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Oncology > Clinical Nutrition and Dietetics > Flashcards

Clinical Nutrition and Dietetics Flashcards

1
Q

Cancer cachexia syndrome is characterized by …

A

decreased appetite and food intake with loss of body weight and lean body mass

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2
Q

Weight loss in cancer patients is associated with… (4)

A
  1. Poor performance status
  2. Increased metastatic sites and tumour burden
  3. Shorter survial
  4. Possible worse anemia and oral mucositis during chemo
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3
Q

EPCRC cachexia definition

A

A multifactoral syndrome defined by ongoing loss of skeletal muscle that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment

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4
Q

Main effects of cachexia (5)

A
  1. Physical deterioration
  2. Weakness
  3. Mental fatigue
  4. Decreased QOL
  5. Pronounced weight loss
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5
Q

Cachexia stats (3)

A

50% of patients have progressive weight loss
Cachexia is observed in 80% of advanced cancer
Cachexia is responsible for 20-40% of cancer deaths

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6
Q

In cachexia, death usually occurs when a patient has lost __% of their pre-diagnosis weight

A

30%

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7
Q

Primary causes of cachexia

A

Pro-inflammatory, pro-cachetic, and endocrine factors –> inflammatory/ metabolic changes –> increased systemic inflammation and acute phase response, protein breakdown, lipolysis, decreases in protein synthesis, lipogenesis, and appetite

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8
Q

Secondary causes of cachexia

A

Reduced appetite d/t tumor, cancer treatment, and psychological factors – pain, GI obstruction, NV, taste alteration, inactivity, pre-operative fasting, depression

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9
Q

Pathophysiology of cachexia is characterized by ___, driven by __

A

a negaive protein and energy balance; inflammation

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10
Q

Tumour cells initiate production of pro-inflammatory factors (3)

A
  1. Interleukins (IL1, IL6, IL11)
  2. Interferon-gamma
  3. TNF-alpha
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11
Q

Patient at most risk of malnourishment are… (4)

A

Lung, head and neck, GI, pancreatic cancers

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12
Q

Methods of nutritional assessment (6)

A

Diet hx, anthropometric measurements, lab tests, bioimpedance analysis, presence of nutrition impact symptoms

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13
Q

Why is weight loss an inadequate indicator of cachexia? (3)

A
  1. Cachexia is under-recognized in obese pts with sarcopenic obesity
  2. Sarcopenia can be present but obscured by accumulation of fluids
  3. Third-spacing of fluid in low oncotic pressure is an indicator of nutritional deficiency and inflammation even w/out weight loss
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14
Q

Generally albumin <2.2 g/dL reflects ___ and prealbumin <18 mg/dL reflects ____

A

severe malnutrition; decreased caloric intake

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15
Q

Nutritional focused PE findings include…

A

pallor, stomatitis, cheilosis, glossitis, thrush, quality of hair/ nails, loss of muscle mass, sunken eyes, skin turgor, bowel sounds, bloating, ascites, peripheral edema

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16
Q

Diagnosis of cachexia - primary indicators (3)

A

Weight loss >10%
Low caloric intake = 1500 kcal/ day
Systemic inflammation: serum CRP >/= 10 mg/ L

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17
Q

EPCRC cachexia diagnosis (3)

A
  1. Total body weight loss >5% in 6 mo w/out starvation
  2. Total body weight loss >2% in pt w/ BMI <20
  3. Appendcular skeletal muscle index consistent with sarcopenia (<7.26 m, <5.45 F) and >2% weight loss
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18
Q

Stages of cachexia

A
  1. Precachexia
  2. Cachexia
  3. Refractory cachexia
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19
Q

Precachexia

A

Weight loss = 5%, anorexia and metabolic change

May have poor appetite and impaired glucose tolerance

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20
Q

Refractory cachexia

A

Cancer not responsive to tx
Low performance score
<3 month’s expected survival

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21
Q

Cachexia validated questionnaires (2)

A
  1. Anorexia/ Cachexia subscale of FAACT questionnaire

2. The Scored Patient-Generated Subjective Global Assessment (PG-SGA)

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22
Q

Cachexia related progostic score

A

Glasgow Prognostic Score (mGPS)

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23
Q

Weight loss in pts is associated with … (5)

A

Chemo related side effects, fewer completed chemo cycles, reduced chemo response, increased surgical risk, decreased survival rates

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24
Q

Nutritional therapy is particularly valuable in …

A

the precachexia stage

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25
Q

Cachexia treatment multitarget support includes (4)

A

Nutrient, physical, psychosocial, pharmaceutical

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26
Q

Off-label pharmaceutical agents used

A

Progestational agents
Glucocorticoids
Cannabinoids
Anabolic agents

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27
Q

Specific nutritional recommendations for cachexia

A

Protein 1-1.5 g/kg/day
Calories min 1700 M and 1300 F –> in metastatic dz aim for 30-35 kcal/kg.d
Fluids 1 mL per 1 kcal consumed or 20 mL/kg day
Micronutrients: Vit A, B, C, D, Zn, Fe, Se deficiencies are common

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28
Q

Fish oil may affect cachexia by…

A

inhibiting pro-inflammatory cytokines that contribute to acute phase protein reponse

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29
Q

Fish oil may benefit weight maintanence in patients with…

A

Non-small cell lung cancer, head and neck cancer, pancreatic cancer, colorectal and gastric cancer undergoing chemo, pediatric cancer

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30
Q

Carnitine deficiency has been identified in ___% of patients with advanced cancer

A

78%; supplementation normalizes levels

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31
Q

How is glutamine related to cachexia?

