Sample Test Flashcards
Folate in the form of calcium leucovorin may be used to “rescue” patients from what drug/treatment toxicity?
Methotrexate
Why are blood tests used to test for cancer?
To determine levels of circulating tumor cell metabolites.
Which is not an external factor that acts together to initiate or promote the carcinogenic process?
A) Sunlight exposure
B) Unhealthy diet
C) Hormones
D) Smoking
Hormones
Which vitamin, once carcinogenesis is initiated, provides substrate for DNA synthesis & accelerates cancer cell proliferation & tumor expansion?
Folate
What nutrient has been shown to play a number or roles in DNA protection, and DNA repair including induction of cell cycle arrest?
Selenium
What are the compounds in garlic that may block the formation and activation of carcinogens, enhancing DNA repair, reduce cell proliferation and/or induce apoptosis.
Ally sulfur compounds
Which bioactive compound found in cruciferous vegetables has been shown to influence estrogen regulation, induce cell cycle arrest & apoptosis, inhibit angiogenesis, and suppress inflammatory responses?
Indole-3-carbinol
Research shows that moderate soy consumption does not increase cancer risk and in some cases may lower it. What is considered moderate intake in serving sizes?
1-2 servings (7-14gm soy protein, 25-50mg isoflavones)
What are some examples of foods that contain soy proteins, isoflavones?
Tofu Soy milk Soy protein isolates Edamame Textured vegetable proteins Soy nuts
True/False-Curcumin, a polyphenol in turmeric, may induce cell cycle arrest (apoptosis) and inhibit the formation of the blood supply to a growing tumor (angiogenesis).
True
TNM Classification System-What does T signify?
T-Tumor grade (Tx, T0, Tis, T1, T2, T3, T4) reflects the size and/or extent of the tumor.
TNM Classification System-What does N signify?
N-Lymph node grade (Nx, N0, N1, N2, N3) is for the extent of spread to local lymph nodes
TNM Classification System-What does M signify?
M-Metastasis grade (Mx, M0, M1) indicates the presence of distant metastasis
Which nutrients play a protective role in the body’s natural ability to provide DNA repair and apoptosis to initiated cells in the carcinogenesis process?
Antioxidants, Folate, Selenium, Curcumin
Which nutrients protect DNA from oxidative damage?
Antioxidants
Which nutrient provides methyl groups for DNA synthesis and repair?
Folate
Which nutrient supports DNA repair and apoptosis?
Selenium
Which nutrient induces apoptosis?
Curcumin
ER+ PR+ HER2- Breast Cancer-Pathology staged as T1 N0 M0
What is her lymph node involvement and risk for developing lymphedema?
No regional lymph node involvement, minimal risk for lymphedema
On average, how many years does it take for cancer to develop?
Ten years
Healthy patterns of diet and physical activity can prevent what percentage of the most common cancers?
33%
What is the single most effective nutritional goal in cancer prevention?
Achieving and maintaining a healthy body weight
What are the physical exercise recommendations for cancer prevention?
150 minutes a week of moderate intensity, strength training 2 days per week
True/False-Both hereditary and acquired factors influence the carcinogenic process.
True
All of the following are potential nutrition-related issues during the initial treatment period except:
A) Lower health costs
B) Fatigue
C) Immunosuppression
D) Mucositis
A) Lower health costs
Adequate intake of what nutrient has been shown to be associated with lower risk of cancer in large, prospective cohort studies?
Folate
Which of the following is not a recommendation of the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF)?
A) Consume energy-dense food sparingly
B) Adults should get at least 75 minutes of moderate activity or 45 minutes of vigorous activity each week
C) Dietary supplements are not recommended for cancer prevention
D) Eat at least 5 servings of a variety of fruits and non-starchy vegetables daily
B) Adults should get at least 75 minutes of moderate activity or 45 minutes of vigorous activity each week
True/False-The epigenetic effects of tea polyphenols have been found to stimulate enzymes that deactivate carcinogens, decrease tumor growth, increase apoptosis, and restrain the ability of cancer cells to spread.
True
Food components may have protective effects in carcinogenesis through multiple mechanisms including all of the following except:
A) Cell differentiation
B) Apoptosis
C) Angiogenesis
D) Inflammatory response
C) Angiogenesis
Yes/No-T3 N2 M1, does this patient have metastatic disease?
