16: Brain Tumors

Question 1

What are the two main types of brain tumors?

Answer 1

Primary (PBT) – start in brain and rarely spread. There are 120 types

Secondary – mets from other cancer types. Most common are lung, breast, kidney and blood cancers

Question 2

Are the different treatment types used?

Answer 2

Surgery, chemo and radiation are all possible

Surgery is often used as curative for low-grade tumors, while high-grade require adjuvant chemo/radiation

Question 3

What are common nutrition impact symptoms in PBT?

Answer 3

weight loss
N/V
headaches
dysphagia
fatigue

malnutrition rate is lower than most (17.6%)

Question 4

What is a common treatment (medication) side effect to monitor? Can it impact outcomes?

Answer 4

Hyperglycemia — dexamethasone is often used to treat peritumoral edema and radiation side effects.

Yes/No — there is an inverse relationship with hyperglycemia and survival, however treating the glucose levels hasn’t been studied to see if it helps outcomes, probably due to the overall poor prognosis with PBTs

Question 5

What diet is often used with PBTs? Is it standard of care?

Answer 5

Ketogenic Diet — no

Question 6

How do you calculate the ratio in the Keto diet? What are the common levels aimed for?

Answer 6

fat g : (CHO g + Pro g)

3:1 or 4:1 are the most common.

3:1 is 87% of energy coming from fat sources; 4:1 is 90%

Question 7

What is the ratio for modified Atkins diet, a version of keto? Why was it created?

Answer 7

1:1 or 2:1 ratio

Found to be easier to do on outpatient side (fat down to 65% or 82%)

Question 8

PBT often have poor long-term survival, due to cognitive impairment/seizures/neurological damage/personality changes. What are some challenges and steps the caregiver can make to help the patient?

Answer 8

Inability to recognize appetite cues/missing meals —- schedule/plan meals and have a daily menu to help pt remember

fatigue — use a clock/phone alarm to remind patient of need to eat/drink. Drink containers with lids/straws to help reduce spills

can’t tell between hot/cold beverages — use different mugs/cups for each ie red for hot, blue for cold

loss of coordination/fine motor skills — see OT to help find options with plates/utensils, also use finger foods

decreased taste — fresh herbs/spices liberally, use FASS to help. Keep food moist.

distractions at/during mealtime — keep eating table clear of clutter. Use a brightly colored place mat or special chair for the patient to use

dehydration — several cups of variety nearby (colors like above)

inability to follow steps/difficult to follow meal related tasks — short, simple checklists as daily reminders of activities that include mealtime reminders and boxes for the patient to check once completed

Question 9

What are some main keto diet side effects and prevention/treatment measures?

Answer 9

constipation – medium-chain triglycerides, add veg, check fluid, add meds if needed

N/V – check labs, adjust ratio, meds (particularly depends on rest of treatment regimen)

Acidosis – check hydration and phos, check ketosis level, add bicarb or citrate supplement

Hyperlipidemia – healthy fat sources, reduce ratio, long-chain fatty acids, possibly carnitine therapy

pancreatitis – monitor labs (lipids, amylase, lipase), carnitine if needed, reduce ratio if needed

Osteoporosis – adequate Ca, Vit D, Mg, Phos