A

Cachexia depletes skeletal glutamine; glutamine modulates protein turnover and enhances synthesis

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32
Q

Glutamine supplementation may improve…

A

Nitrogen balance, protein synthesis; revent deterioration of gut permeablity

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33
Q

Have force-feeding, appetite stimulating medications, or IV nutrition been shown to improve quality of quantitity of life?

A

No

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34
Q

Lab tests for nutritional assessment

A

CBC, electrolytes, FBG, albumin, transthyretin (prealbumin), iron panel, serum B12

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35
Q

Which cells preferentially use glutamine for energy?

A

Enterocytes, lymphocytes, macrophages

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36
Q

Common uses of glutamine (4)

A
  1. Chemo-induced mucositis (flueorouracil, anthracycline)
  2. GI toxicity of chemo and radiation
  3. Chemo-induced peripheral neuropathy (oxiliplatin, paclitaxel)
  4. Cachexia (w/ HMB and arginine)
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37
Q

Glutamine dosage

A

10-15 g TID

38
Q

Glutamine a/e and interactions

A

None common

Caution in pts w/ severe hepatic and renal impairment

39
Q

Glutamine controversy

A

Some suggest that tumors are dependent on glutamine for growth and maintanence; this is mostly refuted

40
Q

Fish oil may benefit cachexia in ….

A

muscle and weight maintanence in non-small cell lung cancer, head and neck cancer, colorectal and gastric cancer, and pediatric cancer

41
Q

Fish oil may benefit patients in chemotherapy by…

A
  • reducing peripheral neuropathy (paclitaxel)
  • improving neutrophils number and function
  • improving QOL and functional status (stage III lung)
  • may increase efficacy of chemo (metastatic breast, NSCLC)
42
Q

Fish oil may reduce the efficacy of which chemotherapy?

A

Cisplatin

43
Q

Fish oil dosing

A

2-3 g EPA and DHA

44
Q

Fish oil adverse effects

A

Nausea, loose stools

Possible anticoagulant effect (not show post surgery)

45
Q

Which fatty acid in fish oil may create chemo-negating effects?

A

16:4(n-3)

46
Q

Flaxseed has chemoprotective effects in post-menopausal women by …

A

altering estrogen metabolism, increasing the ratio of 2-hydroxyestrogen to 16 alpha hydroxyestrone

47
Q

Flaxseed is commonly used in …(4)

A
  1. Breast cancer
  2. Prostate cancer
  3. Hot flashes
  4. Constipation and diarrhea
48
Q

Flaxseed’s effects on breast cancer include… (3)

A
  1. Prevetion
  2. Decrease in proliferation and growth
  3. Increase in apoptosis via upregulating p53
49
Q

Flaxseed’s effects on prostate cancer include… (2)

A
  1. inhibit proliferation of

2. Lower total and free T, PSA

50
Q

Flaxseed dosage

A

25 g (2-3 tablespoons) freshly ground, with water

51
Q

Flaxseed adverse effects

A

Initial gas and bloating, constipation

Inhibit absoprtion of other medication

52
Q

Fermented Wheat Germ Extract uses (4)

A
  1. Melanoma
  2. Colorectal cancer
  3. Head and Neck
  4. Febrile neutropenia
53
Q

Fermented wheat germ extract and melanoma

A

Improved survival and progression-free survival in stage III when combined with decarbazine

54
Q

Fermented wheat germ extract and colorectal cancer

A

Reduced metastases, higher overall survival, longer progression-free survival combined with radiation or chemo

55
Q

Fermented wheat germ extract and head and neck cancer

A

Fewer local relapses and progressions in stage II and III

Better quality of life in stage III and IV

56
Q

Fermented wheat germ extract and febrile neutropenia

A

Reduced incidence in pediatric cancer

57
Q

Fermented wheat germ extract dosage

A

one sachet in water once a day; possbily increased in people >90 kg

58
Q

Fermented wheat germ extract adverse reactions and interactions

A

Mild and infrequent diarrhea, nausea, flatulence, soft stool, constipation, dizziness
Take 2 hours away from foods/ supplements with vitamin C

59
Q

Fermented wheat germ extract contraindications (5)

A
  1. Pregnant and nursing women
  2. Pts w/ organ or tissue transplants
  3. Pts w/ bleeding gastric or duodenal ulcers, enteritis/ colitis, malabsorption syndrome
  4. Pts w/ sensitivity to gluten or fructose
  5. W/in 2 days of barium X-ray contrast
60
Q