Yes
True/False-The term carcinogenesis refers to the process by which normal cells transform into cancer cells, usually as a result of accumulating genetic damage.
True
Early cancer detection refers to identifying tumors before they become palpable. Which of the following are screening tools for early detection?
A) Physical exam
B) Imaging procedures
C) Blood tests
D) All of the above
D) All of the above
Which of the following is not a plausible mechanism though which body fatness could influence cancer risk?
A) Fat cells influence production of hormones, such as leptin and adiponectin
B) Excess body fat is associated with insulin resistance
C) Excess body fat directly causes decreased physical activity levels
D) Excess weight is associated with a state of low grad chronic inflammation
C) Excess body fat directly causes decreased physical activity levels
The AICR and the WCRF recommends people who eat red meat should consume less than what number of ounces per week?
18oz
True/False-Research has shown resveratrol, a phytochemical found in red wine, decreases cancer risk.
False
What nutrient may be used to enhance the effectiveness of 5-fluorouracil, as 5-fluorouracil targets enzymes that use this nutrient as a cofactor?
Folate
Gluthathione-S-transferace is an example of what type of enzyme?
Carcinogen-detoxifying enzyme
In the colon, intestinal bacteria act on ______ and _____ to produce butyrate, a short chain fatty acid that promotes normal colon cell development and may reduce inflammation.
Fermentable fiber and resistant starch
List the 5 most common types of cancer found in men in the U.S.
Prostate, lung, colorectal, urinary bladder, melanoma
Why do cancer-related side effects such as loss of appetite, nausea, mucositis, and diarrhea develop?
Chemotherapy causes damage to normal cells including those found in bone marrow, the digestive tract, and the reproductive system thus causing side effects.
True/False-Pharmacologic doses of some nutrients play a protective role in carcinogenesis processes?
False
Extremely high doses of what nutrient may promote the growth of undetected cancers?
Folate
True/False-Body fatness is associated with a state of low-grade chronic inflammation that can promote cancer development.
True
What are allium vegetables and what type of cancer do they protect against?
Garlic, onions, leeks-protective against stomach cancer
Prostate cancer risk increases with what levels of calcium supplementation?
Above 1500mg
AICR recommends waist circumference be no greater than ___ inches in men and ___ inches in women.
37in men, 31.5in women
True/False-There is no convincing evidence that breastfeeding reduces a mother’s risk of both pre- and postmenopausal breast cancer.
False
Mechanisms by which breastfeeding may protect against breast cancer include:
A) Elimination of cells with potential DNA damage through exfoliation of breast tissue during lactation
B) A major apoptosis of epithelial cells at the end of breastfeeding
C) Leads to amenorrhea, reducing lifetime exposure to estrogen
D) All of the above
D) All of the above
True/False-Evidence does not support the use of dietary supplements as an effective strategy to reduce cancer risk.
True
There is convincing evidence that red and processed meats are causes of which cancer type?
Colorectal cancer
True/False-Consuming as little as the current recommendation for one standard drink per day increases a woman’s risk of breast cancer.
True
Salt and salt-preserved foods are a probable cause of which cancer type?
Stomach cancer
True/False-People with hormonal cancers like breast , endometrial, or prostate cancer should avoid soy foods.
False
True/False-Non-starchy vegetables and fruits protect against cancers of the mouth, pharynx, larynx, esophagus, stomach, and lung.
True
What are AICR recommendations for cancer prevention/survivorship with regards to salt and sodium?
Limit consumption of processed foods with added salt to ensure intake less than 6g (2.4g sodium) per day
True/False-Fat loss may occur with or without cachexia.
True
Cancer cachexia is indicated as a factor in the cause of death in what % of all cancer patients?
30-50%
What % of weight loss predicts a reduced response of oncology treatment, reduced survival, and reduced quality of life?
6%
Toxicity from radiation treatment can lead to unplanned treatment breaks that results in lower loco-regional control and survival rates in patients with head and neck cancers. Tumor control is reduced by what % for each day that the radiation therapy plan is interrupted?
1%
When pursuing modest weight loss during treatment, for example, in an overweight or obese early breast cancer patient, what is considered modest weight loss?
Less than 2 pounds per week
What validated screening tool for use with oncology patients is designed for the inpatient setting only?
