medical nutrition therapy for cancer

Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc.Elsevier items and derived items © 2008, 2004 by Saunders, an imprint of Elsevier Inc.

Medical Nutrition Medical Nutrition Therapy for CancerTherapy for CancerMedical Nutrition Medical Nutrition

Therapy for CancerTherapy for Cancer

Chapter 37Chapter 37


CancerCancer Abnormal cell division and reproduction Abnormal cell division and reproduction

that can spread throughout the bodythat can spread throughout the body

Major cause of mortality in the U.S., Major cause of mortality in the U.S., second only to cardiovascular diseasesecond only to cardiovascular disease

Most cases occur in older individuals Most cases occur in older individuals (2/3(2/3rdrd in persons over age 65) in persons over age 65)

Rates vary by ethnicity: African Rates vary by ethnicity: African American men higher rates than white American men higher rates than white men. African American women have men. African American women have lower incidence rates but higher mortality lower incidence rates but higher mortality rates than white womenrates than white women


EtiologyEtiology

Multistep process in which normal cells Multistep process in which normal cells are transformed into cancer cellsare transformed into cancer cells

Causes: exposure to carcinogens, Causes: exposure to carcinogens, genetics, nutritiongenetics, nutrition

1/31/3rdrd of deaths attributed to diet and of deaths attributed to diet and exercise and 1/3exercise and 1/3rdrd attributed to cigarettes attributed to cigarettes


PathophysiologyPathophysiology

Normal body cells have closely regulated Normal body cells have closely regulated growthgrowth

Cellular growth is partly controlled by a Cellular growth is partly controlled by a counting system based on telomeres.counting system based on telomeres.

Telomeres are end pieces of Telomeres are end pieces of chromosomes that become shorter after chromosomes that become shorter after each cell divisioneach cell division

When the telomere shortens to a specific When the telomere shortens to a specific length, the cell will stop dividinglength, the cell will stop dividing


Pathophysiology cont.Pathophysiology cont. Cancer cells produce at an uncontrolled Cancer cells produce at an uncontrolled

raterate

Cancer cells become autonomous from Cancer cells become autonomous from the normal growth signals and genetic the normal growth signals and genetic control and may even secrete their own control and may even secrete their own growth factorgrowth factor

An enzyme is secreted that destroys the An enzyme is secreted that destroys the telomere, leading to loss of the celltelomere, leading to loss of the cell’’s s internal clock & counting system which internal clock & counting system which controls replicationcontrols replication


Pathophysiology cont.Pathophysiology cont. The cell may take on other traits: The cell may take on other traits:

nucleus/cytoplasm may be enlarged or nucleus/cytoplasm may be enlarged or misshapen, mitosis rate becomes higher, misshapen, mitosis rate becomes higher, derangements in chromosome sequencederangements in chromosome sequence

Three stagesThree stages

– Initiation: transformation of cellInitiation: transformation of cell

– Promotion: multiplication of cellsPromotion: multiplication of cells

– Tumor progression, includes metastasisTumor progression, includes metastasis

Response to treatment is complete, Response to treatment is complete, partial, stable, or progressivepartial, stable, or progressive


TreatmentTreatment

ChemotherapyChemotherapy: systemic – affects all : systemic – affects all body systems. Interrupts stages of cell body systems. Interrupts stages of cell replication. Affects rapidly dividing cells replication. Affects rapidly dividing cells such as the GI tract. Ptsuch as the GI tract. Pt’’s experience s experience nausea and other GI problems during nausea and other GI problems during treatment. Hair loss is also a side affect. treatment. Hair loss is also a side affect. Pt may experience neutropenia and Pt may experience neutropenia and anemia because bone marrow cells are anemia because bone marrow cells are affected.affected.

– Most the normal cells in the body are in a Most the normal cells in the body are in a resting stage and are somewhat protected resting stage and are somewhat protected from the effectsfrom the effects


Chemotherapy cont.Chemotherapy cont.

Use of chemical agents or medications to treat Use of chemical agents or medications to treat cancercancer

Anemia, fatigue, nausea, vomiting, loss of Anemia, fatigue, nausea, vomiting, loss of appetite, mucositis, changes in taste and small, appetite, mucositis, changes in taste and small, xerostomia, dysphagia, diarrhea, constipationxerostomia, dysphagia, diarrhea, constipation

Severity of side effects depend on specific Severity of side effects depend on specific agents used, dosage, duration, number of agents used, dosage, duration, number of treatments, current health status.treatments, current health status.

