Nutritional Management of CA Patients Flashcards
patients with increased risk for malnutrition
- smoking hx
- low socioeconomic status
- poor performance status
- older age
t/f 20% of ca patients die because of malnutrition
true
top 5 nutrition impact symptoms across all cancers
anorexia dry mouth nausea smell intolerance taste changes
severity of weight loss depends on ___
cancer type, cancer stage, type of surgeries and treatment being done to the patients
release of cytokines lead to __
hypermetabolism, anorexia, lean body mass loss, decreased adipose tissue
tumor related factors drive up proteolysis and lipid mobilization causing ___
losses in lean body mass and losses in adiposity
a complex metabolic syndrome associated with underlying illness characterized by muscle loss with or without fat loss
cachexia
prominent features of cachexia
adults: weight loss
children: growth failure
symptoms of cachexia
unintentional weight loss, anorexia, skeletal muscle wasting, lowered quality of life
t/f cancer cachexia always has fat mass loss
false, can be with or without this
t/f cancer cachexia cannot be fully reversed by conventional nutritional support
true
t/f cancer cachexia leads to progressive functional impairment
true
pathophysiology of cancer cachexia
negative protein energy balance driven by reduced food intake and abnormal metabolism
central pathophysiological problem in cancer cachexia
- inflammation
- interaction of cytokines and hypothalamic systems interacting with hypothalamus (center for appetite)
in cancer cachexia, neurotransmitters ad proinflammatory cytokines interact with the brain resulting to ___
- decrease in orexigenic signals (lower appetite stimulation)
- increase in anorexigenic signals (lack of appetite goes up)
t/f anorexia is just reduced intake
false, the brain is not functioning well to tell the patient that they have to eat!!
treatable causes of weight loss
MEALS ON WHEELS
medications emotional problems anorexia late-life paranoid swallowing disorders
oral factors
no money
wandering (dementia) hyperthyroidism hyperparathyroidism hypoadrenalism enteric problems eating problems (inability to feed self) low salt, low cholesterol stones, social problems
t/f involuntary weight loss combined with low muscle mass was more closely associated with poor quality of life than involuntary weight loss along in community dwelling oler adults
true
what is sarcopenia
muscle wasting
methods for assessing sarcopenia
- muscle mass: calf circumference
- muscle strength: handgrip strength, handshake test, handgrip dynamometer
- performance: sppb, get up and go, 6 min walk
patient profile in precachexia
- normal
- weight loss is less/= 5%
- some anorexia
- some metabolic changes
treatment for precachexia
- monitor and prevention
- be aggressive and manage nutritional status
patient profile in cachexia
- weight loss >5% OR
- bmi < 20 AND weight loss >2% OR
- presence of sarcopenia and weight loss (>2%)
- often with reduced food intake/ systemic inflammation
treatment for cachexia
multimodal approach to reversible factors
patient profile in refractory cachexia
- variable degree of cachexia
- cancer disease both pro-catabolic and no longer responsive to anticancer treatment
- low performance score
- <3 mos expected survival
treatment for refractory cachexia
- palliation and ethics
- patient is prepared for eventual death
adverse effects of radiation therapy depends on
- individual or host response
- severity/dose of radiation
- site of radiation administration
most vulnerable sites to adverse effects of radiation and chemo therapy
- skin
- internal mucosa
- immune system
common effects of radiation therapy in h&n cancer
- salivary glands dry up
- oral mucositis
- swallowing defects
- esophagitis
adverse effects of chemotherapy depend on ___
- agent used
- dose and route of administration
- length of therapy
common side effects of chemo
- constipation, diarrhea, vomiting
- fatigue, pain
surgical effects on gi function
- tumor site
- extent of resection
- adjunctive therapies used
espen guidelines on malnutrition in ca pts
- screen them first and assess if there’s malnutrition
- how aggressive is the malnutrition
- where is the malnutrition coming from
part one of the pg-sga (patient-generated subjective global assessment)
patient info
- weight history
- food intake
- symptoms impairing food intake
- activities and function
part 2 of the pg-sga
healthcare professional scoring
- quantifies, qualifies, and scores:
- weight loss
- disease and relation to nutritional demang
- metabolic demand
- nutrition focused PE
t/f you can give the same amount of proteins to a ca patient and a normal pt
false, you must give at least more than 1 g/kg. give more than the rda
t/f majority of ca patients can eat regular diets
true
symptoms and factors affecting diminished nutrient intake
table 2
one way to maximize oral feeding is with ___
oral nutritional supplements or foods for special medical purposes
content of ons
- carbohydrates (lactose free)
- fats (essential fa or omega 3 fats)
- proteins
- fiber
- water
how to select ons
acceptable, available, affordable
t/f we must exhaust all tehcniques and methods of oral feeding before considering tube feeding
true
purpose of neutropenic diets
to avoid food more likely to contain infection causing bacteria
indications of neutropenic diets
- allogeneic transplants
- autologous transplant (until 3 mos after)
- chemo/radio
(chemo pts and bone marrow transplant pts who are extremely immunocompromised)
t/f there is sufficient evidence to keep allogeneic transplant patients on the neutropenic diet for 30 days
false
a more practical guide to the neutropenic diet
- keep food clean
- proper hand hygiene
- avoid cross contamination
- cook the food to proper temp
- refrigerate properly
usual diet vs ketogenic diet
usual: 50-55% carbs, 15-20% protein, 25-30% fat
ketogenic: 70-90% fat, 8-10% protein, 2-5% carbs
potential risks of ketogenic diet
- inducing weight loss = NO NO!
- acute and chronic effects
how to stratify patients in palliative care
life expectancy
considerations for patients with life expectancy of >3 mos to years
improve nutritional status!!
- treat reversible cause of anorexia
- note goals of care:
- weight stabilization or gain
- improve symptoms that interfere with intake
- improved energy
- resolution of metabolic and endo abnormalities
considerations for patients with life expectancy of < 3 mos to weeks
- quality of life and wishes of family
- goals of care: read
- nutrition support may not change outcomes, but lessen distress