MSTC
Which screening tools are validated for outpatient use?
MST, PG-SGA
Weight loss in obese patients can lead to sarcopenic obesity, which is defined as:
Decreased muscle mass and increased fat mass
The AND and ASPEN consensus document for identification and documentation of adult malnutrition lists 6 characteristics to represent a complete nutrition assessment. How many of the 6 characteristics need to be present for a diagnosis of malnutrition?
2 or more
True/False-Weight loss may be indicated for specific patients undergoing cancer treatment.
True
What does an ECOG score of 1 represent?
Ambulatory, restricted in strenuous activity, able to carry our light work or activity.
True/False-Any weight loss that is unintended in adult oncology patients has potential for significance.
True
Which screening tools are used for both outpatient and inpatient settings?
PG-SGA and MST
True/False-Cancer cachexia is a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass that can be fully reversed by conventional nutritional support.
False
Which of the following is not 1 of the 6 characteristics of malnutrition?
A) Muscle wasting
B) Insufficient energy intake
C) Unintended weight loss
D) Low prealbumin
Low prealbumin
You initiate TPN on a malnourished oncology patient who is at risk of refeeding-what would you recommend for calorie requirements?
20 kcal/kg or no more than 1000 kcal per day, advance as tolerated while monitoring electrolyte levels
True/False-Harris-Benedict Equation is appropriate for actuely or critically ill patients for assessing energy needs.
False
Which of the following would you use to estimate energy needs based on body weight for gastric cancer patient who is hypermetabolic and stressed?
35 kcals for stressed, hypermetabolic cancer patients
Which vitamin is not affected by inflammation (a decrease in serum level)?
Vitamin B12
True/False-Supplementation in excess of the DRIs may not result in elevated serum levels and may be detrimental. Patients should aim for an intake of 100% of the RDAs/AIs for micronutrients, unless otherwise indicated.
True
In the Palliative care setting, what average fluid volume is considered acceptable for adequate urine output and hydration?
1000mL
Which predictive formulas are best suited for the oncology population?
Penn State 2003b, Swinamer, Ireton-Jones 1992 and 1997, Mifflin-St. Jeor
True/False-Hypophosphatemia is a major sign of refeeding syndrome
True
True/False-Always use Adjusted Body Weight in predictive formulas for obese patients.
False
What is an individuals protein requirements with cancer cachexia?
1.5-2.5 g/kg/d
Where should you begin with calorie repletion in a patient with refeeding syndrome?
20 kcal/kg, 1000 kcal/d, 25% estimated daily needs and advance to goal within 3-5 days
Zinc, iron, selenium, vitamins A, B, and C are commonly deficient in individuals who are ill. How should these be restored?
A daily multivitamin that providers around 100% RDA
What is a result of negative energy balance driven by reduced food intake and/or abnormal metabolism malnutrition?
Cachexia
What % of cancer patients experience anorexia and weight loss prior to diagnosis?
40%
List 4 potential side effects that correlate with unintentional weight loss during cancer treatments.
Lower performance status, reduced response to treatment, lower survival rates, lower quality of life.
Persistence of _______ from cancer can lead to a decrease in lean body mass, causing functional impairment, and is considered “disease-related malnutrition.”
Inflammation
Inflammation does not appear to affect the serum levels of which micronutrients?
Thiamin, riboflavin, vitamin B12, folate
Conditions needed for a valid assessment of Indirect Calorimetry?
Hemodynamic stability, cooperative or sedated patient, period of rest prior to test, absence of chest tubes.
True/False-Hypocaloric feeds have been shown to positively affect protein anabolism.
True
Introduction of carbohydrates into the system and the compensatory release of insulin drives phosphorus, magnesium, and potassium back into the cells is called?
Refeeding syndrome
Protein requirements from cancer and cancer cachexia are ___ and ___ g/kg/day, respectively.
1.0-1.5 and 1.5-2.5 g/kg/d
True/False-Hypophosphatemia usually occurs within 3 days of starting nutrition intervention.
True
What is the “gold standard” for estimating energy needs?
Indirect calorimetry
True/False-Individuals with colorectal cancer have been round to have higher energy expenditures than individuals with other types of cancers.
False
Protein recommendations for metabolically stressed individuals.
