Chapter 4: Nutritional Needs of the Adult Oncology Patient

Question 1

What is the gold standard for predicting energy requirements?

Answer 1

Indirect Calorimetry

Question 2

What patients are at risk of refeeding syndrome?

Answer 2

Several conditions are risk factors for refeeding – anorexia, alcoholism, prolonged starvation, morbid obesity with substantial weight loss, and chronic diseases like cancer and cirrhosis

Question 3

Which predictive equation is best at predicting RMR in non-obese and obese populations?

Answer 3

Mifflin-St Joer

Question 4

True or False: Using body weight alone, the estimated calorie needs per kg for a cancer patient needing weight gain is 30-35 kcal/kg

Answer 4

True

Question 5

Name the different general medical conditions that can affect vitamin and mineral levels

Answer 5

Alcoholic liver
Renal Failure
GI fistulas and diarrhea
Loss of Bile
Pancreatitis
Chylous leaks and fistulas
Gastrectomy or terminal ileum resection
Bariatric surgery (Roux-en-Y and banding)
Critical Illness

Question 6

Micronutrient deficiencies in an already ill person can affect various biochemical processes and enzyme functions. This can lead to:

Answer 6

Muscle Weakness
Poor wound healing
altered immunity

Question 7

What is a long term consequence of both over and under feeding in the oncology population?

Answer 7

immunosuppression

Question 8

What energy level would an RD consider initiating nutrition support for individuals at risk of refeeding syndrome and then monitor electrolyte levels for the ability to advance to better meet needs?

Answer 8

20 kcal/kg or 1000 kcal/day

Question 9

According to the AND pocket guide for nutrition assessment, what are the protein requirements for metabolically stressed individuals?

Answer 9

1.5 g/kg of body weight per day

Question 10

What energy needs (kcal/kg) would you recommend, based on ASPEN guidelines, for a 62 yr old female, 65”, 108# with pancreatic CA and anticipating surgery

Answer 10

30-35 kcal/kg of body weight

Question 11

You are assessing a lung CA patient, initiating chemotherapy. No WT loss, is 15# overweight, and appears healthy/content. What range would you use for his protein needs?

How would you quickly assess his energy needs?

Answer 11

1-1.5 g/kg of body weight

25-30 kcal/kg of body weight

Question 12

What is not an appropriate method for estimating fluid needs?

Answer 12

1.5 x reported urine volume

Appropriate methods:
ASPEN - 20-40 ml/kg or 1-1.5 ml/kcal energy expended
RDA - 1 ml/kcal consumed
BSA - 1500 ml/m2 or BSA x 1500 ml

Question 13

80 yr old male s/p neck dissection with slight Wt loss post-op. Starting chemo-radiation for H&N CA. 69”, 172#. What would you use for his needs (energy and protein)?

Answer 13

30-35 kcal/kg and 1-1.5 gm/kg

Question 14

Patients with GI cancers that develop fistulas and/or diarrhea are at risk of having low levels of what micronutrients?

Answer 14

Zinc and Selenium

Question 15

What type of cancer has shown not to have a significant different in energy expenditure from control patients?

Answer 15

Colorectal

Question 16

What type of cancer has shown to have significant higher energy expenditures from control patients?

Answer 16

Esophageal
Gastric
Pancreatic
NSCLC

Question 17

For a patient at risk for refeeding syndrome, what should calorie repletion start at?

Answer 17

15 kcal/kg

Question 18

What labs should be monitored if you are worried about a patient at risk of refeeding sydrome?

Answer 18

K
Mg
Phos
Gluc

Question 19

What serum vitamin and mineral levels are effected by the inflammatory process?

Answer 19

Decrease: vitamins A, C, and E. Selenium, copper, iron, and zinc levels.

Lower levels of iron help protect against bacterial infections, therefore lower levels of trace minerals may occasionally be beneficial.

Typically not affected: thiamin, riboflavin, vitamin B-12, folate

Question 20

What are the acceptable macronutrient distribution ranges for adults?

Answer 20

fat 20-35% of calories
carbohydrates 45-65% of calories
protein 10-35% of calories

Question 21

Thirst is the main determinant but not always a reliable gauge for fluid needs. The formula for calculating fluid needs using BSA is:

Answer 21

1500ml/m2

Question 22

Gastrectomy or terminal ileum resection can cause a decrease in which 2 nutrients?

Answer 22

Iron and B12

Question 23

Critical illness can cause a decrease in which vitamin, despite supplementation?

Answer 23

Vitamin C