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S and P- Nutrition > Nutrition and the cancer patient > Flashcards

Nutrition and the cancer patient Flashcards

1
Q

10 most common cancers?

A 
Prostate
Lung
Bowel
Bladder
NHL
Malignant melanoma
Kidney
Oesophagus
Leukaemia
Brain tumours
Other sites
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2
Q

What are the three most common cancers in men?

A

Prostate, lung and bowel

Account for 50% of male cancers

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3
Q

What are the three most common cancers in women?

A

Breast, lung and bowel

Over 50%

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4
Q

Which cancer accounts for most deaths?

A

Lung

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5
Q

How effective is nutritional support in lung cancer therapy?

A

Little evidence that dietary therapy in patients with lung cancer undergoing radiotherapy has an effect on patient or clinical outcomes- randomised controlled trials are needed

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6
Q

Which cancer patients are at high risk of weight loss?

A

Upper GI: stomach, pancreatic (secretions affected and cytokines released by tumours causing cachexia), head and neck
Medium- Prostate, colon and lung
Low- Breast, sarcoma and favourable NHL

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7
Q

What are the consequences of weight loss?

A 
Reduced immunity
Impaired muscle function, weakness
Impairments to organ functions e.g. cardiac and respiratory
Reduced mobility, loos of independence
Reduced quality of life
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8
Q

What does the therapeutic index dictate?

A

Ability of patient to cope with toxic treatment that they are given

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9
Q

What is therapeutic index scaled to?

A

Weight, height, body surface area +/- GFR, +/- blood levels

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10
Q

What does too much therapy lead to?

A

Toxicity

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11
Q

What does too little therapy lead to?

A

Ineffective treatment

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12
Q

What is the greatest risk factor for response to therapy?

A

Sarcopaenia

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13
Q

What is sarcopaenia?

A

Loss of muscle mass

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14
Q

In what way is the relationship between sarcopenia and txicity a two way process?

A

Toxicity aggravates loss of weight and muscle

Weight loss and sarcopenia enhance toxicity

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15
Q

What is sarcopenia associated with?

A

More treatment delays
Dose reductions
Termination of treatment
Decreased OS in age, sex, stage and performance matched patients

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16
Q

What are the 5 main causes of malnourishment in lung cancer patients?

A 
Iatrogenic causes of decreased intake
Inadequate symptom control
Site of tumour- functional and physiological causes of malnutrition
Increased metabolic rate
Cancer cachexia
17
Q

What iatrogenic causes of decreased intake are there?

A

Decreased intake, increased expenditure and increased losses
Surgery- pain and fatigue, SOB
RadioTx: odynophagia (painful swallowing, fatigue, dysgeusia (altered taste) due to low saliva production all cause patient to eat less
Chemotherapy:
-Fatigue, nausea, anorexia and dysgeusia
-Vomiting and bowel changes (directing chemo at absorptive surfaces of gut will cause diarrhoea)- energy losses
- Infection will cause increase expenditure
-Mucositis

18
Q

What is the relationship between symptoms and amount of weight loss?

A

Weak significant association

19
Q

What are the common symptoms?

A 
Most common to least:
No appetite
Early satiety
Pain
Taste changes
Nausea
Dry mouth
Constipation
Vomiting
Diarrhoea
20
Q

Which sites of tumours can lead to weight loss?

A

GI function/motility- changes affecting absorption of food
Obstructions of tumours in GIT- in head and neck cancer- difficult to eat
Malabsorption- cancer/mets in small intestine

21
Q

What happens to BMR in vast majority of cancers as cancer progresses?

A

It increases

22
Q

What are the two different definitions of cachexia?

A

Multifactorial syndrome that leads to ongoing loss of skeletal muscle with/without loss of fat mass. Can’t be fully reversed by conventional nutritional support and leads to progressive functional impairment

Specific metabolic response brought about by the presence of tumour, either from the tumour itself or its metabolites and stimulation of immune/acute phase response.