1.5 g/kg/d
All of the following are common micronutrient deficiencies in individuals who are ill except:
A) Zinc
B) Calcium
C) Selenium
D) Vitamin A, B, C
B) Calcium
Name some benefits of exercise during cancer treatment.
Associated with improvements in fatigue, muscular strength, depression, anxiety, quality of life, and cardiopulmonary fitness.
True/False-Prostate cancer treatment may impact body composition.
True
True/False-ACS guidelines on nutrition and physical activity recommend that cancer survivorship in all phases of the cancer-care spectrum be as physically active as possible.
True
Calorie restriction (CR) during chemotherapy is defined as a reduction in caloric intake by ____%.
20-40%
Increased adiposity promotes the carcinogenesis process by which of the following mechanisms:
A) Lowers adiponectin levels
B) Increases leptin levels
C) Increases VEGF synthesis and promotion of angiogenesis
D) Increases estrogen production through promotion of aromatase enzymatic activity
E) All of the above
E) All of the above
Physical activity goals per week?
150 minutes/week of moderate intensity
75 minutes/week of vigorous intensity
Twice weekly weight resistance training
True/False-Being overweight or obese at time of diagnosis of some cancers is associated with adverse outcomes including increased risk of disease recurrence and reduced survival.
True
What are the goals of MNT during cancer treatment?
Managing symptoms, preventing weight loss, and maintaining optimal nutritional status
Name all parts of the cancer continuum of care.
Prevention, treatment, survivorship, palliative care, and hospice
Nutrition referrals and role in survivorship care plans.
Weight management strategies, behavioral modification to promote healthy lifestyle, and/or management of late effects of treatment.
Malnutrition is reported in approximately ___% of cancer patients at the time of diagnosis and up to ___% over the course of care.
15-20%, 80%
An oncology nutrition program should be modeled after the Nutrition Care Process and include what components?
Nutrition screening, assessment, intervention, education, and monitoring.
True/False-As defined by NCI, a designated comprehensive cancer center must provide state-of-the-art cancer care, a strong research base and comprehensive oncology nutrition programs.
True
What are some of the positive effects of calorie restriction (CR) before or during chemo reported in literature?
Less fatigue, less weakness, and less GI issues
What are some proposed mechanisms of CR?
Modulation of insulin, IGF, pro-inflammatory cytokines, adiponectin, leptin, increased antioxidant defense and DNA repair mechanisms
What are the American College of Sports Medicine exercise guidelines for cancer survivors, who are cleared (no neuropathy, high bone fracture/muscle tear risks, etc.)?
150min moderate or 75 min vigorous aerobic exercise PLUS weight training all muscle groups twice weekly
Malnutrition is reported in how many cancer patients at time of diagnosis?
15-20%
True/False-The American College of Surgeons Commission on Cancer require a component of cancer care to address nutrition through either an on-site RD or by referral.
True
These are guidelines are used as a tool to evaluate nutrition oncology practice, identify areas for professional development, and used as a basis for job descriptions and professional competencies.
The Academy SOP and SOPP for the Oncology RD
True/False-Nutrition care does not need to be provided during hospice as nutritional status is not important at that time.
False
Physical activity is a key component of the integrative approach. An active lifestyle has been shown to reduce risk of which cancer diagnoses?
Breast, Colon, Prostate
The chemopreventative effects of tumeric appear most promising for which diagnoses?
Colorectal and Pancreatic cancers
Epigallocatechin gallate (EGCG) found in green tea could inhibit the activity of ______ in multiple myeloma treatment.
bortezomib
The most common side effect of vitamin D supplementation is _____.
GI side effects
Excess vitamin D supplementation can lead to ______.
Hypercalcemia
In severe vitamin D deficiency, each 1000 IU dose increase 25-hydroxyvitamin D levels by ______.
10ng/mL
Curcumin’s systemic availability can be increased by the active component piperine from __________.
Black pepper
True/False-Decaffeinated green tea may not have the same chemopreventative effectiveness as caffeinated forms.
True
True/False-All edible mushrooms should be cooked, as heating inactivates the agaritine and allows for better utilization of nutrients.
True
_______ has anti-inflammatory properties and trials have shown it to be sage with gemcitabine and perhaps synergistic with taxanes by sensitizing tumor cells.
Curcumin
Consumption of no more than ___ cups of green tea daily is likely adequate for desired benefits with low risk of adverse effects.
