Ch 33: Cancer

Question 1

CA patients w/ weight loss have increased turnover of what?

Answer 1

Free FA and glycerol

Question 2

In pancreatic CA, most resectable tumors are located where?

Answer 2

Most resectable tumors are in head of pancreas, and surgery of choice is pancreaticoduodenectomy

Question 3

What is the most common nutrition impact symptom presenting with esophageal CA?

Answer 3

Dysphagia

Question 4

What type of EN formula should be selected for most CA patients?

Answer 4

Standard formula

Question 5

In which type of CA patients may clinicians place prophylactic PEG?

Answer 5

H/N CA, though ideal timing is not clear

Question 6

Which nutrition assessment tool is common and accepted approach to diagnosing malnutrition in CA patients?

Answer 6

The patient generated subjective global assessment (PG SGA) is another common and accepted approach to diagnosing malnutrition in CA patients; it has been validated for use and endorsed by AND and ASPEN for assessing nutrition status

Question 7

Many patients with pancreatic CA experience what?

Answer 7

Exocrine pancreatic insufficiency; many need pancreatic enzyme replacement therapy

Question 8

Which test is better indicator of body folate stores than serum folate and should be evaluated if folate deficiency suspected?

Answer 8

Serum red blood cell folate

Question 9

What is GVHD?

Answer 9

Specific derangements of skin, liver, and GI tract which may result in altered nutrition requirements

Allogenic HSCT is associated w/ more frequent infections and noninfectious complications caused by bacterial, fungal, or vial pathogens and can result in compromised organ function/failure

Question 10

Self-reported taste and smell alterations are prevalent in upward of what percentage of CA patients?

Answer 10

upward of 86%; may be related to proinflammatory cytokines and neuropeptide activity as well as side effects for treatments

Question 11

When would a peri-op CA patient benefit from PN?

Answer 11

Moderately to severely malnourished patients may benefit from peri-op PN if its administration is 7-14 days before surgery

Question 12

Which nutrient deficiencies are common post gastrectomy?

Answer 12

Iron, folate, B12, Calcium, and Vit D

Question 13

Which cancers have the highest risk of malnutrition is (over 80%)?

Answer 13

Patients with pancreatic, head/neck, and gastric CA.

Question 14

When is EN appropriate for patients receiving active anti-CA treatment?

Answer 14

EN is appropriate for patients receiving active anti-CA treatment who are malnourished or likely to become malnourished and likely unable to ingest/absorb adequate nutrients for > 7-14 days

Question 15

What is the treatment of choice for palliation of malignant dysphagia when feasible?

Answer 15

Self Expanding Metal Stent (SEMS)

EN via gastrostomy or jejunostomy is an effective method for nutrition support in patents with EN is indicated

Question 16

Which patients may benefit from perioperative nutrition?

Answer 16

Moderate to severely malnourished patients if EN is administered for 7-14 days pre op, but potential must be weight against risks (i.e. delaying surgery)

EN should not routinely be used in periop surgical cases

Question 17

What is the role for glutamine is HSCT?

Answer 17

ASPEN concludes that parenteral glutamine may benefit patients undergoing HSCT but there is no role for oral glutamine

Further complicating issues, there is a lack of parenteral glutamine supplementation commercially available in the US

Question 18

What can induce a systemic inflammatory response leading to characteristic metabolic derangements associated w/ CA cachexia?

Answer 18

Glycoproteins, proinflammatory cytokines, neurotransmitters, and neuropeptides

Question 19

What does the US Summit on Immune Enhancing Enteral Therapy recommend?

Answer 19

that malnourished patients undergoing GI or major H/N surgery receive 5-7 days of immune enriched formula feedings preoperatively

ASPEN suggests immune modulating EN containing arginine, nucleic acids and EFA may be beneficial in malnourished CA patients undergoing major operations

Question 20

Which complementary strategies have found to have significant benefits for reducing severity of mucositis in H/N CA patients?

Answer 20

Oral glutamine 30 g/d divided in 3 doses, 20 mL of natural honey swished daily in the mouth 3 times daily then swallowed

Question 21

CA patients have increased protein turnover which is thought to be caused by what?

Answer 21

Increased hepatic protein synthesis, increased muscle protein degradation, and impaired protein synthesis

Question 22

What are energy requirements for HSCT patients?

Answer 22

In general, energy requirements are 1.3-1.5 times basal expenditure or approximately 30-35 kcal/kg/d for patients who are not critically ill; however, lower requirements of 25-30 have been suggested for HSCT patients who are not severely malnourished

Question 23

What are they types of HSCT?

Answer 23

• Autologous is infusion of patients own stem cells harvested before conditioning therapy; whereas infusion of stem cells from histocompatibility donor is allogenic; least common is syngeneic transplant, where stem cells are harvested from identical monozygous twin

Question 24

When patients can continue adequate intake, HSCT centers should instruct patients to follow which type of diet?

Answer 24

Low microbial diets which vary in degree of sterility; food safety practices should also be taught

Question 25

Surgical resection of gastric tumors can result in what nutrition impact symptoms?

Answer 25

Dietary intolerances, weight loss, and vit/mineral malabsorption secondary to inadequate intake, malabsorption, rapid intestinal transit and bacterial overgrowth

Question 26

What type of EN formula may be used for H/N CA patient?

Answer 26

Little evidence available to determine best EN formula for use in patients with H/N CA; standard polymetric formulas w/ 1.5-2.0 kcal/mL are typically used and well tolerated (this helps limit number of feedings needed to achieve goals)

Question 27

What are protein requirments for HSCT patients?

Answer 27

Goal for protein should be 1.5-2.0 g during the first 1-3 months after transplantation

Question 28

Supplementation with which nutrient is routinely restricted during the early stages following hematopoietic stem cell transplantation (HSCT)?

Answer 28

Iron

Blood product support, hyper-transfusion, is usually required before, during and after HSCT, thus leading to iron overload. Iron overload may adversely affect the outcome of the transplant by increasing the likelihood of acute graft-versus-host disease, blood and fungal infections, and sinusoidal obstruction syndrome of the liver.

Question 29

What is tumor lysis syndrome?

Answer 29

Tumor lysis syndrome (TLS) is caused by massive tumor cell lysis with the release of large amounts of potassium (hyperkalemia), phosphate (hyperphosphatemia), and nucleic acids into the systemic circulation. Catabolism of the nucleic acids to uric acid leads to hyperuricemia. TLS most often occurs after the initiation of cytotoxic therapy.

Question 30

Methotrexate acts by interfering with the normal intracellular metabolism of which nutrient?

Answer 30

Folic acid