nutritional aspects of cancer management - chapter 12

Nutritional Aspects of Cancer Management

Chapter 12

Epidemiology

• Age is major risk factor in cancer incidence• Multiple causes, including personal choices

and behaviors• Lifetime risk– 1:10 men– 1:3 women

• Survival– Increased longevity

Prevention

• Fruit and Vegetable Consumption– Limited fruit and vegetable consumption is a

cancer risk– Healthy People 2010 suggests > 5 daily servings– Access to nutrient-dense foods can be

problematic for low-income populations– Isoflavones inversely associated with some types

of cancer

Prevention

• Weight– Increased weight is a risk factor for a number of

cancers common in older adults

• Low-Fat Diet– Decreased risk of invasive ovarian cancer

• Trans-fatty Acids– Intake may be risk factor for cancer of the small

intestine

Prevention

• Cholesterol-Lowering Drugs– Associated with a reduction for the risk of

advanced prostate cancer and other cancers• Folate and Cobalamin– Studies show inconsistent results

• Fiber– Recommended for prevention of colon cancer

• Omega-3 Fatty Acids– May decrease risk of cancer

Prevention• Carotenes– An antioxidant• Linked to lower mortality in older adults

– Beta-carotene• May act as both an oxidant and an antioxidant

when consumed in high doses

• Vitamin D– High-dose activated vitamin D combined with

chemotherapy may increase survival in men with prostate cancer

Prevention

• Aspirin and Vitamin E– Some research shows aspirin and other anti-

inflammatory drugs may protect against colon cancer

• Multivitamin Use– Has little or no influence on risk for common

cancers or total mortality in postmenopausal women

Prevention

• Coffee– Inverse relationship between caffeine intake and

ovarian cancer risk

• Meat Mutagens– Heterocyclic amines (HCAs)• Formed from cooking meat at high

temperatures• Carcinogens found in beef, pork, fowl, and fish

Ethnicity, Culture, and Cancers

• American and Alaskan Natives– Cancer rates among this population has been

increasing in the past 20 years• African Americans– Cancer is second leading cause of death in this

population– Cancer survival is lower compared to whites in the

U.S.• Asian Americans– Cancer is the number one cause of death for this

population

Ethnicity, Culture, and Cancers

• Native Hawaiians and Pacific Islanders– Native Hawaiians have the second highest

incidence of cancers and of cancer-related mortality

– Pacific Islanders have significant health-related high-risk behaviors

• Seventh-day Adventists– Have a very low incidence of cancer

Common Cancers and Dietary Recommendations

• Prostate Cancer– Diet: limit intake of red meat and full-fat dairy

products and eat at least five servings of fruits and vegetables daily

• Breast Cancer– Older women who smoke or have smoked appear

to be at very high risk for breast cancer– Recommendations• Exercise at least four hours each week• High folate intake• Limit alcohol to no more than one drink/day

Common Cancers and Dietary Recommendations

• Lung and Bronchus Cancers– Diets high in phytochemicals have been shown to

decrease lung and bronchus cancer risk

• Colon and Rectum– Recommendations• Increase physical activity• Avoid obesity• Limit meat consumption• Increase fruit and vegetable intake

Cancer Treatments

• Many therapies are aggressive• Patient may require aggressive nutrition

management• Dietary counseling is part of the treatment

plan• Therapy kills both cancer cells and healthy

cells• Therapy has side effects that affect eating and

nutrition

Cancer Treatments

• Surgery– If malnourished, patient should correct prior to

surgery, if time permits– After surgery body needs extra calories and

protein– Maintain adequate fluid intake– Side effects may affect eating and food intake

Cancer Treatments

• Chemotherapy– A systemic therapy • Affects the entire body

– Use of high-calorie and high-protein liquid supplements between meals

– Avoid fried foods– Small, frequent meals are encouraged– Drink adequate fluids

Cancer Treatments

• Radiation Therapy– Affects both healthy and diseased tissues– Side effects are usually acute and begin the 2nd or