5 cups
The contraindication of St. John’s Wort vs. imatinib, irinotecan, and a number of other chemotherapeutic drugs is explained by which shared pharmacokinetic pathways?
Cytochrome p450, as St. John’s Wort is a strong inducer of many CYP isoforms
True/False-Integrative Oncology and Complementary and Alternative Medicine (CAM) are interchangeable terms.
False-Integrative Oncology does not incorporate alternative medicine
According to the NIH National Center for Complementary and Alternative Medicine (NCCAM), what are the recognized “whole systems” practices?
Ayurveda (diet based upon the patient’s dosha), Traditional Chinese Medicine (diet recommended using the TCM diagnosis system of tongue exam and palpation of 12 pulses), Naturopathy, and Homeopathy
What are the 4 areas of Integrative Oncology?
Mind and body (ex. yoga), Manipulation (ex. massage), Energy based treatment (ex. Reiki), Natural products (ex. probiotics)
What does the Integrative Oncology area of “Natural Products” include?
Dietary intervention and dietary supplements such as antioxidants, probiotics, and botanicals
Define Integrative Medicine.
Provides relationship-centered care with an emphasis on addressing the needs of the whole person-body, mind, spirit, and community.
What are the chemoprotective properties of Green Tea?
The unfermented leaves of Camellia Sinensis contain a polyphenol Epigallocatechin Gallate (EGCG), which can act against cancer by pro-apoptotic effects, inhibition of signaling molecules, antimetastatic and antioxidant effects
Green tea may antagonize ______ due to vitamin K content.
Warfarin
In summary, what are the dietary recommendations supported by the American Society of Clinical Oncologists and the American Cancer Society to reduce the epidemic of chronic diseases?
Healthy, organic, plant-based, antioxidant rich, anti-inflammatory, whole foods diet
Which alternative diet includes the quark recipe (flaxseed oil and cottage cheese)?
Budwig
What alternative diet includes a vaccine usually derived from the patient’s own blood or urine?
Livingston-Wheeler
What alternative diet proposed for cancer treatment emphasizes natural unrefined foods, only sweeteners from honey, dates, figs, berries, and fruit juices. Whole grains are allowed. Recommends eating a flaxseed oil cottage cheese or “quark” twice daily. Avoids trans fat, animal fat, pork, seafood, and dairy. Includes specific breathing exercises and enemas if tolerated.
Budwig diet
Ready-to-eat cereals fortified and enriched with vitamins, minerals, and phytonutrients including lycopene and lutein are examples of?
Modified foods
Define functional foods and the role they play in cancer survivors.
Functional foods are conventional foods that have been enhanced to benefit health beyond the effects of basic nutrition, can provide versatile options for meeting nutrition and health needs or each cancer survivor and when someone is unable to consume certain conventional foods.
Which of the following foods would be avoided on Budwig diet?
A) Milk
B) Cottage cheese
C) Seafood
D) Whole wheat bread
Milk and Seafood
The Raw Food Diet may be deficient in which of the following nutrients?
A) Calcium
B) Vitamin B12
C) Zinc
D) All of the above
All of the above (Ca, Vit B12, Zinc)
Which are components of the Gonzalez Regimen?
A) Metabolic therapy including pancreatic enzyme supplements and coffee enemas
B) Essaic tea
C) Dry and juice fasts over several days
D) 80% alkaline foods, 20% acidic foods
A) Metabolic therapy including pancreatic enzyme supplements and coffee enemas
Which is not defined as Functional Foods?
A) Whole foods
B) Lutein and lycopene enriched cereals
C) Genistein enriched snack bars
D) PKU gels
D) PKU gels
What 25(OH)D level has the Institute of Medicine (IOM) determined as a requirement for bone health?
> 20ng/mL
Li-Fraumeni Syndrome is associated with the inherited defect in which gene?
TP53
Point mutations in genes which causes loss-of-function are termed _____.
Tumor suppressor genes
Epigenetic changes caused by the following are potentially reversible modifications in DNA:
A) Oncogenes B) Tumor suppressor genes C) Methylation D) Acetylation E) A and B F) C and D
F) C and D (Methylation and Acetylation)
What are the two types of epigenetic changes? Describe them.
