Cancer- Nutritional assessment and intervention Flashcards
nutritional assessment
weight loss , MM and strength, abnormal biochemical tests, subjective assessemt
nutritional intervention
counselling, nutritional needs, promising therapy
what aspects affect nutritional status
tumour, host response, anti-cancer treatment
why assess?
early identification of patients at risk, improves patients well being, survival and immune function, improves response to treatment
what is assessment
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
%weight loss
U-Current/ usual
what is most powerful independent variable that predicts mortality in CA - and clinical manifestation of Cancer cachexia
% weight loss
> 5% moderate
10% severe
15% very severe
what do need to be careful to watch out for with % weight change
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
how to assess loss of muscle mass?
- MAMA
- creatinine/height index
- methH excretion
- DXA
- BIA
- CT scan
- muscle grip
- functional tests
MAMA ! when?
<15th percentile for age and sex
3-MH/creatinine ration
marker of myofibrillar protein degradation
best functional tests
6 min walking test, gait speed
what do you look at for biochem tests in cancer patients?
- albumin
- B12
- Calcium
- folate
- glucose
- hemoglobin
- potassium
- lymphocyte count
albumin high
dehydration
albumin low
inflammation, protein def, sepsis, hyper hydration (too much fluids)
B12 high
leukaemia (blood cancer)
B12 high
gastrectomy
hg low
radio or chemo, blood losses, leukaemia, lymphoma, Hodgkin
potassium values
low means Tx with cisplatin
if results look whack what should you look at the interpret if dehydration screwed the results
- 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
how to measure inflammation
CRP and albumin and utilize glasgo prognosis score
what does Glasgow prognostic score tell you
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
possible nutritional diagnoses after nutrition assessment has taken place
- involuntary weight loss
- malnutrition
- dehydration
nutrition intervention
- preventative
- adjuvant
- palliative
nutritional needs: ESPEN guidelines
- energy - 25-30 kcal/kg/d
- protein - 1.0-1.5 (moderate exercise) or 1.2-2.0 (bed ridden)
- micronutrients
4 consider efficiency of feeding - assess/ communicate about potentially harmful diets (keto, fasting)
parenteral is not recommended for??
advanced cancer patients receiving chemo
what are some common complications with hematopoietic stem cell transplantation
infection- immunosuppression, symptoms of toxicity, graft-vs-host defence - skin rash, liver disfunction, GI problems
nutrition approach for hematopoietic cell transplant
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
nutrition approach for hematopoietic cell transplant
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
promising nutritional therapies for cachexia
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
how to ease symptoms of N/V
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
how to ease early satiety
- 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
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)
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
symptoms of mucositis
pain and burning when swallowing
- if severe- patient won’t eat of drink
-
what’s important for patients with mucositis
good oral hygiene- to prevent infection
what foods to give to patient with mucositis
high-pro, high energy dense milk shakes, soft, non-acidic, lots of water/liquids, non-fibrous foods, pureed foods
how to ease diarrhea symptoms in Ca patients
drink small amounts of fluid frequently, limit excess fructose ( limit fruit juices), rehydration drinks, anti-diarrhea agents, high fiber intake (soluble)
how to ease Dysgeusia- alteration in taste- (meats have a bitter taste, morning coffee tastes weird)
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
how to ease Xerostomia (reduced saliva production)
- 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
how to ease the symptoms of Anorexia
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
hematopoietic stem cell transplantation
bone marrow transplant
-
what is conditioning phase?
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
side effects of HSCT
high rate of infection and GVHD
long term complications of GVHD (more common in allogeneic HSCT)
growth retardation, infertility, endocrine failure, osteopenia, delayed gastric emptying
when is parental nutrition recommended for head and neck patients:
- 5% weight loss over last month or10% in 6 months
- ongoing dehydration, dysphagia, anorexia or pain
- severe aspiration
nutritional support for HSCT
-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
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