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Neoplastic Disease
KNH 411
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Cancer
Carcinogenesis - EtiologyGenes may be affected by antioxidants, soy, protein,
fat, kcal, alcoholNutritional genomics – study of genetic variations
that cause different phenotypic responses to diet
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© 2007 Thomson - Wadsworth
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Chemotherapy
Common side effects due to toxicity to rapidly dividing cells:Neutropenia- low white blood cell count
Thrombocytopenia- low platelet count
AnemiaDiarrheaMucositisAlopecia- hair loss
Cardiotoxicity, neurotoxicity, nephrotoxicity- toxicity to the heart, brain, kidneys
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Radiation
Side effects:Delayed wound healingFatigue, mucositis, dysguesia, xerostomia,
dysphagia, odynophagia, severe esophagitis, dehydration
Radiation enteritis, fistulas, strictures, chronic malabsorption, severe diarrhea
TPN may be warranted to prevent weight loss
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Nutrition Therapy
Prevent malnutritionScreening and assessment importantBe aware of cancer dg and treatments most likely to
cause malnutrition
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Nutrition Implications
Cachexia –Metabolic alterations Tumor induces hypermetabolic catabolic state
through chemical mediatorsTumor specific “cachectic factors”Weight loss, anorexia, muscle wasting, fatigue, early
satietyStandard therapy – nutrition support
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© 2007 Thomson - Wadsworth
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Nutrition Implications
Abnormalities in CHO, lipid, protein metabolismNormal physiologic conservation seen in starvation
does not occurCHO – insulin resistance, increased glucose
synthesis, gluconeogenesis, increased Cori cycle activity, decreased glucose tolerance and turnover
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Nutrition Implications
Abnormalities in CHO, lipid, protein metabolismProtein - amino acids not spared, depletion of lean
body mass, increased protein catabolism, or decreased protein synthesis
Lipid – increased lipid metabolism, decreased lipogenesis, decreased LPL, presence of lipid-mobilizing factor (LMF)
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Nutrition Implications
Cancer treatmentNausea, vomitingEarly satietyDysgeusiaDiarrheaMucositisXerostomiaConstipationWeight lossAnemia
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Nutrition Interventions
Nutrition AssessmentSGAAnthropometrics including height, weight, detailed
weight hx, fluid retention, body compositionBiochemical including serum hepatic proteins Clinical signs and symptoms
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Nutrition Interventions
Nutrition AssessmentDetailed diet hx and current intake
Foods tolerated, special diets, use of CAM, supplements, liquid nutritional supplement preferences
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Nutrition Interventions
Determining Nutrient RequirementsIndividualizedKcal to maintain weight and prevent loss Protein to prevent negative nitrogen balance
and meet synthesis needsFluid needs - 30-35 mL/kgMultivitamin mineral supplement < 150%
DRI
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Nutrition InterventionsNausea & Vomiting
Avoid noxious odorsReview medication list for potential causesSmall, frequent mealsPro-kineticsCAM – acupressure, acupuncture, hypnosis, guided
imagery
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Nutrition InterventionsNausea & Vomiting - Chemotherapy
Small, low-fat meals morning of, avoid fried, greasy and favorite foods for several days
Clear liquid dietElectrolyte-fortified beveragesNon-acid fruit drinksAvoid favorite foods Avoid “creamy” liquid nutritional drinks Anti-emetics 30-45 min. before meal
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Nutrition InterventionsEarly Satiety
Small, frequent nutrient-dense mealsBeverages between meals and should contain
nutrientsAvoid high-fiber and raw vegetablesPro-kinetics
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Nutrition Interventions
Mucositis Thorough and systematic assessment of
mouthGood oral hygiene importantOral glutamineNarcotic analgesicsEat soft, non-fibrous, non-acidic foodsAvoid hot foodsEncourage liquids; non-acidic juicesHigh-kcal, high-protein shakes &
supplements
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Nutrition InterventionsDiarrhea
Drink small amounts of fluid frequently throughout day
Avoid large amounts of fruit juiceOral rehydration fluids and nutritional beveragesAntidiarrheal medicationsFoods high in soluble fiber
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Nutrition InterventionsDysgeusia
Assess taste changes – metallic taste, aguesia, heightening of certain tastes (sweets), aversions
Avoid metal utensils, drink from glass Incorporate other high-protein foods if aversion to
meats exists Increase spices, flavors Non-sweet supplements, or juice- or yogurt-based
alternatives
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Nutrition InterventionsXerostomia
Artificial saliva/ mouth moisturizersGels, lozenges, mouthwashesSugar-free gum, sour-flavored hard candy
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Nutrition InterventionsAnorexia
Pharmacologic agents to increase appetitePharmacologic agents to treat weight lossPhysical activityOral supplements
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Nutrition InterventionsNutrition Support
Enteral vs. parenteral Nutrition support inappropriate for those with terminal
cancer or for pts. with poor prognosis for whom other therapies have been exhausted
ASPEN practice guidelines for nutrition support
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Nutrition InterventionsNutrition Support
Home nutrition support May maintain quality of life Lack of appetite and food intake may be greater concern
to family members, caregivers than to pt.