Methylation and acetylation
Methylation is the addition of methyl (-CH3) groups to DNA
Acetylation is the modification of histones by attachment of acetyl groups
What are the two ways in which diet impacts epigenetics?
Host somatic cell mitosis and germ cell transgenerational inheritance
True/False-The majority of cancer survivors have difficulty following healthy diet patterns that meet public health guidelines for diet, physical activity and cancer prevention.
True
What is the scientific investigation of the composite interactions between nutrients, bioactive food components, and the genome as they impact host health and disease?
Nutritional genomics
What are chemicals found in an organism but not produced by it, such as drugs or pollutants?
Xenobiotics
_____ are typically minor variations in nucleotide sequence that may impact the function of corresponding protein to varying degrees and thereby modify cancer risk.
Polymorphisms
What is the leading risk factor for cancer?
Age
What % of cancers are diagnosed in people over 55 years of age?
75%
Protein intake of up to ___ is associated with reduced frailty.
1.2 g/kg/day
True/False-The dietary and lifestyle habits of women prior to a cancer diagnosis appear to have a significant influence on survival and recurrent disease.
True
Which diagnoses represent that vast majority of cancer survivors?
Breast, Prostate, Colon
True/False-Weight lifting and weight bearing activity supports adequate bone health, which is commonly compromised after cancer therapy and is considered sage and effective for controlling lymphedema after breast cancer.
True
Supplementation of what nutrient in colo-rectal cancer patients can reduce survival if the patient is also smoking cigarettes and drinking alcohol?
Beta-carotene
Close to __% of patients diagnosed with cancer survive beyond the five-year monitoring period.
70%
Which study showed a significant ~50% reduction in mortality rate for those who entered the study reporting dietary habits that included >5 servings of vegetables/fruit daily and 30 minutes of moderate exercise 5-6 days a week?
Whel Study
How many Americans are living with a history of cancer diagnosis?
13 million
What are potential lifestyle treatments for fatigued survivors who eat to reward themselves?
Physical exercise and 6 months of lifestyle coaching to lower response to high calorie food cues.
How much protein is recommended to reduce muscle frailty among post-menopausal cancer survivors?
1.2gm/kg/day
What are typical body composition changes seen in cancer survivors?
Reduction in skeletal muscle mass.
Evidence based and consensus driven cancer treatment standards of care are sanctioned by what organization?
NCCN-National Comprehensive Cancer Network
Which healthy body cells (with rapid turnover) are most susceptible to the effects of chemotherapeutic agents?
Bone marrow, hair follicles, testes and ovaries, and gastrointestinal mucosa
Subclasses of chemotherapy and agent example.
- Alkylating agents such as Cisplatin
- Antimetabolites such as Xeloda
- Antitumor antibiotics such as Adriamycin
- Epiodophyllo-toxins such as Etoposide
- Taxanes such as Taxol
- Vinca alkaloids such as Oncovin
Subclasses of biotherapy and agent example.
- Monoclonal antibodies such as Rituxan
- Protein targeted therapies such as mTOR inhibitors like Affinitor for renal/pancreatic cell cancers
- Angiogenesis inhibitors such as Avastin
- Cytokines such as Interleukin-2 or Interferon
- Cancer vaccine therapy such as Gardasil to protect against HPV
Subclasses of hormone therapy and agent example.
- Selective estrogen modulators SERMS such as Tamoxifen
- Aromatase inhibitors AI such as Aromasin
- Progesterone such as Megace used in breast, endometrial, and renal cancers
- Antiandrogens such as Casodex in prostate cancer
- Luteinizing hormone releasing hormone agonists such as Lupron
Subclasses of radiation therapy.
- External beam therapy EBRT-3D CRT conformal radiation therapy, intensity modulated radiation IMRT, image guided radiation therapy IGRT, stereotactic radiosurgery and radiation therapy SRS/SRT, total body irradiation TBI
- Brachytherapy
- Radiopharmaceutical therapy-radioimmunotherapy agents used with B-cell lymphomas (Ibritumomab/Zevalin), radioactive substances such as iodine 131 for thyroid cancer, radiopharmaceuticals to relive bone pain such as Stronium
List potential nutritional interventions to treat diarrhea.
Low fat, low fiber, low lactose, avoid gas producing foods, caffeine and ETOH.
Small, frequent meals.
