Haematological Cancers Nutrition Support Flashcards
What type of Cancers are these?
Haematological cancers involve the blood or lymphatic system.
Leukaemia
Lymphoma
Myeloma
Myelodysplastic syndromes
Lymphoproliferative disorders
What are the two types of stem cell transplants?
Autologous - the patient is given back their own cells
Allogeneic - donor cells
What is GvHD?
Are there any nutritional requirements for this?
GvHD = Graft versus host disease
Treated with immunosuppressants.
Nutritional requirements are raised in acute GvHD (first 100 days).
Chronic GvHD patients have elevated resting energy expenditure which may contribute to chronic weight loss
What are the side effects of chemotherapy?
Nausea/ Vomiting
Taste Changes
Stomatitis
Mucositis
Oesophagitis
Diarrhoea
Constipation
Neutropenia
What does mucositis effect?
It affects the GI tract, resulting in mouth or throat pain or ulceration, abdominal pain, nausea, vomiting and diarrhoea.
Upto 80% of SCT patients will experience severe mucositis.
What type of nutrition support is recommended for these patients?
Parental Nutrition is recommended for SCT patients due to mucositis. However, there are infection risks in this immunocompromised group.
Enteral Nutrition is recommended for situations where GI tract remains accessible and functioning. However feeding tube needs to be placed prior to development of mucositis to avoid pain and damage to mucosal.
Why is it important to monitor nutritional status in these patients?
High risk of developing malnutrition
Improve tolerance to chemo and radiotherapy
Maintenance of immunocompetence
How does GvHD cause Nutritional Complications
Acute GvHD affects mainly the skin, liver and GI tract.
Mild to severe gastrointestinal impairment may develop. Mucosal diarrhoea with severe nitrogen loss, to mucosal ulcers and perforation needing emergency surgery.
Chronic GvHD may impair both nutritional oral intake and intestinal nutrient absorption.
Nutritional Complications of HSCT
Negative nitrogen balance.
It is generally assumed that HSCT patients have an increased energy expenditure
Steroid medications may negatively affect CHO metabolism and induce impaired glucose tolerance.
HSCT may negatively affect beta-cells function and induce glucose intolerance .
In initial phase of HSCT lipid metabolism is normal. Patients on long term cyclosporine treatment have elevated serum- cholesterol and triacylglycerol concentrations.
Vitamin status may be altered due to poor intake and malabsorption of vitamins secondary to intestinal mucositis.
Problems in assessing Nutritional status
Anthropometric measurements may be influenced by fluid and electrolyte disturbances
Biochemical indices do not accurately reflect changes in nutritional status.
Nitrogen balance is the best form of measurement of nutritional status. however urine collection may be difficult.
Nutrition and Metabolic support (in terms of Energy/Fat and Protein) following HSCT
Energy - 130-150% of predicted Basel energy expenditure
Lipids- 30-40% of non-protein energy
Protein - 1.4-1.5g/kg body weight per day