Intestinal mucosa and digestive processes are Intestinal mucosa and digestive processes are affected which alter digestion and absorption of affected which alter digestion and absorption of some nutrientssome nutrients

Watch for drug nutrient interactionsWatch for drug nutrient interactions


Treatment cont.Treatment cont.

RadiationRadiation: used alone is the most : used alone is the most common treatment for certain cancers of common treatment for certain cancers of the head and neck. May cure some the head and neck. May cure some cancers such as Hodgkins, thyroid cancers such as Hodgkins, thyroid carcinoma, localized cancers of the head carcinoma, localized cancers of the head and neck.and neck.

– Ionizing radiation breaks the strands of the Ionizing radiation breaks the strands of the DNA helix, leading to cell death.DNA helix, leading to cell death.

– Toxicity of radiation is localized to the Toxicity of radiation is localized to the region being treatedregion being treated


Radiation Therapy (site specific)Radiation Therapy (site specific) Radiation to head and neck:Radiation to head and neck:

– Sore mouthSore mouth

– Altered taste & smellAltered taste & smell

– Dysphagia & odynophagiaDysphagia & odynophagia

– MucositisMucositis

– XerostomiaXerostomia

– AnorexiaAnorexia

– FatigueFatigue

– Weight lossWeight loss

Need aggressive enteral nutritionNeed aggressive enteral nutrition


Cancer Treatment and Nutritional Cancer Treatment and Nutritional Implications–contImplications–cont’’dd Hematopoietic stem cell transplantationHematopoietic stem cell transplantation

(treatment for leukemia, lymphoma)(treatment for leukemia, lymphoma)

– Nausea, vomiting, anorexia, dysgeusia, Nausea, vomiting, anorexia, dysgeusia, stomatitis, oral and esophageal mucositis, stomatitis, oral and esophageal mucositis, fatigue, and diarrheafatigue, and diarrhea

– Dietary precautions with neutropenia: food Dietary precautions with neutropenia: food safety (avoid undercooked meats, unpasteurized safety (avoid undercooked meats, unpasteurized beverages). Serve primarily cooked foods.beverages). Serve primarily cooked foods.

– Graft versus host disease (GVHD): donar stem Graft versus host disease (GVHD): donar stem cells react against the tissues of the forein hostcells react against the tissues of the forein host

– Sinusoidal obstructive syndrome (SOS): chemo Sinusoidal obstructive syndrome (SOS): chemo or radiation therapy damage to the hepatic or radiation therapy damage to the hepatic venulesvenules


Severe Oral Mucositis Following Severe Oral Mucositis Following Marrow TransplantationMarrow Transplantation


SurgerySurgery After surgery, patients may experience fatigue, After surgery, patients may experience fatigue,

changes in appetite and bowel function, pain.changes in appetite and bowel function, pain.

Require additional energy and protein for wound Require additional energy and protein for wound healing.healing.

Head & neck cancer: impaired mastication and chewing Head & neck cancer: impaired mastication and chewing due to tumor mass- usually rely on enteral nutritiondue to tumor mass- usually rely on enteral nutrition

Stomach cancer – surgery is most common treatment.Stomach cancer – surgery is most common treatment.

– Malabsorption, deficiency of iron, folate & B12 Malabsorption, deficiency of iron, folate & B12

Pancreatic cancer: Whipple procedurePancreatic cancer: Whipple procedure

– Delayed gastric emptying, early satiety, glucose Delayed gastric emptying, early satiety, glucose intolerance, bile acid insufficiency, diarrhea, fat intolerance, bile acid insufficiency, diarrhea, fat malabsorptionmalabsorption

– Usually need pancreatic enzyme replacement and Usually need pancreatic enzyme replacement and low fat dietlow fat diet


Nutrition in the Etiology of CancerNutrition in the Etiology of Cancer Nutrition may modify carcinogenic process at Nutrition may modify carcinogenic process at

any stage: carcinogen metabolism, cellular and any stage: carcinogen metabolism, cellular and host defense, cell differentiation, and tumor host defense, cell differentiation, and tumor growthgrowth

Nutrition is adversely affected by cancer itself, Nutrition is adversely affected by cancer itself, treatment (radiation therapy, chemotherapy, and treatment (radiation therapy, chemotherapy, and surgery), and current health and nutritional status surgery), and current health and nutritional status

One third of all cancer deaths attributed to diet, One third of all cancer deaths attributed to diet, nutrition, and lifestyle behaviors such as poor nutrition, and lifestyle behaviors such as poor diet, physical inactivity, overweight and obesity, diet, physical inactivity, overweight and obesity, and alcohol use; another third related to cigarette and alcohol use; another third related to cigarette and tobacco useand tobacco use


Types of Epidemiologic Studies Types of Epidemiologic Studies of Cancerof Cancer

Case Control StudiesThe diets of individuals with cancer are compared with those of cancer-free controls matched for age, sex, and other key factors.

