If you are not able to eat or drink enough to maintain your weight, your doctors or dietitian may suggest tube feeding for nutritional support.
Cancer, or the effects of cancer treatments, can sometimes cause malnutrition and weight loss.
Malnutrition is when the body is not getting enough vitamins, minerals and nutrients from your diet , such as protein, to keep healthy and maintain weight. This may be because you have a reduced appetite, or have symptoms such as difficulty swallowing or a sore mouth.
These problems may only happen for a short time. Making changes to your diet or adding nutritious drinks or supplements is sometimes all you need.
But for some people, this will not be enough to keep to a healthy weight. If someone cannot swallow or is having difficulty swallowing, they may need additional support.
If you cannot eat or drink enough to maintain your weight, your cancer doctors or dietitian may suggest artificial nutritional support. This is when you are given nutrients through a tube (artificial feeding). This tube may go either into the stomach or bowel, or into a vein. It can be used to help people who are not able to eat or drink in the usual way.
This can seem overwhelming at first. But when people feel the benefits of having nutritional support, they usually start to feel less worried.
Tube feeding for nutritional support can help:
- prevent weight loss
- you to put on weight
- with weakness or tiredness
- you get enough liquid
- reduce your worry about having to eat, for example, if you have problems swallowing or eating.
Tube feeding may be used if you:
- have difficulty swallowing and your mouth is sore
- lost a lot of weight (usually 10% or more of your body weight) and dietary supplements and nutrition support strategies have not helped
- are unable to eat or drink enough, and dietary supplements have not helped.
There are two main types.
Enteral nutrition (EN)
Enteral nutrition (EN) is when nutritional fluid (or feed) is given through a tube going into the stomach or small bowel.
There are different ways of giving enteral nutrition:
Nasogastric or NG feeding tube
A thin tube is passed through the nose and into the stomach.
Nasojejunal or NJ feeding tube
A thin tube is passed down the nose, into the stomach and into the jejunum (part of the small bowel).
Percutaneous endoscopic gastrostomy or PEG feeding tube
A tube is passed through the skin and muscle of the tummy (abdomen) into the stomach.
Percutaneous endoscopic jejunostomy or PEJ feeding tube
A tube is passed through the skin and muscle of the tummy (abdomen) into the middle of the small bowel (the jejunum) just below the stomach.
Radiologically inserted gastrostomy or RIG feeding tube
An x-ray is used to guide a tube through the skin and muscle of the tummy (abdomen) into the stomach.
Parenteral nutrition (PN)
Parenteral nutrition (PN) is when nutritional fluid is given directly into the bloodstream through a tube into a vein (intravenously).
It may be needed if:
- you cannot have the nutrition through your digestive system. For example, if you have had surgery to your small bowel, or your bowel is blocked.
- it is difficult to put in a tube used for enteral nutrition (EN). For example, after some types of surgery to the head, neck or stomach.
Many people can have tube feeding at home. Having parenteral nutrition (PN) is more difficult to deal with than having enteral nutrition (EN), such as NG or PEG feeding. You may need to be referred to a specialist hospital to be shown how to manage the PN feeds at home.
The thought of having tube feeding at home may make you feel anxious. Before you are discharged from hospital, you will be shown how to manage your feeding system. If you have a carer, they will be shown too. You are usually given written instructions to help when you are at home.
Home tube feeding for nutritional support will not start until you, and your carer if you have one, feel confident in dealing with the tube and the feeds.
A team of healthcare professionals will also help to support you at home. The support offered to people may vary, but your GP, district nurse and dietitian can help you.
NHS trusts often work in partnership with specialist home-care companies to make sure people who go home with feeding have the support they need.
Many people feel upset if they need a feeding tube for nutritional support or cannot eat or drink as they normally would. You may find having enteral feeding such as an NG tube or a PEG affects how you feel about your body image. These are all normal reactions.
We have more information about coping with your emotions.
Below is a sample of the sources used in our nutritional support information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical Nutrition, 2017; 36, 5, 1187-1196. Available from www.espen.org (accessed Jan 2020).
Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clinical Nutrition, 2020; 39, 1, 5-22. Available from www.espen.org (accessed Jan 2020).
National Institute for Health and Care Excellence (NICE). Nutrition support in adults. Quality standard [QS24]. Published: 30 November 2012. Available from www.nice.org.uk/guidance/qs24 (accessed February 2020).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.