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\author{Michellephillips02}
\pdfinfo{
  /Title (oncology.pdf)
  /Creator (Cheatography)
  /Author (Michellephillips02)
  /Subject (Oncology Cheat Sheet)
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Oncology Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Michellephillips02} via \textcolor{DarkBackground}{\uline{cheatography.com/214485/cs/46727/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Michellephillips02 \\
  \uline{cheatography.com/michellephillips02} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 22nd September, 2025.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Guidelines \& References}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{ESPEN expert group recommendations for action against cancer-related malnutrition} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{ESPEN practical guide: Clinical nutrition in cancer} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Oncology Society of Australia. Position statement: Cancer-related malnutrition and sarcopenia} \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Grading}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Uses tumour biopsy} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{X to 4} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Higher grade = undifferentiated = more intense treatment} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Gx = grade cannot be assessed (undetermined)} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{G4 = undifferentiated (high grade)} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{undifferentiated = {\emph{cells that don't look or act like normal cells. They've lost their original identity and are very abnormal.}}} \tn 
% Row Count 9 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{description of a tumour based on how abnormal the tumour cells look under a microscope.} \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{It is an indicator of how quickly the tumour is likely to grow and spread.} \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Staging}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{TNM.}} Higher number = more severe} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{T}} = tumour size (1-4). Higher number = larger tumour} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{N}} = number of lymph nodes which contain cancer (1-3). Higher number = more lymph nodes affected} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{M}} = Distant metastasised. X = cannot be measured. O = no met. 1 = met.} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{T4N3M1 = large tumour which has spread significantly to lympth nodes and has metastasised – will continue to grow \& spread rapidly}}} \tn 
% Row Count 10 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Not usually used for:}} Leukaemia, Lymphomas, Myelomas} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Terminology + acronyms}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Benign}} (nonmalignant) = not cancer} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Malignant}} = cancer} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Metastasis}} = spread of cancer cells} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Neoadjuvant:}} Treatment given as a first step to shrink a tumour before the main treatment (usually surgery). Includes chemo, radiation or hormone therapy} \tn 
% Row Count 7 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Adjuvant:}} Additional treatment given after the primary treatment to lower the risk of the cancer coming back. Includes chemo, radiation, hormones, biological or targeted therapy} \tn 
% Row Count 11 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cancer cachexia:}} unintentional weight and muscle loss in people with cancer, not fully reversible by eating more} \tn 
% Row Count 14 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Gy:}} grey - measures radiation} \tn 
% Row Count 15 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{\#:}} fractions - radiation dose - has to be fractioned because one fraction would be too damaging} \tn 
% Row Count 17 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{70Gy/35\#}} = 70 Grey total radiation broken up into 35 \#} \tn 
% Row Count 19 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{hypogeusia:}} decreased taste sensitivity} \tn 
% Row Count 20 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{hypergeusia:}} increased taste sensitivity} \tn 
% Row Count 21 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Phantogeusia:}} Perception of an unpleasant taste, without actually eating anything} \tn 