Cohort Studies The diets of different groups of subjects are determined before cancer onset, and the incidences of developing cancers in each group are compared.

Cross-sectional StudiesThe diets of different groups of subjects are compared, using the same measures at a single point in time.


Nutrition in the Etiology of Cancer– Nutrition in the Etiology of Cancer– contcont’’dd

Complex relationshipComplex relationship

Dietary carcinogens: naturally occurring and Dietary carcinogens: naturally occurring and added in food preparation and preservationadded in food preparation and preservation

Inhibitors of carcinogenesis: antioxidants, Inhibitors of carcinogenesis: antioxidants, phytochemicalsphytochemicals

Enhancers of carcinogenesis: fat in red meat, Enhancers of carcinogenesis: fat in red meat, compounds formed when meat is grilled at high compounds formed when meat is grilled at high temperaturestemperatures

Latency period between initiation and Latency period between initiation and promotionpromotion


Energy Intake, Body Weight, Energy Intake, Body Weight, Obesity, and Physical ActivityObesity, and Physical Activity

Energy restriction inhibits cancer and Energy restriction inhibits cancer and extends life span in animalsextends life span in animals

Positive associations between overweight Positive associations between overweight and cancers of the breast, endometrium, and cancers of the breast, endometrium, kidney, colon, prostate, and otherskidney, colon, prostate, and others

Overweight increases risk of cancer Overweight increases risk of cancer recurrence and decreases survivalrecurrence and decreases survival

Physical activity is inversely associated Physical activity is inversely associated with cancerwith cancer


Nutrition and Cancer EtiologyNutrition and Cancer Etiology Fat: positive associationFat: positive association

Protein: increased red meat intake associated Protein: increased red meat intake associated with colon and prostate cancerwith colon and prostate cancer

Soy and phytoestrogens: protective against Soy and phytoestrogens: protective against breast cancer. For women already dx, moderate breast cancer. For women already dx, moderate use of soy is recommended but avoid use of soy is recommended but avoid supplementssupplements

Carbohydrates: fiber, sugars, and glycemic Carbohydrates: fiber, sugars, and glycemic indexindex– Fiber protectiveFiber protective

– Simple sugars – may stimulate cancer cell growth Simple sugars – may stimulate cancer cell growth due to increased insulin productiondue to increased insulin production

Fruits and vegetables: protectiveFruits and vegetables: protective

Nonnutritive sweeteners: not a concernNonnutritive sweeteners: not a concern


Nutrition and Cancer Etiology– contNutrition and Cancer Etiology– cont’’dd Alcohol: associated with cancer of the mouth, Alcohol: associated with cancer of the mouth,

pharynx, larynx, esophagus, lung, colon, pharynx, larynx, esophagus, lung, colon, rectum, liver, breastrectum, liver, breast

Coffee and tea: no significant relationshipCoffee and tea: no significant relationship

Methods of food preparation and preservation: Methods of food preparation and preservation: high heat cooking methods and processed high heat cooking methods and processed meats may be linkedmeats may be linked

Cancer chemoprevention: supplementation of Cancer chemoprevention: supplementation of nutrients such as betacarotene to prevent cancer nutrients such as betacarotene to prevent cancer – no statistical relatinship– no statistical relatinship

Cancer prevention recommendations: nutrition Cancer prevention recommendations: nutrition and physical activityand physical activity

Nutrition and physical activity Nutrition and physical activity recommendations for cancer survivors: Table recommendations for cancer survivors: Table 37-237-2


Color Code System of Vegetables Color Code System of Vegetables and Fruitsand FruitsColorColor PhytochemicalPhytochemical Vegetables and FruitsVegetables and Fruits

RedRed LycopeneLycopene Tomatoes and tomato Tomatoes and tomato products, pink grapefruit, products, pink grapefruit, watermelonwatermelon