23
Q

What defines an increased inflammatory response/status?

A

Increased CRP, IL-1, IL-6, IL-10 and TNF-alpha

24
Q

What are the symptoms of cancer cachexia?

A

Reduced food intake/anorexia
Fatigue
Weight loss- muscle and fat
Weakness
Impaired immunity
Can be masked by oedema or obesity- very important in certain cancers e.g. breast, people remain overweight
Early cancer patients less likely to have cachexia than metastatic patients

25
Q

What are the key differences between starvation and cancer cachexia?

A

The key differences are in cachexia,glucose (lowered in starvation) and protein metabolism (not increased in starvation, protein is preserved) are elevated; and there is rapid weight loss (slow in starvation) due to increased energy expenditure

26
Q

Give an overview of cancer metabolism?

A

Tumour uses glucose to fuel itself- via anaerobic metabolism. Therefore no ATP is generated, instead lactate is which is delivered to liver and reprocessed into pyruvate -> glucose
Increased glucose cycling causes protein to be pulled from muscle to mett tumours demand for glucose. Release of TNF causes an increased breakdown of muscle to fuel the cancer.
With so much glucose used by the tumour, the body relies on fat metabolism to fuel itself
This causes preferential loss of lean body tissue. Increased muscle turnover and decreased synthesis, upregulated proteolytic pathways come into play
Increased lipolysis is required for liver to convert lactate into glucose which is very energy costly. This fuels the liver

27
Q

What are the stages of cancer cachexia?

A

Precachexia- weight loss is 5%. Anorexia and metabolic change

Cachexia- Weight loss is >5%.
or BMI<20 and weight loss >2%
or sarcopenia and weight loss>2%
Often reduced food intake and systemic inflammation

Refractory cachexia- Variable degree
Cancer disease both pro-catabolic and not responsive to anti-cancer treatment. Low performance score. <3m expected survival

28
Q

What are the goals of nutritional support in cancer?

A

Depends on what you’re trying to do and where patient is in their treatment pathway and what is happening:
Prevent/treat cancer therapy related malnutrition and/or weight loss
Increase treatment efficacy
Increase strength and quality of life

29
Q

What are quality of life scores determined by?>

A

Tumour site- 30%
Weight loss- 30%
Intake- 20%

30
Q

When should artificial nutritional support be given (tube or IV)?

A

Moderatly-severely malnourished patients if given 7-14 days pre-op
Anticipated inability to ingest/absorb nutrients for 7-14 days in malnourished at risk patient receiving treatment

31
Q

When should you not give artificial nutrition?

A

As routine adjunct to surgery or chemo

Terminal illness- Rarely results in weight gain or altered outcome

32
Q

Between breast and lung cancer, which patients are at greater risk of wasting?

A

Lung

33
Q

What are the dietary recommendations for a cancer patient?

A

Decreased saturated fat
Increased intake of fish
Variety is good- maximise essential vitamins and minerals
Increase carotenoid containing fruit and veg
Prostate- increase soy intake
Colorectal- increase fibre

34
Q

What are the physical activity recommendations for cancer patients?

A

At least 30 minutes 5 or more days/week
Even modest amounts help -> dose-response relationship
Exercise to improve lean body mass most useful in GI, head and neck cancers
Exercise to control body weight and lose body fat most useful in breast cancer

35
Q

Give summary points for lecture?

A

Malnourishment is common in cancer patients and multifactorial
Important for all team to consider early nutritional intervention
Important to effectively manage symptoms
Metabolic changes due to cancer can’t be reversed without treating underlying cause first
Nutritional support is important in- improving oral intake, help with symptoms and side effects, improve tolerance to treatments, improve rehab potential, enhancing quality of life
Improved detection and treatment result in increased numbers living with and beyond cancer which changes emphasis of advice for cancer survivors
Not a single disease and requires holistic approach

S and P- Nutrition (15 decks)

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