% Row Count 23 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Breakthrough nausea:}} occurs despite the use of preventive (prophylactic) antiemetic medications} \tn 
% Row Count 25 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{2.14011 cm} x{2.83689 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Types of cancers}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Carcinomas}} & Most common. Arise from epithelia cells. Breast, prostate, lung, colorectal, melanoma. \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
{\bf{Lymphoma}} & Cancer of the lymphatic system (hodgkin lymphoma and non- Hodgkin lymphoma) \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Leukemia}} & Cancer of white blood cells, often starting in bone marrow \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
{\bf{Multiple myeloma}} & A cancer of plasma cells in the bone marrow. \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{Sarcomas}} & From bone, muscle, fat. Osteosarcoma (bone), Leiomyosarcoma (smooth muscle tissue) \tn 
% Row Count 17 (+ 4)
% Row 5
\SetRowColor{white}
{\bf{Glioblastoma}} & An aggressive brain tumor. \tn 
% Row Count 19 (+ 2)
% Row 6
\SetRowColor{LightBackground}
{\bf{Basal Cell Carcinoma (BCC)}} & Subtype of skin cancer - common - rarely met. \tn 
% Row Count 22 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Metabolic Changes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Cachexia + sarcopenia} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Due to treatment: stem cells + blood cells depleted - anaemia, impaired blood clotting, more susceptible to infections} \tn 
% Row Count 4 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.59264 cm} x{3.38436 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Chemo}} & Oral, IV or injection \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Stop or slow growth through irreversible damage to the DNA - kills all fast-growing cells - incl healthy cells \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
 & Given in cycles – gives the healthy cells a chance to grow back.  C3D8 = cycle 3 (of 8), Day 8 (of the 14 day cycle) \tn 
% Row Count 11 (+ 5)
% Row 3
\SetRowColor{white}
 & S/E: V\&D, constipation, dysphagia, fatigue, altered taste, oral thrush, thickened saliva, reflux, dry mouth, mucositis \tn 
% Row Count 16 (+ 5)
% Row 4
\SetRowColor{LightBackground}
{\bf{Immunotherapy}} & Helps the patients own immune system to fight cancer Eg. immune checkpoint inhibitors or monoclonal antibodies \tn 
% Row Count 21 (+ 5)
% Row 5
\SetRowColor{white}
 & Not as big effect on nutrition \tn 
% Row Count 23 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & S/E: Diarrhoea, abdo pain, bloating \tn 
% Row Count 25 (+ 2)
% Row 7
\SetRowColor{white}
{\bf{Radiation (XRT)}} & Kills or slows the growth of cells by damaging the DNA. In a big machine (linear accelerator or LINAC), similar to a CT scan. Measured in "grey" and given in "fractions" \tn 
% Row Count 32 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.59264 cm} x{3.38436 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Treatment (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
 & S/S occur after 2 weeks of treatment \& accumulate \tn 
% Row Count 2 (+ 2)
% Row 9
\SetRowColor{white}
 & S/E: Fatigue, dysphagia, diarrhea, vomiting, thick salvia, pain, taste changes, damage to bowels (eg bleeding) \tn 
% Row Count 7 (+ 5)
% Row 10
\SetRowColor{LightBackground}
 & Internal radiation: radiation is placed inside the body. e.g radioactive iodine liquid (systemic therapy) is used for thyroid cancer. \tn 
% Row Count 12 (+ 5)
% Row 11
\SetRowColor{white}
 & EXTERNAL BEAM RADIATION THERAPY: most common type of radiation. \tn 
% Row Count 15 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Intervention}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Symptom management}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Malnutrition}} assessment: SGA, PG-SGA SF (for chemo)} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Malnutrition screening – MST, MUST} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Sarcopenia screening (SARC-F)} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{HPHE - ONS/Fortification/EN} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Educate: Food safety \& hygiene – Immunocompromised. Avoid illness} \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Depending on the person/prognosis: low-inflammatory foods – more so in people In remission} \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Consider:}} site of cancer, refeeding risk, tube position (is it in the right place?)} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nut Reqs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Energy \textasciitilde{}125kJ}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Chemo \& Radiation: \textgreater{}125kJ/kg} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Cancer cachexia: \textgreater{}125kJ/kg} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Malnutrition = repletion (125-145kJ)} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Protein \textasciitilde{}1.2-1.5g}}} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Chemo \& Radiation: \textgreater{}1.2g/kg} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Older/chronically ill/repletion: 1.2-1.5g/day} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Renal failure: 1.0-1.2g/kg} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Cancer cachexia: \textgreater{} 1.4g/kg} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{SPEN: 2.0-2.2g EPA and 1.5g DHA} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{SPEN: Leucine 2-4g; HMB 3g; Glutamine 0.3g/kg;      Carnitine 4-6g; Creatine 5g} \tn 
% Row Count 12 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{SPEN: 600-800 IU Vitamin D + multivitamin/minerals} \tn 
% Row Count 13 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Example PESS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Inadequate oral intake related to loss of appetite and nausea 2}} to chemotherapy, as evidenced by pt consuming \textasciitilde{}\_\_\% of EER and \_\_\_\% of EPR*} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Food and nutrition knowledge deficit} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Inadequate protein-energy intake} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{0.82386 cm} x{2.33427 cm} x{1.41887 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Medications}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Drug}} & {\bf{Indication}} & {\bf{S/E}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\seqsplit{ondansetron} & Prevention, treatment of nausea, vomiting. & \seqsplit{constipation}, xerostomia \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{metoclopramide} & nausea, vomiting & GI upset, oedema \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\seqsplit{dexamethasone} & Corticosteroid &  \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\seqsplit{loperamide} & Symptomatic relief of acute nonspecific diarrhoea &  \tn 
% Row Count 12 (+ 3)
% Row 5
\SetRowColor{white}
\seqsplit{Lomotil} & Opioid. Adjunctive therapy for acute, chronic diarrhoea &  \tn 
% Row Count 15 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\seqsplit{Codeine} & Opioid analgesic. Short-term management of severe pain &  \tn 
% Row Count 18 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Nutrition Strategies – based on S/S}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\emph{CTCAE Grading 1 to 5. 1 = mild, intervention not indicated. 5 = death related to S/S.}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Taste Changes}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & {\bf{tasteless:}} add salt or seasoning, ginger, pickles, honey, adding herbs/spices, honey, pickles, marinades, sauces etc. Varied texture and taste (e.g. adding granola, freezing smoothies) - can make the eating experience more exciting. Over-the-counter artificial salivas. Flavour enhancers - e.g. miracle berry. \tn 
% Row Count 12 (+ 9)
% Row 3
\SetRowColor{white}
 & {\bf{too strong:}} use straw. No added sugar products. Low salt alternatives. Avoid fizzy drinks/mints/chewing gum \tn 
% Row Count 16 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & {\bf{Too salty:}} Roast meats over deli meats. Add sugar or honey to food. \tn 
% Row Count 18 (+ 2)
% Row 5
\SetRowColor{white}
 & {\bf{Too sweet:}} Avoid added sugars/fruit etc. Plain breakfast cereals. Add salt or lemon juice. \tn 
% Row Count 21 (+ 3)
% Row 6
\SetRowColor{LightBackground}
 & {\bf{Metallic:}} ginger, small sips of flavoured drinks. Non-metallic cutlery. Suck on boiled lollies. Brushing teeth just before \& after eating. Bicarb mouth wash before eating. \tn 
% Row Count 26 (+ 5)
% Row 7
\SetRowColor{white}
 & Feel like "sand", "straw" "cardboard" – Change the consistency of the food, soft, moist foods, add sauces/gravies, soups \& smoothies, drink lots of water, medications to replace saliva \tn 
% Row Count 32 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Nutrition Strategies – based on S/S (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
 & {\emph{pink lady}} – Gaviscon + a numbing agent – pharmacist \tn 
% Row Count 2 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Smell changes}}} \tn 
% Row Count 3 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Ask friends/family to cook for you \tn 
% Row Count 4 (+ 1)
