Chapter 8: Nutr & Survivorship Flashcards
“Cancer Survivor” definition per textbook
Those living after initial cancer therapy, primarily those who are disease-free or with stable disease
These 3 cancers make up the majority of cancer survivors
- Breast
- Prostate
- Colorectal
*they’re typically diagnosed more often at an early stage d/t screenings
T/F: People who survive cancer are more likely to modify their diet rather than other behaviors (smoking, physical activity, alcohol)
True
The early survival period post-therapy is typically considered up to ____________
12 months
What should be the primary nutrition goal during the early survival period?
Reduce persistent therapy-related side effects within the GI tract
Weight ______(gain or loss) is common during the initial survival period
Gain, which puts survivors at risk for sarcopenic obesity
2 most common side effects post-treatment for ALL cancers:
- Fatigue
- Weight change/change in body composition
5 tips for management of fatigue
- Develop an individualized eating plan and involve caregivers
- Choose easy to prepare & easy to eat foods
- Use medical nutrition beverages
- Monitor wt/nutrition status
- Encourage physical activity as tolerated
3 tips for management of weight change/changes in body composition
- Monitor wt
- Ensure intake is balanced to maintain or achieve a healthy weight
- Promote physical activity, including resistance training & weight-baring exercise
3 most common side effects of BREAST cancer
- Impaired bone health
- Weight gain/metabolic syndrome
- Cardiovascular complications
2 tips for impaired bone health
- Ensure adequate intake of calcium & vitamin d
- Promote weight-baring exercises if appropriate
2 tips of managing weight gain/metabolic syndrome
- Adjust kcal and macronutrients for BG control & improved lipids
- Promote physical activity to meet guidelines for survivors
2 tips to monitor cardiovascular complications
- Plant-based diet
- Weight control
2 most common side effects of prostate cancer
1.Impaired bone health
2. Enteritis (inflammation of intestine) & chronic diarrhea
2 tips to manage enteritis/chronic diarrhea
- Increase fluids and balance electrolytes
- Decrease fat, ALTER fiber, limit dairy if needed
2 most common side effects of lung/bronchus cancer
- Esophageal pain/dysphagia
- Respiratory failure
5 tips to manage esophageal pain/dysphagia
- Alter consistencies
- Alter food temperatures and avoid irritants (alcohol, spicy, acidic) - esophagitis only
- Monitor nutrition status & wt
- ONS
- Consult SLP for H&N cancers
2 tips to manage respiratory failure
- Monitor & correct fluid balance
- Decrease CHO intake if needed
6 most common side effects from colorectal cancer
- Malabsorption
- Altered liver function/cirrhosis
- Weight change
- Irregular BMs
- Enteritis/chronic diarrhea
- Bowl strictures or obstructions
3 tips for managing malabsorption
- Increase of modify nutrients of foods that are malabsorbed
- Monitor nutrition status /weight
- Consider PERT (only for pancreatic cancer)
3 tips for altered liver function, cirrhosis
- Increase intake malabsorbed
- Monitor liver enzymes
- MNT for cirrhosis (high pro, low sodium)
3 tips for irregular bowel movements
- Alter fiber intake
- Consume adequate fluid
- Use pre/probiotics if appropriate (ONLY for colorectal & pancrease)
1 tip for managing bowel structure or obstruction
EN or PN if needed
1 most common side effect for urinary bladder
Irregular BMs
1 most common side effect of Uterine cancer
Impaired bone health
1 most common side effect of hypothyroid cancer
Hypothyroidism
2 tips for managing hypothyroidism
- Adjust energy to maintain a healthy wt
- Physical activity to meet guidelines for survivors
2 most common side effects of Non-Hodgkin Lymphoma
- Metabolic syndrome
- Hypothyroidism
3 most common side effects for kidney cancer
- Decreased creatinine clearance
- Hypertension
- Renal failure
Main guidance for renal failure & decreased creatinine clearence
Individualize - monitor labs and adjust MNT based on stage/alabs
3 tips for management of hypertension
- Monitor/adjust sodium intake (usually reduce)
- Promote wt loss and physical activity as appropriate
- Promote adequate intake of potassium and calcium
3 most common side effects for H&N cancer
- Xerostomia
- Dysphagia
- Tooth dental/periodontal disease
6 tips for management of Xerostomia
- Ensure nutrient requirements are met PO
- Consider nutrition support if needed
- Promote intake of “wet” foods
- Good oral care
- ONS
- Alter food and beverage consistency it needed
5 tips for management of tooth decay/peridontal disease
- Alter food and beverage consistency as needed
- ONS
- Alter food temp for tooth sensitivity
- Alter types of food is dysgesia is an issue
- Consult a dental professional
4 most common side effects for Leukemia
- Kidney stones
- Impaired bone health
- Metabolic syndrome
- Hypothyroidism
1 tip for management of kidney stones
Increase fluid intake to recommended levels
3 most common side effects for Ovarian cancer
- Impaired bone health
- Bowel strictures or obstructions
- Irregular bowel movements
2 most common side effects for pancreatic cancer
- Malabsorption
- Irregular BMs
Pairing RDs with ___________ or _____________ is advised for optimal progress for those who need to increase lean mass
Exercise physiologists or physical therapists
Analysis from __________ & _________ can provide assessment on bone health and lean body mass
CT & Dexa
BIA is also OK for lean versus fat mass
3 nutrients important for bone health
- Calcium
- Vitamin D
- Magnesium
Early in survivorship, biochemical data is typically used to assess for deficiencies but it’s also important to monitor ____________, ____________, & _____________ which may impact diet intervention
HLD, Hyperglycemia, inflammatory labs (i.e. CRP)
T/F: patients on more toxic therapies tend to have more difficulty meeting micronutrient needs without oral supplementation
True
The main nutritional goal after the early post-treatment phase (> 12 months) shifts towards….
Health promotion & cancer prevention
(higher risk for chronic disease & cancer recurrence)
Obesity is associated with risk for _____ different cancer. May predict poorer prognosis & decreased survival
13
Findings from SUCCEED trial on obese survivors of endometrial cancer regarding relationship with food
Women tend to seek high energy foods as a reward. Coaching and understanding this relationship mat help.
*fatigue may also drive people to seek higher energy foods
The ideal weight loss program should include… (3)
- Healthy food choices (meal patterns, portion control)
- Physical activity (including weight baring/resistance)
- Individualized behavior modification
Successful behavioral strategies for improving diet/physical activity in survivors includes (3)
- Motivational interviewing
- Self-efficacy (belief in self)
- Self-determination theory (internal motivation)
Alcohol may alter _________ (nutrient) status, influence aromatase activity, contribute low nutrient-density, or contribute to high energy-dense snacks. Thus should be limited or avoided by all cancer survivors.
Folate status
What is Aromatase?
Enzyme that turns testosterone into estrogen
Fiber goals for cancer survivors?
Strive for US population recs, 25-30 g
A recent study of healthy post-menopausal women indicated that ______
amount of protein intake per day is associated with reduced musculoskeletal
frailty
1.2 g/kg
There is a common and steady reduction in skeletal muscle mass, an increase
in fat to lean mass ratio, and an increase in osteopenia/osteoporosis in those over
the age of…
75
Protein needs for cancer survivors > 50, reduced fraility
1.2 g/kg