Red/purpleRed/purple Anthocyanins, Anthocyanins, polyphenolspolyphenols

Berries, grapes, red wine, Berries, grapes, red wine, prunesprunes

OrangeOrange αα-, -, ββ--carotenecarotene Carrots, mangoes, Carrots, mangoes, pumpkinpumpkin

Orange/yellowOrange/yellow ββ--cryptoxanthin, cryptoxanthin, flavonoidsflavonoids

Cantaloupe, peaches, Cantaloupe, peaches, oranges, papaya, oranges, papaya, nectarinesnectarines

Yellow/greenYellow/green Lutein, zeaxanthinLutein, zeaxanthin Spinach, avocado, Spinach, avocado, honeydew, collard and honeydew, collard and turnip greensturnip greens

GreenGreen Sulforaphanes, indolesSulforaphanes, indoles Cabbage, broccoli, Cabbage, broccoli, Brussels sprouts, Brussels sprouts, cauliflowercauliflower

White/greenWhite/green Allyl sulphidesAllyl sulphides Leeks, onion, garlic, Leeks, onion, garlic, chiveschives

Data from Heber D: Vegetables, fruits and phytoestrogens in the prevention of diseases, Data from Heber D: Vegetables, fruits and phytoestrogens in the prevention of diseases, F Postgrad MedF Postgrad Med 50:145, 2004. 50:145, 2004.


Guidelines for Cancer PreventionGuidelines for Cancer Prevention

1. Choose a diet rich in a variety of plant-based foods.2. Eat plenty of vegetables and fruits.3. Maintain a healthy weight and be physically active.4. Drink alcohol only in moderation, if at all.5. Select foods low in fat and salt.6. Prepare and store food safely.

And always remember . . . Do not use tobacco in any form.

From American Institute for Cancer Research: From American Institute for Cancer Research: Simple steps to prevent cancer,Simple steps to prevent cancer, Washington, DC, 2000, AICR. Washington, DC, 2000, AICR.


Nutritional Implications of CancerNutritional Implications of Cancer

Goal: prevent malnutritionGoal: prevent malnutrition

Adverse nutritional effects of cancer Adverse nutritional effects of cancer compounded by treatmentcompounded by treatment

Even small weight loss (<5% body Even small weight loss (<5% body weight) before treatment adversely affect weight) before treatment adversely affect prognosisprognosis


Factors That Affect AppetiteFactors That Affect Appetite


Cancer CachexiaCancer Cachexia Progressive weight loss. One of the most Progressive weight loss. One of the most

common causes of death among pts with cancer common causes of death among pts with cancer and is present in 80% at time of death.and is present in 80% at time of death.

Characterized by: anorexia, involuntary weight Characterized by: anorexia, involuntary weight loss, tissue wasting, inability to perform ADLs, loss, tissue wasting, inability to perform ADLs, altered BMR.altered BMR.

Abnormalities in fluid and energy metabolismAbnormalities in fluid and energy metabolism

Mediated via cytokines, including tumor Mediated via cytokines, including tumor necrosis factor (TNFnecrosis factor (TNF and TNF and TNF), cachectin, ), cachectin, interleukin-1, interleukin-6, and interferon-interleukin-1, interleukin-6, and interferon-

Diagnosis stems from presenting signs and Diagnosis stems from presenting signs and symptomssymptoms


Metabolism and Tumor GrowthMetabolism and Tumor Growth

Energy needs are variableEnergy needs are variable

Protein, fat, and carbohydrate: tumors exert Protein, fat, and carbohydrate: tumors exert consistent demand for glucoseconsistent demand for glucose

CHO abnormalifies: insulin resistance, CHO abnormalifies: insulin resistance, increased glucose synthesis, gluconeogenesis, increased glucose synthesis, gluconeogenesis, decreased glucose tolerancedecreased glucose tolerance

In cancer cachexia, amino acids are not spared In cancer cachexia, amino acids are not spared as they are during simple starvation and as they are during simple starvation and depletion of lean muscle mass occursdepletion of lean muscle mass occurs

Muscle wasting: increased protein catabolism Muscle wasting: increased protein catabolism and/or decreased protein synthesisand/or decreased protein synthesis

Nutrition support preserves lean body mass; Nutrition support preserves lean body mass; also benefits malignancyalso benefits malignancy


Metabolism and Tumor Growth Metabolism and Tumor Growth cont.cont.

