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Clinical Nutrition > Cancer- Nutritional assessment and intervention > Flashcards

Cancer- Nutritional assessment and intervention Flashcards

1
Q

nutritional assessment

A

weight loss , MM and strength, abnormal biochemical tests, subjective assessemt

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2
Q

nutritional intervention

A

counselling, nutritional needs, promising therapy

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3
Q

what aspects affect nutritional status

A

tumour, host response, anti-cancer treatment

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4
Q

why assess?

A

early identification of patients at risk, improves patients well being, survival and immune function, improves response to treatment

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5
Q

what is assessment

A

assessing body compartments and analysis the function of organs and metabolic effects : done through medical and dietary history, physical examination, anthropometric measurements, biochem tests, clinical symptoms

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6
Q

%weight loss

A

U-Current/ usual

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7
Q

what is most powerful independent variable that predicts mortality in CA - and clinical manifestation of Cancer cachexia

A

% weight loss

> 5% moderate
10% severe
15% very severe

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8
Q

what do need to be careful to watch out for with % weight change

A

edema, ascites, pleural effusion - weight could actually be a lot less but if patient has these they will appear heavier bc of excess fluid load

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9
Q

how to assess loss of muscle mass?

A
  • MAMA
  • creatinine/height index
  • methH excretion
  • DXA
  • BIA
  • CT scan
  • muscle grip
  • functional tests
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10
Q

MAMA ! when?

A

<15th percentile for age and sex

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11
Q

3-MH/creatinine ration

A

marker of myofibrillar protein degradation

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12
Q

best functional tests

A

6 min walking test, gait speed

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13
Q

what do you look at for biochem tests in cancer patients?

A
  1. albumin
  2. B12
  3. Calcium
  4. folate
  5. glucose
  6. hemoglobin
  7. potassium
  8. lymphocyte count
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14
Q

albumin high

A

dehydration

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15
Q

albumin low

A

inflammation, protein def, sepsis, hyper hydration (too much fluids)

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16
Q

B12 high

A

leukaemia (blood cancer)

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17
Q

B12 high

A

gastrectomy

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18
Q

hg low

A

radio or chemo, blood losses, leukaemia, lymphoma, Hodgkin

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19
Q

potassium values

A

low means Tx with cisplatin

20
Q

if results look whack what should you look at the interpret if dehydration screwed the results

A
  • if blood values have high concentrations of electrolytes, BUN, creatine, CBC: hematocrit indicates dehydration
  • or look at clinical signs- low BP, rapid HR, dry skin, dry mouth and lips, confusion, thirst
21
Q

how to measure inflammation

A

CRP and albumin and utilize glasgo prognosis score

22
Q

what does Glasgow prognostic score tell you

A

about cachexia - it is a measure of CRP and albumin –> pre cachexia would be high CRP and normal albumin, or refractory cachexia would be Hugh CRP and low albumin

23
Q

possible nutritional diagnoses after nutrition assessment has taken place

A
  1. involuntary weight loss
  2. malnutrition
  3. dehydration
24
Q

nutrition intervention

A
  1. preventative
  2. adjuvant
  3. palliative
25
Q

nutritional needs: ESPEN guidelines

A
  1. energy - 25-30 kcal/kg/d
  2. protein - 1.0-1.5 (moderate exercise) or 1.2-2.0 (bed ridden)
  3. micronutrients
    4 consider efficiency of feeding
  4. assess/ communicate about potentially harmful diets (keto, fasting)
26
Q

parenteral is not recommended for??

A

advanced cancer patients receiving chemo

27
Q

what are some common complications with hematopoietic stem cell transplantation

A

infection- immunosuppression, symptoms of toxicity, graft-vs-host defence - skin rash, liver disfunction, GI problems

28
Q

nutrition approach for hematopoietic cell transplant

A

avoid foods that have increased risk of infection ( and safe handling procedure)
- may have to use parental feeding for patients that develop GVHD or cannot ingest and absorb food for a long time

29
Q

nutrition approach for hematopoietic cell transplant

A

avoid foods that have increased risk of infection ( and safe handling procedure)
- may have to use parental feeding for patients that develop GVHD or cannot ingest and absorb food for a long time