Probiotics mechanisms (3)

A
  1. antimicrobial against pathogenic bacteria via reducing pH, secreting antimicrobial peptides, inhibition of bacterial invasion and adhesion
  2. Enhancing barrier integrity and function via SCFA (ie butyrate)
  3. Immunomodulation via action on epithelial cells, dendritic cells, monocytes/ macrophages, lymphocytes
61
Q

Probiotic main use in cancer

A

Treating intestinal toxicity from chemo and radiation

62
Q

Probiotics and intestinal toxicity

A
  1. Less diarrhea, abdominal discomfort, less hospital care, fewer reductions in chemo dose (fluorouracil)
  2. Generally less diarrhea, fewer bowel movements, less severe diarrhea, need for antidiarrheal medication (radiation)
63
Q

Probiotics adverse effects and interactions

A

Generally none, may temporarily increase gas

Theoretical risk of sepsis in cancer pts with neutropenia

64
Q

Vitamin D anticancer effects are thought to be due to….

A

induction of cell differentiation, antiproliferation, and angiogenesis, may enhance effects of cytotoxic agents

65
Q

Vitamin D in oncology (2)

A
  1. Improved prognosis

2. Bone health (w/ bisphosphanates)

66
Q

In which cancers does vitamin D improve prognosis? (4)

A

Prostate, colorectal*, CLL, large B-cell lymphoma

67
Q

Dose vitamin D w/ caution d/t hypercalcemia in which cancers? (8)

A

multiple myeloma, breast, parathyroid, lung, kidney, lymphomas, leukemias, any advanced cancer with bone metastases

68
Q

Vitamin D dosing

A

Base on serum levels - he goe for 100-125 nmol/L

69
Q

Vitamin D adverse effects

A

GI sxs, renal disease, nephrolithiasis, hypercalcemia, hypercalciuria

70
Q

Monitor vitamin D supplementation in the following conditions (7)

A

kidney stones, kidney disease, hypercalcemia, GI disease, heart disease, liver disease, other dzs associated with calcium metabolism

71
Q

Nutritional supplements CI in cancer (4)

A

Iron, copper, folic acid, L-arginine

72
Q

How/ why is iron supplementation CI in cancer?

A

catalyzes oxidative damage; may be involved in initiation

Should only supplement a deficiency

73
Q

How/ why is copper supplementation CI in cancer?

A

Important factor in angiogenesis

only supplement w/ known deficiency

74
Q

How/ why is folic acid CI in cancer?

A

its role in methylation may promote progression

Supplement w/ caution in cancer or pre-cancerous

75
Q

Why is l-arginine CI in cancer?

A

Stimulates IGF-1, known growth factor of many common cancers

76
Q

Why are antioxidants often discouraged during chemo and radiation?

A

chemo/ radiation are cytotoxic through oxidative stress

77
Q

What evidence supports antioxidant use during chemo/ radiation? (3)

A

Cancer cells may not be able to use them
Antioxidants may protect healthy cells without protecting cancerous
Many antioxidants are pro-oxidant in certain situations; may increase cytotoxicity in cancer cells

78
Q

What is the Breuss cancer cure?

A

42 day fast with vegetable juices (500 ml) and teas (sage, kidney, cranesbill)

79
Q

What is the main concern with the Breuss cancer cure?

A

could result in malnutrition, risk discontinuing conventional care

80
Q

What is the Budwig diet?

A

lacto-vegetarian + mixture of ground flaxseed and cottage cheese/ quark
All foods fresh, organic, raw

81
Q

What did Budwig think cancer was caused by?

A

inadequate cell maturation and incomplete cell growth, impaired cellular maturation

82
Q

What is the Gerson Therapy?

A

Organic and vegetarian diet + 13 glasses of juices
Suplements
Coffee enemas up to 5x daily

83
Q

What are harms associated with the Gerson therapy?

A

Weight loss, electrolyte imbalances

Does not recommend chemotherapy

84
Q

Which type of cancer is particularly vulnerable to ketosis?

A

Brain tumors

85
Q

Those who stayed on the ketogenic diet reported what findings?

A

improved emotional functioning, less insomnia

86
Q

What is the Ornish Diet and Lifestyle Modification Program?

A

Supplemented low-fat vegan diet w/ exercise, stress management, smoking cessation, and group support sessions

87
Q

What were hte effects of the Ornish diet?

A

In prostate cancer, lowered PSA and fewer pts undergoing conventional tc

88
Q

What supplements are part of the Ornish program?

A

Soy protein, vitamin E, selenium, vitamin C

89
Q

Generally, what effect does melatonin have when combined with chemotherapy?

A

Higher tumor regression rate, 5-year survival, better complete and partial response, better tolerance of chemotherapy (all done by same authors)

90
Q

What is the primary use of CoQ10 in chemotherapy?

A

Prevention of anthracycline-induced cardiotoxicity, poss other chemo toxicity

91
Q

What does fasting do to chemo?

A

Better effectiveness, possibly less metastases and disease free survival
Improved QOL in people

Oncology (7 decks)

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