Hypercalcemia in patients with bone Hypercalcemia in patients with bone metastasesmetastases

Fluid and electrolyte imbalances: cancers Fluid and electrolyte imbalances: cancers that promote excessive diarrhea or that promote excessive diarrhea or vomitingvomiting

Loss of appetite and sensory changes. Loss of appetite and sensory changes. Alterations in taste and smell are Alterations in taste and smell are commoncommon

Nausea, vomiting, early satiety, Nausea, vomiting, early satiety, mucositis, constipationmucositis, constipation


Nutritional Care of AdultsNutritional Care of Adults Goals: prevent or reverse nutrient Goals: prevent or reverse nutrient

deficiencies, preserve lean body mass, deficiencies, preserve lean body mass, minimize nutrition-related side effects, minimize nutrition-related side effects, maximize quality of lifemaximize quality of life

Nutritional screening and risk Nutritional screening and risk assessment: SGA considered reliableassessment: SGA considered reliable

Body weight: maintain body wt and Body weight: maintain body wt and nutrient stores. Wt loss not typically nutrient stores. Wt loss not typically recommended.recommended.

Antioxidants: controversy over whether Antioxidants: controversy over whether or not to take supplementsor not to take supplements


Energy and Protein RequirementsEnergy and Protein Requirements EnergyEnergy

– Standardized equations, indirect calorimetryStandardized equations, indirect calorimetry

– Should be 25-35 kcal/kg to maintain and 35-Should be 25-35 kcal/kg to maintain and 35-45 kcal/kg to replenish. Add kcal if patient 45 kcal/kg to replenish. Add kcal if patient is febrile or septic.is febrile or septic.

– Some indicate that okay for obese patients to Some indicate that okay for obese patients to receive 21-25 kcal/kgreceive 21-25 kcal/kg

ProteinProtein

– Consider degree of malnutrition, extent of Consider degree of malnutrition, extent of disease, degree of stress, ability to disease, degree of stress, ability to metabolize and use proteinmetabolize and use protein


Daily Protein Requirements for Daily Protein Requirements for Patients with CancerPatients with Cancer

RDA for adults: 0.8 g/kg

Normal maintenance: 0.8 to 1 g/kg

Nonstressed cancer patient: 1 to 1.2 g/kg

Hypercatabolic cancer patient: 1.2 to 1.6 g/kg

Severely stressed cancer patient: 1.5 to 2.5

g/kg

Hematopoietic stem cell transplant patient:

1.5 to 2 g/kg Data from Charuhas PM et al: Medical nutrition therapy in bone marrow transplantation: energy, protein, Data from Charuhas PM et al: Medical nutrition therapy in bone marrow transplantation: energy, protein, micronutrient, and fluid requirement. In Elliott L et al, editors: micronutrient, and fluid requirement. In Elliott L et al, editors: The clinical guide to oncology nutrition,The clinical guide to oncology nutrition, ed 2, ed 2, Chicago, 2006, American Dietetic Association.Chicago, 2006, American Dietetic Association.


Contributor to AnorexiaContributor to Anorexia

Cachectin:Cachectin:

– Tumor necrosis factorTumor necrosis factor

– It is a cytokine protein that promotes It is a cytokine protein that promotes breakdown of both protein and fat stores to breakdown of both protein and fat stores to provide adequate energy for tumor cells.provide adequate energy for tumor cells.

– Insulin resistance occurs because of the Insulin resistance occurs because of the excessive fatty acid oxidation.excessive fatty acid oxidation.

– Glucose levels increase but the glucose and Glucose levels increase but the glucose and amino acids made available are used by the amino acids made available are used by the cancer cells.cancer cells.


Nauea/VomitingNauea/Vomiting Assess causeAssess cause

If odors contribute, take precautions to avoid If odors contribute, take precautions to avoid the odorsthe odors

Assess for early satiety: small frequent meals Assess for early satiety: small frequent meals may be helpfulmay be helpful

Many times, n/v is a result of medications Many times, n/v is a result of medications (chemotherapy most common)(chemotherapy most common)

– Eat small, low fat meal the mornin of the Eat small, low fat meal the mornin of the first treatment and avoid fried, greasy and first treatment and avoid fried, greasy and favorite foods for several days following the favorite foods for several days following the treatmenttreatment

– Encourage ptEncourage pt’’s to take anti-emetics as s to take anti-emetics as prescribedprescribed


Early SatietyEarly Satiety

Small, frequent meals that are nutrient Small, frequent meals that are nutrient densedense