30
Q

promising nutritional therapies for cachexia

A

omega-3 –> anti-inflammation, reduce chemotoxicity in animal models, improve appetite, body weight and body comp in weight losing cachexia patients
-amino acids- anabolic response- leucine stimulates protein synth adninsulin secretion, glut and arginine increases immune competence, help wound heali

31
Q

how to ease symptoms of N/V

A

antiemetics- 30-45 mins before eating, cook in microwave, marihuana, avoid frying food, tell fam members to avoid perfumes,

  • eat small, low fat meals - avoid greasy, fried and favourite foods,
  • could do clear liquid for first 24 h
  • non-acidic fruit drinks
  • electrolyte drinks
  • prokinetics may be prescribed
32
Q

how to ease early satiety

A
  • eat small, frequent meals that are nutrient dense
  • beverages that contain nutrients should be consumed between meals and not at meals so as not to add to the feeling of fullness
  • no high fiber or raw veg
  • prokinestics - meds that increase gastric emptying can be used–> Side effect = diarrhea
33
Q

how to ease mucositis (stomatitis- irritation and inflam of epithelial cells of the muscular membrane and lining of the gastrointestinal tract- any point from mouth to anus)

A

this is the main source of cancer treatment pain

  • 40-70% patients suffer from this
  • related to direct and indirect cytotoxicity
  • chemo induced occurs 5-7 days after chemo
  • to ease: zinc supplements to ease pain, narcotic analgesics, topical therapies
  • eat soft and non-fibrous foods, non-acidic foods, no hot foods, encourage liquids, high protein nd high energy dense milk shakes
34
Q

symptoms of mucositis

A

pain and burning when swallowing
- if severe- patient won’t eat of drink
-

35
Q

what’s important for patients with mucositis

A

good oral hygiene- to prevent infection

36
Q

what foods to give to patient with mucositis

A

high-pro, high energy dense milk shakes, soft, non-acidic, lots of water/liquids, non-fibrous foods, pureed foods

37
Q

how to ease diarrhea symptoms in Ca patients

A

drink small amounts of fluid frequently, limit excess fructose ( limit fruit juices), rehydration drinks, anti-diarrhea agents, high fiber intake (soluble)

38
Q

how to ease Dysgeusia- alteration in taste- (meats have a bitter taste, morning coffee tastes weird)

A

profound impact on ability to eat adequate food

  • could be metallic taste, no taste, heightening of certain tastes, aversions to foods
  • metallic taste- don’t use metal utensils
  • stop eating meat- need to watch protein intake
  • usually can’t tolerate sweets
39
Q

how to ease Xerostomia (reduced saliva production)

A
  • common in head and neck radiation or chemo
  • or from CVHD, dehydration or medications
  • treatment: artificial saliva, mouth moisturizers,
  • ## sugar free gum and sour flavoured candies may help produce saliva
40
Q

how to ease the symptoms of Anorexia

A

50% prevelance

  • omega-3
  • exercise
  • eat smaller more frequent meals
  • max your intake when appetite is most normal
  • limit fluid intake with meals
  • glass of wine before meal may help stimulate appetite
  • ventilate eating area
  • pharmacologic interventions (corticosteroids and megestrol acetate
41
Q

hematopoietic stem cell transplantation

A

bone marrow transplant

-

42
Q

what is conditioning phase?

A

remove stem cells from bone marrow
- high does chemo or total body radiation to 1) immunosupress the body so as not to react to transplant and 2) kill malignant cells

43
Q

side effects of HSCT

A

high rate of infection and GVHD

44
Q

long term complications of GVHD (more common in allogeneic HSCT)

A

growth retardation, infertility, endocrine failure, osteopenia, delayed gastric emptying

45
Q

when is parental nutrition recommended for head and neck patients:

A
  • 5% weight loss over last month or10% in 6 months
  • ongoing dehydration, dysphagia, anorexia or pain
  • severe aspiration
46
Q

nutritional support for HSCT

A

-enerteral for patients with functioning GI
-parental only in severe cases
-parental glutamine may be beneficial
-deitary counselling for food that have low infection risk
-

Clinical Nutrition (25 decks)

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