% Row 11
\SetRowColor{white}
 & Cook in bulk and freeze \tn 
% Row Count 5 (+ 1)
% Row 12
\SetRowColor{LightBackground}
 & Bland foods. \tn 
% Row Count 6 (+ 1)
% Row 13
\SetRowColor{white}
 & Cold or room temp (avoid hot) \tn 
% Row Count 7 (+ 1)
% Row 14
\SetRowColor{LightBackground}
 & Avoid strong flavours: garlic, onion etc \tn 
% Row Count 9 (+ 2)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{N/V}}} \tn 
% Row Count 10 (+ 1)
% Row 16
\SetRowColor{LightBackground}
 & Medications – pharmacist \tn 
% Row Count 11 (+ 1)
% Row 17
\SetRowColor{white}
 & Cold or room temp food – usually better tolerated. sandwiches, salads, jelly, custard and yoghurt (NEMO) \tn 
% Row Count 14 (+ 3)
% Row 18
\SetRowColor{LightBackground}
 & Smaller frequent meals – avoid having an empty stomach  Peppermint or ginger \tn 
% Row Count 17 (+ 3)
% Row 19
\SetRowColor{white}
 & Take opioids with crackers or light meal \tn 
% Row Count 19 (+ 2)
% Row 20
\SetRowColor{LightBackground}
 & Salty snacks/dry crackers, biscuits, noodles, cereal, toast, pretzels, crackers \tn 
% Row Count 22 (+ 3)
% Row 21
\SetRowColor{white}
 & Avoid skipping meals/snacks as empty stomach can worsen \tn 
% Row Count 24 (+ 2)
% Row 22
\SetRowColor{LightBackground}
 & Avoid alcohol and high volumes of coffee \tn 
% Row Count 26 (+ 2)
% Row 23
\SetRowColor{white}
 & sucking on ice blocks \tn 
% Row Count 27 (+ 1)
% Row 24
\SetRowColor{LightBackground}
 & regular small sips of water or cold clear fluids – cordial, lemonade, ginger ale, juice \tn 
% Row Count 30 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Nutrition Strategies – based on S/S (cont)}}  \tn
% Row 25
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Mucositis \& dysphagia}}} \tn 
% Row Count 1 (+ 1)
% Row 26
\SetRowColor{white}
 & Artificial sweeteners \tn 
% Row Count 2 (+ 1)
% Row 27
\SetRowColor{LightBackground}
 & Sugar free gum \tn 
% Row Count 3 (+ 1)
% Row 28
\SetRowColor{white}
 & Avoiding hot food \tn 
% Row Count 4 (+ 1)
% Row 29
\SetRowColor{LightBackground}
 & Avoiding sources of trauma – hard toothbrush, crispy foods \tn 
% Row Count 6 (+ 2)
% Row 30
\SetRowColor{white}
 & Analgesia mouth washes - before food to improve intake \tn 
% Row Count 8 (+ 2)
% Row 31
\SetRowColor{LightBackground}
 & {\bf{Causes to consider:}} oral thrush, xerostomia \tn 
% Row Count 10 (+ 2)
% Row 32
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Diarrhoea}}} \tn 
% Row Count 11 (+ 1)
% Row 33
\SetRowColor{LightBackground}
 & Medical management – consult medical team/Pharmacist \tn 
% Row Count 13 (+ 2)
% Row 34
\SetRowColor{white}
 & {\emph{Monitor dehydration \& electrolyte losses}} \tn 
% Row Count 15 (+ 2)
% Row 35
\SetRowColor{LightBackground}
 & ORS (oral rehydration solutions): homemade or double strength hydrolyte \tn 
% Row Count 17 (+ 2)
% Row 36
\SetRowColor{white}
 & Consider non-treatment causes – Fibre, lactose, intolerances, sugar-free products \tn 
% Row Count 20 (+ 3)
% Row 37
\SetRowColor{LightBackground}
 & Limiting fatty/greasy dishes, high fibre foods and fizzy drinks \tn 
% Row Count 22 (+ 2)
% Row 38
\SetRowColor{white}
 & Bland foods \tn 
% Row Count 23 (+ 1)
% Row 39
\SetRowColor{LightBackground}
 & Avoid caffeine \tn 
% Row Count 24 (+ 1)
% Row 40
\SetRowColor{white}
 & Try low lactose alternatives \tn 
% Row Count 25 (+ 1)
% Row 41
\SetRowColor{LightBackground}
 & Excess fructose (e.g. fruit juice) can exacerbate diarrhoea \tn 
% Row Count 27 (+ 2)
% Row 42
\SetRowColor{white}
 & Soluble fibre - psyllium husk - can help bulk the stool \tn 
% Row Count 29 (+ 2)
% Row 43
\SetRowColor{LightBackground}
 & {\emph{temporary}} Low fibre and/or low FODMAP \tn 
% Row Count 31 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Nutrition Strategies – based on S/S (cont)}}  \tn
% Row 44
\SetRowColor{LightBackground}
 & Monitor for signs of pancreatic exocrine insufficiency (fat malabs, greasy stools etc)+ stool tests for infections \tn 
% Row Count 4 (+ 4)
% Row 45
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Loss of appetite/Anorexia}}} \tn 
% Row Count 5 (+ 1)
% Row 46
\SetRowColor{LightBackground}
 & Meds: Appetite stimulants \tn 
% Row Count 6 (+ 1)
% Row 47
\SetRowColor{white}
 & HPHE \& ONS – Sustagen, up \& go, milkshakes etc \tn 
% Row Count 8 (+ 2)
% Row 48
\SetRowColor{LightBackground}
 & 6 smaller meals/day - use smaller plates \tn 
% Row Count 10 (+ 2)
% Row 49
\SetRowColor{white}
 & Encourage to eat by the clock – avoid waiting until they are hungry \tn 
% Row Count 12 (+ 2)
% Row 50
\SetRowColor{LightBackground}
 & Eat when appetite is better – commonly morning \tn 
% Row Count 14 (+ 2)
% Row 51
\SetRowColor{white}
 & Encourage favourite foods – discuss with family \tn 