3rd week of therapy– GI tract most susceptible to nutrition-related

radiation side effects

• Immunotherapy– Monoclonal antibodies (MAb)• Made in the laboratory

Side Effects of Therapy: Nutrition and Symptom Management

• Eat when hungry, rather at “meal times”• Eat favorite foods• Dine with family and friends• Have others prepare foods• Eat small, frequent meals and snack

throughout the day• Maintain hydration


• Protein-Calorie Malnutrition– Most common nutrition diagnosis associated with

cancer– May be unable to digest certain foods– Metabolic abnormalities may occur

• The Immunocompromised Patient– Avoid infection-causing organism type foods– Practice safe food-handling techniques


• Anorexia– Loss of appetite or desire to eat– Multiple recommendations to combat anorexia


• Cachexia– A wasting syndrome– Cause is probably multifactorial, but not well

understood– Treatment includes medications

• Fatigue– Numerous suggestions to manage fatigue


• Weakness and Falls– A common side effect of cancer therapy and

cancer– Vitamin D may reduce risk of falls• Vitamin D production is diminished in older

adults• Consistent use of sunscreens will decrease

synthesis of Vitamin D


• Altered Taste– Prevent developing an aversion to meat with

preparation suggestions– If experiencing a bitter or metallic taste:• Use plastic utensils• Suck lemon drops or mints• Rule out dental problems• Check if medications could cause odd taste

– Alter food flavor as needed


• Mucositis and Stomatitis– Eat soft foods– Avoid irritating foods and beverages– Use a straw to drink liquids– Eat foods cold or at room temperature– Practice good oral hygiene– Increase fluid intake by adding sauces, gravy, or

broths to foods– Numb the mouth with ice chips or ice pops


• Dysphagia– Puree or thicken food or liquids to a consistency

that is easy to swallow– Meet with speech therapist– Call physician or nurse if choking while eating– Drink 6 – 8 cups of fluid per day– Use liquid supplements– Use pureed vegetables in soup


• Nausea and Vomiting– Sip clear liquids frequently– Eat dry foods– Sit up or keep head raised after eating– Eat bland, soft foods– Eat away from odors– Eat in a cool room– Rinse mouth before and after eating– Suck on hard candies– Eat easy-to-digest foods– Ask about anti-nausea medications


• Diarrhea– Drink room temperature fluids– Drink 1 cup of liquid after each bowel movement– Limit milk to 2 cups per day– Avoid foods that cause gas– Avoid sugar-free gum and candies– Avoid high-fiber foods– Eat small frequent meals and snacks– Eat high-sodium foods– Drink high-potassium liquids and foods– Eat foods high in soluble fiber


• Constipation– Eat high-fiber foods– Drink 8-10 cups of fluid daily– Try to eat at the same time each day– Limit gas-causing drinks and foods– Limit chewing gum, talking while eating, chewing

with mouth open, and using straws– Exercise


• Advanced Cancers– Patients often have no appetite and lose weight

rapidly– Appetite stimulants may be effective– Look up American Cancer Society suggestions– Food should not be a source of stress

Methods of Nutrient Delivery

• Nasogastric Tubes– Used for a short period of time– Cost-effective management of nutrition

• Percutaneous Endoscopic Gastrostomy Tubes– Used for longer period of time– Bolus vs. continuous feeds

Methods of Nutrition Delivery

• Parenteral Nutrition– Used in patients with nonfunctioning gut or

profound nausea– Delivered via central venous catheter or a

peripheral venous catheter

Palliative Care

• Maintain comfort and quality of life• Nutrition and hydration are considered

medical interventions that can be stopped• Advisable not to force eating and drinking

Conclusion

• Goal of nutrition therapy for the older adult with cancer is to provide optimal nutritional status and to maximize quality of life

nutritional aspects of cancer management - chapter 12

Education