5: Nutrition Needs in Adults with Cancer

Question 1

Explain the effects of systemic inflammation on macronutrient metabolism

Answer 1

Protein metabolism: changes in protein synthesis and degradation, loss of fat and muscle mass, and an increase in the production of acute-phase protein, such as C-reactive protein

Carb metabolism: increased insulin resistance and impaired glucose tolerance

Lipid metabolism: maintained or increased lipid oxidation, particularly in the presence of weight loss

Question 2

DRI for Protein in Adult with Cancer, cancer cahexia, and hematopoietic stem cell transplant (HSCT)

Answer 2

g/kg/d (actual body weight unless otherwise specified)

Cancer: 1-1.5
Cachexia: 1.5-2.5
HSCT: 1.5

Question 3

Which cancers are typically seen as hypermetabolic?

Answer 3

pancreatic, gastric, bile duct, kidney, adrenal, non-small cell lung, and head & neck

Question 4

Which cancers are typically seen as normometabolic or not statistically significantly different from the control group?

Answer 4

breast, colorectal, and bladdar

Question 5

Why is underhydration usually a problem for cancer patients?

Answer 5

Usually having decreased fluid intake (difficulty obtaining and consuming fluids) and excessive fluid losses (volume depletion due to vomiting and diarrhea)

Also noted impaired thirst mechanisms and access issues due to mobility issues in older oncology patients

Question 6

What are the three methods for calculating fluid needs?

Answer 6

Weight (Holliday-Segar), BSA method, or RDA (energy) method

none are validated

Question 7

What micronutrients are decreased with inflammation?

Answer 7

Selenium, copper, iron, and zinc

Question 8

What micronutrients are usually not impacted by inflammation? (Low=likely true deficiency issue)

Answer 8

Thiamine, riboflavin, B12, and folate

Question 9

Micronutrient level changes: Alcoholic liver

Answer 9

decrease in folate, thiamine, pyridoxine, and vit A

Question 10

Micronutrient level changes: Renal failure

Answer 10

decrease in pyridoxine, folate and vit C

Question 11

Micronutrient level changes: GI fistulas and diarrhea

Answer 11

Decrease in all vitamin and multiple trace minerals, particularly zinc and selenium

Question 12

Micronutrient level changes: Loss of bile

Answer 12

decrease in fat-soluble vitamins

Question 13

Micronutrient level changes: pancreatitis

Answer 13

decrease in absorption of B12

Question 14

Micronutrient level changes: chyle leas and fistulas

Answer 14

decrease in micronutrients

Question 15

Micronutrient level changes: Gastrectomy or terminal ileum resection

Answer 15

decrease in iron and B12

Question 16

Micronutrient level changes: bariatric surgery

Answer 16

Decrease in fat-soluble vitamins, water-soluble vitamins, and minerals such as iron and zinc

Question 17

Micronutrient level changes: critical illness

Answer 17

decrease in Vit C despite supplementation

Question 18

Micronutrient level changes: syndrome of inappropriate antidiuretic hormone (SIADH)

Answer 18

decrease in sodium

Question 19

Micronutrient level changes: Cisplatin

Answer 19

Decrease in magnesium

Question 20

What factors should be considered when deciding on energy need requirements for cancer patients?

Answer 20

Medical (cancer) diagnosis
presence and extent of comorbidities
intent of treatment (cure, control, palliative)
anticancer treatment modalities
presence and extent of malnutrition
stress factors (fever, infection)
presence of advance directives, if appropriate

Question 21

What are the recommendations for cancer patients using weight (kcal/kg)?
Cancer-wt gain:
Cancer- maintain/non-stress
Cancer- hypermetabolic
sepsis-
HSCT-

Answer 21

Cancer - weight gain: 30-35
Cancer - maintain/non stressed: 25-30
Cancer - hypermetabolic: 35
Sepsis: 25-30
HSCT: 30-35

Question 22

What is a hallmark of refeeding syndrome?

Answer 22

Hypophosohatemia - usually within 3 days of starting intervention

Question 23

Common conditions for refeeding syndrome to occur in?

Answer 23

long-standing alcohol abuse with or without cirrhosis
prolonged undernutrition
morbid obesity with substantial weight loss

Question 24

How do you address/prevent refeeding syndrome?

Answer 24

for at risk patients, start with 25% of needs and slowly advance over next 3-5 days, watching electrolytes for signs. Can add thiamine to help with glucose levels

Question 25

DRI of Calcium

Answer 25

19–50 years 1,000 mg (M) 1,000 mg (F)
51–70 years 1,000 mg (M) 1,200 mg (F)

Question 26

DRI of Vitamin E

Answer 26

15 mg (22 IU)

Question 27

DRI of B-carotene

Answer 27

75 to 180 mg of beta-carotene
(the equivalent of 125,000 to 300,000 Units of vitamin A activity)