Beverages should contain nutrients and Beverages should contain nutrients and consumed between meals rather than consumed between meals rather than with meals to avoid fullnesswith meals to avoid fullness

Avoid consumption of raw vegetables Avoid consumption of raw vegetables and other high fiber foodsand other high fiber foods

Medications that increase gastric Medications that increase gastric emptying may be usedemptying may be used


MucositisMucositis Associated pain is the main source of Associated pain is the main source of

cancer treatment-related paincancer treatment-related pain

– Pain can be severe enough that patients Pain can be severe enough that patients avoids food and drink which can lead to avoids food and drink which can lead to dehydration and weight lossdehydration and weight loss

– Good oral hygeineGood oral hygeine

– Narcotic analgesicsNarcotic analgesics

– Soft, non-fibrous, non-acidic foods; Avoid Soft, non-fibrous, non-acidic foods; Avoid hot foodshot foods

– Liquids to prevent dehydration; high Liquids to prevent dehydration; high kcal/high protein milkshakes helpfulkcal/high protein milkshakes helpful


Diarrhea Antineoplastic agents target cells that have the

highest replication ate and often cause diarrhea

When mucositis is present in the oral mucosa, it can be assumed that it may also be present in the stomach and intestines, resulting in diarrhea

Monitor for dehydration

Small amts of fluid frequently

Avoid large amts of fruit juice (excessive fructose can increase diarrhea)

Use anti-diarrheal meds as prescribed

Increasing soluble fibers may help but poor appetite may make it difficult


Dysgeusia

Alterations in taste: due to tumors or treatment options

Metallic taste:

– avoid metal utensils

– drink supplements from glass, not can

– use high protein non-meat sources (peanut butter, cheese, soy, poultry)

Use more highly spiced and flavorful foods


Xerostomia

Dry mouth: common side-effect of head and neck radiation and chemotherapy

Use artificial saliva and/or mouth moisturizers

Sugar-free gum and sour-flavored sugar-free hard candies may increase the flow of saliva

Chewing gum may be effective


Anorexia

Lack of appetite

Prevalence in cancer pts is estimated at 50% of patients

Can lead to weight loss and increase the development of cancer cachexia

Manipulation of diet does little to help improve a poor appetite

Exercise may help but many pts are unable to tolerate increased activity

Appetite stimulants: Megestrol acetate & corticosteroids agents


Fluid and Micronutrient Fluid and Micronutrient RequirementsRequirements FluidFluid

– Body surface area: 1500 mL/mBody surface area: 1500 mL/m22 or BSA × 1500 or BSA × 1500 mLmL

– Daily requirements method: 1 mL fluid per 1 Daily requirements method: 1 mL fluid per 1 kcal of estimated needskcal of estimated needs

– Holliday-Seger method: >20 kg of body weight Holliday-Seger method: >20 kg of body weight = 1500 mL + 20 mL/kg for each kg >20 kg= 1500 mL + 20 mL/kg for each kg >20 kg

– Age based method: <55 year of age – 30 to 40 Age based method: <55 year of age – 30 to 40 mL/kg, 55 to 65 years of age – 30 mL/kg, >65 mL/kg, 55 to 65 years of age – 30 mL/kg, >65 years of age – 25 mL/kgyears of age – 25 mL/kg

MicronutrientsMicronutrients– High-dose supplements commonHigh-dose supplements common– Pre-existing deficienciesPre-existing deficiencies– Recommend supplement with 100% DRIRecommend supplement with 100% DRI


Cancer Treatment and Cancer Treatment and Nutritional ImplicationsNutritional Implications ChemotherapyChemotherapy

ImmunotherapyImmunotherapy

– Biologic agents used to kill cancer cellsBiologic agents used to kill cancer cells

– Fatigue, chills, fever, flu-like symptoms, decreased Fatigue, chills, fever, flu-like symptoms, decreased food intakefood intake

Radiation therapyRadiation therapy

– Fatigue, loss of appetite, skin changes, and site-Fatigue, loss of appetite, skin changes, and site-specific effectsspecific effects


FatigueFatigue

Fatigue is most common side effectFatigue is most common side effect

– Consume frequent, small feedingsConsume frequent, small feedings

– Emphasis on Emphasis on morning feedingmorning feeding when energy when energy is betteris better