% Row Count 16 (+ 2)
% Row 52
\SetRowColor{LightBackground}
 & Social eating \tn 
% Row Count 17 (+ 1)
% Row 53
\SetRowColor{white}
 & Softer foods that don't require chewing \tn 
% Row Count 19 (+ 2)
% Row 54
\SetRowColor{LightBackground}
 & Cook in bulk and freeze – less exposure to food smells \tn 
% Row Count 21 (+ 2)
% Row 55
\SetRowColor{white}
 & Have ready-prepared meals/snacks \tn 
% Row Count 22 (+ 1)
% Row 56
\SetRowColor{LightBackground}
 & Encourage gentle exercise \tn 
% Row Count 23 (+ 1)
% Row 57
\SetRowColor{white}
 & Consider: mouth \seqsplit{sores/changes/infections?/aging/other} medications, psychosoical factors \tn 
% Row Count 26 (+ 3)
% Row 58
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Oral Health/dry mouth}}} \tn 
% Row Count 27 (+ 1)
% Row 59
\SetRowColor{white}
 & Regular sips of water to keep mouth hydrated \& stimulates saliva \tn 
% Row Count 29 (+ 2)
% Row 60
\SetRowColor{LightBackground}
 & Gum, sucking on lollies \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Nutrition Strategies – based on S/S (cont)}}  \tn
% Row 61
\SetRowColor{LightBackground}
 & Sodium bicarb mouth wash \tn 
% Row Count 1 (+ 1)
% Row 62
\SetRowColor{white}
 & Artificial saliva, alcohol free mouth wash \tn 
% Row Count 3 (+ 2)
% Row 63
\SetRowColor{LightBackground}
 & Oral adhering discs \tn 
% Row Count 4 (+ 1)
% Row 64
\SetRowColor{white}
 & Moist foods + sauces and gravies \tn 
% Row Count 5 (+ 1)
% Row 65
\SetRowColor{LightBackground}
 & Dry mouth: EVOO: acts as a mouth lubricant \tn 
% Row Count 7 (+ 2)
% Row 66
\SetRowColor{white}
 & Mucositis: Honey + coffee mouth rinse or sip (300g honey + 20g - mix 10ml of honey mixture w/ hot water. Either rinse or sip. 10mL every 3hrs) \tn 
% Row Count 11 (+ 4)
% Row 67
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Early Satiety}}} \tn 
% Row Count 12 (+ 1)
% Row 68
\SetRowColor{white}
 & Small, frequent nutrient dense meals \tn 
% Row Count 13 (+ 1)
% Row 69
\SetRowColor{LightBackground}
 & Avoiding nutrient-free drinks \tn 
% Row Count 14 (+ 1)
% Row 70
\SetRowColor{white}
 & Avoid having fluids with meals - have inbetween \tn 
% Row Count 16 (+ 2)
% Row 71
\SetRowColor{LightBackground}
 & Prokinetics: increase gastric emptying (e.g. metoclopramide, erythromycin) \tn 
% Row Count 19 (+ 3)
% Row 72
\SetRowColor{white}
 & Medpass: mall volumes of high-calorie, high-protein supplements (like fortified shakes) are administered alongside routine medication times. \tn 
% Row Count 23 (+ 4)
% Row 73
\SetRowColor{LightBackground}
 & Distraction technique - takes some of the focus off food: social eating, calling friends, puzzles, colouring, watching a show, \seqsplit{colouring/drawing/painting}. Risk of 'forgetting' about the food - better when someone else is there \tn 
% Row Count 30 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Nutrition Strategies – based on S/S (cont)}}  \tn
% Row 74
\SetRowColor{LightBackground}
 & Nourishing fluids in between meals \tn 
% Row Count 1 (+ 1)
% Row 75
\SetRowColor{white}
 & {\bf{Causes to consider:}} delayed gastric emptying, nausea, Medications that slow gastric emptying \tn 
% Row Count 4 (+ 3)
% Row 76
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Constipation}}} \tn 
% Row Count 5 (+ 1)
% Row 77
\SetRowColor{white}
 & {\bf{Consider other causes:}} Dehydration, decreased PA, decreased overall intake, hypercalcemia, hypokalemia \tn 
% Row Count 8 (+ 3)
% Row 78
\SetRowColor{LightBackground}
 & Medication: stool softener, Osmotic laxative, \tn 
% Row Count 10 (+ 2)
% Row 79
\SetRowColor{white}
 & Fibre supplements: insoluble + soluble \tn 
% Row Count 12 (+ 2)
% Row 80
\SetRowColor{LightBackground}
 & Encourage fluid intake \tn 
% Row Count 13 (+ 1)
% Row 81
\SetRowColor{white}
 & Encourage PA \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.59264 cm} x{3.38436 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Interventions before/after surgery}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{ERAS protocol} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
EN (head \& neck ca) & Indicated when: \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & 5\% LOW prior to surg, OR 10\% LOW 6/12 \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
 & Ongoing dehydration or dysphagia or pain associated with E+D \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & SPL - severe aspiration 65+ years old \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
 & High risk of long term swallowing difficulties - e.g. high doses of chemo + radiation planned after surgery \tn 
% Row Count 14 (+ 4)
% Row 6
\SetRowColor{LightBackground}
PN & When indicated \tn 
% Row Count 15 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}