A practical oncology nutrition plan rests on a thorough initial assessment, clear goal setting, and ongoing monitoring that allows timely adjustments. Start by screening for nutrition risk and gathering a full picture: recent intake patterns and dietary history, weight history and current measurements, and a concise symptom review that can affect eating (nausea, mucositis, taste changes, appetite loss). Include anthropometrics such as weight, height, BMI, and trends over time, and collect relevant labs and medical data to support decision making. While labs can help, they should complement, not replace, the overall assessment, since nutrition status in cancer is best judged by weight trajectory, intake, symptoms, and functional status alongside inflammation and comorbidities. From this assessment, set realistic energy and protein goals tailored to the patient’s cancer type, treatment plan, and catabolic risk. Common targets might be around adequate energy provision to support weight maintenance or gain and protein intakes sufficient to preserve lean mass, with adjustments for tolerance and goals. Decide on the most appropriate nutrition support route—continue with or optimize oral intake, add enteral nutrition if oral intake is insufficient, or pursue parenteral nutrition only when indicated—then implement the plan with the patient and care team, ensuring interventions are practical and patient-centered. Establish milestones to monitor progress, such as tracking weight trends, ensuring adequate oral intake and tolerance of therapy, and reassessing symptoms and therapy tolerance at regular intervals. Reassess and adjust the plan promptly as the cancer course and treatments evolve. This approach ensures early identification of malnutrition risk, aligns nutrition care with treatment goals, and supports better clinical and functional outcomes. Skipping the initial assessment, focusing only on protein, or delaying action until after therapy ends would miss essential information, over- or under-treat energy needs, and fail to address barriers to intake and therapy tolerance.

Anxiety can drive or worsen nausea and vomiting, especially anticipatory nausea before chemotherapy. The drug most fitting as an adjunct antiemetic due to anxiolytic effects is a benzodiazepine, which calms anxiety, can provide mild sedation, and may cause short-term amnesia. This helps break the cycle of anticipatory nausea and improves overall control of symptoms when used with standard antiemetics. The other choices work through different mechanisms that don’t address anxiety: metoclopramide acts mainly as a dopamine receptor antagonist with prokinetic effects; promethazine is an antihistamine with sedative properties but not anxiolysis; dexamethasone has antiemetic effects via anti-inflammatory pathways but lacks anxiolytic action.

Addressing sarcopenia and polypharmacy in older adults with cancer requires a targeted, multidisciplinary nutrition plan. Combat muscle loss by ensuring energy needs are met and protein quality is high, since adequate calories spare protein for muscle maintenance and repair, and leucine-rich, high-quality protein supports muscle protein synthesis. Distribute protein intake across meals and consider convenient, palatable forms to meet goals. When swallowing issues are present, adjust textures and consistencies (e.g., thicker liquids, purees) and involve speech-language pathology to enable safe, adequate intake while maintaining enjoyment. Polypharmacy increases the risk of drug–nutrient interactions, so the nutrition plan should include reviewing medications with the healthcare team, timing nutrient intake appropriately, and avoiding unnecessary supplements that could interact with treatments. Coordinating care with geriatric specialists and other providers ensures nutrition goals align with functional status, treatment plan, and overall goals of care, making the approach comprehensive and individualized.

The main idea is that blocking serotonin signaling at the 5-HT3 receptor prevents the vomiting reflex triggered by chemotherapy. Ondansetron is a selective antagonist of the 5-HT3 receptor, meaning it specifically blocks serotonin’s action at those receptors located in the gut and in the brain’s chemoreceptor trigger zone. By inhibiting this pathway, it effectively reduces nausea and vomiting associated with chemotherapy, especially in the acute phase right after treatment. This makes it a go-to antiemetic for CINV. Other options listed have different roles: a corticosteroid with antiemetic effects but not a 5-HT3 blocker, a benzodiazepine mainly for anxiety and anticipatory nausea, and a progestin used to stimulate appetite rather than prevent nausea.

Inflammation raises hepcidin, which blocks iron absorption in the gut and traps iron in storage sites, leading to functional iron deficiency in cancer. Oral iron often cannot overcome this blockade and may cause GI side effects, while intravenous iron bypasses the gut and rapidly replenishes iron stores. For cancer patients with inflammation, IV iron is therefore the more reliable and quicker option to correct iron deficiency. The other statements don’t fit: oral iron isn’t always preferred in inflammatory contexts, vitamin D deficiency isn’t fixed by calcium alone, and B12 deficiency can occur in cancer patients.