. The pain may be worse when you lie on one side or the other.

• Fever

A small number of people never have any symptoms.

Management If you have any of these symptoms, your doctor may want to see you. The doctor will order a chest x-ray film to see if there is fluid on the lung. If fluid is seen or suspected, a thoracentesis is done. This test removes fluid from the space around your lung. Many times, people breathe easier when the fluid is removed.

If you are short of breath or if breathing is difficult or painful, there are things you can do to help yourself breathe easier.

• Some positions allow your lungs to better expand. Sit upright, lean forward, and rest your forearms on a table.

• Sleep with the head of the bed raised or use pillows to raise your upper body. Some people are more comfortable sleeping in a recliner.

• Save your energy. Do chores early in the day (bathing, stair-climbing). Take time to rest and relax.

• The doctor may prescribe oxygen to help you breathe.

• Take your pain medication. Some medicines help to relax you and help you breathe easier.

• There is no special diet to follow. Small frequent meals (up to 6 meals per day) might be easier for you and may tire you less.

• Drink 2 to 3 liters of fluids per day, unless your doctor or nurse tells you differently.