Add bulking agents such as pectin or soluble fiber (applesauce, bananas, oatmeal, potatoes, rice)
Avoid sorbitol
Add MVI+ MIN
Common causes of fatigue in cancer patients?
Anemia Inadequate energy intake Weight loss Pain Medications Anti-cancer treatments Dehydration Sleep disturbances
Which antiemetic is considered a serotonin antagonist and used for acute nausea and vomiting?
Zofran (ondansetron)
____ intake is widely recognized as one of the dietary factors most consistently associated with increased breast cancer risk.
Alcohol
True/False-Consuming beverages and foods that are very hot in temperature may increase risk of oral and esophageal cancers
True
Frying, boiling, or grilling meats at very high temperatures creates which chemicals that might increase cancer risk?
A. heterocyclic amines B. N-nitroso compounds C. polycyclic aromatic hydrocarbons D. all of the above E. A and C
E. A and C (heterocyclic amines and polycyclic aromatic hydrocarbons)
When starting total or central PN, it is prudent to initiate with ___% goal dextrose and then titrate up as tolerated.
25-50%
List 4 appropriate patient characteristics for enteral nutrition support.
- Active cancer treatment
- Malnourished
- Anticipated to be unable to ingest/absorb adequate nutrients for >7-14 days
- Head/neck, gastric, esophageal and pancreatic cancers
Which chemotherapy regimen typically includes increased hydration needs?
Cisplatin
What are the 6 main indications for TPN?
- Nonfunctional or inaccessible GI tract (such as bowl rest, bowel obstruction)
- Severe N/V (such as radiation enteritis and refractory SBS)
- Severe diarrhea or malabsorption
- GI fistula (unless able to feed distal to fistula or low fistula output)
- Severe acute necrotizing pancreatitis unable to tolerate EN
- Graft-vs-host dx intolerance to EN support
What are dose limits for PPN?
Final concentration <900 mOsm/L, lower dex concentration (5-10%)
What are 5 possible long-term complications of TPN?
- Steatosis
- Biliary sludge
- Catheter sepsis
- Venous thrombosis
- Hypertriglyceridemia
Describe optimal evidence based pre/post-op MNT.
- EN for 10 days prior to surgery in malnourished patients to preserve bowel mucosa and modulate the immune response.
- Early post-op nutrition when moderate/severe malnourished prior to surgery.
- Limited use of post-op decompression NGT’s.
- Limited narcotics.
- Early mobilization.
What research findings are challenging traditional bowel rest and the protocol to wait for bowel sounds post-op?
- Intraluminal nutrients promote bowel hypertrophy and anastomotic healing.
- Small intestines regain ability to absorb nutrients quickly even in the absence of peristalsis
- Dysmotility can be attenuated if feedings start within 24 hours post-op.
Describe 3 nutritional consequences of esophageal surgeries.
- If LES (lower esophageal sphincter) removed, can cause reflux.
- If the vagus nerve was resected, can cause esophageal and/or gastric dysmotility. Denervation can reduce ability to experience satiety resulting in overeating/regurgitation
- 30% experience strictures (reduced vascularization and late ischemia) requiring dilation or stents
Preoperative education:
A. Allows patients to play an active role in their recovery.
B. Identifies signs of complications.
C. Anticipates normal physiologic responses to GI surgery that left untreated could compromise nutritional status
D. All of the above
D. All of the above
True/False-Achlorhydria may allow bacterial and fungi overgrowth, which can cause pain when eating.
True
The small intestine regains the ability to absorb nutrients quickly after surgery, even in the absence or peristalsis, and dysmotility can be attenuated if feeding is started within ___hr post-op.
24 hours post-op
List the top 5 childhood cancers (prevalence).
Leukemia, Brain and Nervous System, Neuroblastoma, Wilms tumor, Lymphoma
Describe the signs of pediatric moderate malnutrition.
Definite signs of decreased weight and/or growth, experiencing a downward trend but started with normal nutrition status.
Children’s Oncology Group states that protein turnover during cancer treatment is increased possibly by inflammation and promotes loss of muscle mass, and recommends increasing protein needs by ___ %.
50%
Long term effects of childhood cancer include all of the following except:
A. Slow or stunted growth B. Compromised bone health and development C. Eating behaviors D. Quality of life E. Anorexia
E. Anorexia