– Easy to eat foodsEasy to eat foods

– Foods with low preparation timeFoods with low preparation time

– Avoid favorite foods when undergoing Avoid favorite foods when undergoing treatment – may develop negative aversions treatment – may develop negative aversions to the foods if they are associated with to the foods if they are associated with unpleasant symptomsunpleasant symptoms


Enteral NutritionEnteral Nutrition

Preferred if gut is functionalPreferred if gut is functional

Associated with fewer postoperative Associated with fewer postoperative complications and shorter stayscomplications and shorter stays

Nasogastric and nasojejunal feeding Nasogastric and nasojejunal feeding tubes most commonly used for short termtubes most commonly used for short term

Gastrostomy or jejunostomy feeding Gastrostomy or jejunostomy feeding tubes for longer term enteral nutritiontubes for longer term enteral nutrition


Parenteral NutritionParenteral Nutrition Used when oral and enteral feeding is not Used when oral and enteral feeding is not

toleratedtolerated

May use when severe diarrhea or May use when severe diarrhea or malabsortion occursmalabsortion occurs

Usually, patients are severely Usually, patients are severely malnourished with GI malfunctionsmalnourished with GI malfunctions

Intense monitoring and specialized care Intense monitoring and specialized care is requiredis required

Used for pts with reasonable prognosis. Used for pts with reasonable prognosis. Not appropriate for terminal patients.Not appropriate for terminal patients.


Palliative CarePalliative Care

Provide for quality of lifeProvide for quality of life

Diet as desired by individualDiet as desired by individual

Goal is to alleviate negative symptoms Goal is to alleviate negative symptoms (ex: pain, weakness, constipation, nausea, (ex: pain, weakness, constipation, nausea, loss of appetite, dry mouth)loss of appetite, dry mouth)

Emphasize pleasurable aspects of eating Emphasize pleasurable aspects of eating without concern for quantity or without concern for quantity or nutrient/energy contentnutrient/energy content

Hospice careHospice care


Nutritional Care of ChildrenNutritional Care of Children

Families and caregivers often have Families and caregivers often have extreme preoccupation with eating and extreme preoccupation with eating and weightweight

Creativity in feedingCreativity in feeding

Enteral nutrition supportEnteral nutrition support

Individualize requirementsIndividualize requirements

Requirements for growth and Requirements for growth and developmentdevelopment


Complementary and Alternative Complementary and Alternative TherapiesTherapies Whole medical systemsWhole medical systems

– Traditional Chinese Medicine, ayurvedic medicine, Traditional Chinese Medicine, ayurvedic medicine, homeopathy, naturopathyhomeopathy, naturopathy

Mind-body interventionsMind-body interventions– Mindfulness, meditationMindfulness, meditation

Biologically based therapiesBiologically based therapies– Botanicals, dietary supplements, vitamins, mineralsBotanicals, dietary supplements, vitamins, minerals

Manipulative and body-based methodsManipulative and body-based methods– Massage, yoga, reflexologyMassage, yoga, reflexology

Energy therapiesEnergy therapies– Veritable and measurable – sound, light, energyVeritable and measurable – sound, light, energy

– Putative such as biofieldsPutative such as biofields


Focal PointsFocal Points Nutrition plays an important role throughout the continuum of Nutrition plays an important role throughout the continuum of

cancer care—from helping to reduce cancer risk, to caring for cancer care—from helping to reduce cancer risk, to caring for patients undergoing cancer treatment, to promoting healthy patients undergoing cancer treatment, to promoting healthy lifestyles for cancer survivors. lifestyles for cancer survivors.

Patients have different needs and challenges with regard to their Patients have different needs and challenges with regard to their nutrition management, and providing individualized nutritional nutrition management, and providing individualized nutritional guidance is an essential component of their care. guidance is an essential component of their care.

Prompt and appropriate nutrition management may help to improve Prompt and appropriate nutrition management may help to improve patientspatients’’ tolerance of treatment, minimize nutrition impact tolerance of treatment, minimize nutrition impact symptoms, and maximize quality of life. symptoms, and maximize quality of life.

Cancer patients should be encouraged to actively participate in their Cancer patients should be encouraged to actively participate in their care and to communicate with their health care providers. care and to communicate with their health care providers.

When patients are inundated with nutrition-related CAM therapy When patients are inundated with nutrition-related CAM therapy choices, food and professionals can provide sound guidance for choices, food and professionals can provide sound guidance for informed decision making.informed decision making.

medical nutrition therapy for cancer

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