Special Nutritional Needs in Cancer Patients Lecture Powerpoint

Question 1

Patients with cancer cachexia have a much lower survival rate. Skeletal muscle loss and protein depletion decrease survival rate - what percent of terminally ill cancer patients does anorexia affect?

Answer 1

approx 80%

Question 2

Metabolically active tumors can consume more than __% of daily caloric intake, alongside losses from ____ and ___ in cancer patients

Answer 2

15%, bleeding, diarrhea

Question 3

Type of cancers with highest levels of malnutrition

Answer 3

GI malignancies

Question 4

Cancer cachexia (cancer anorexia cachexia)

Answer 4

Specific form of malnutrition characterized by loss of lean body mass, muscle wasting, neg protein energy balance, impaired immune, physical, and mental function that in late stage cannot be reversed by normal nutritional support
anorexia (decreased intake or starvation) cachexia (wasting syndrome)

Question 5

Cancer cachexia is responsible for __% of cancer deaths

Answer 5

20%

Question 6

Energy metabolism in cancer cachexia mech of acion

Answer 6

Tumor is capable of increased basal energy expenditure despite normal response to starvation is decreased metabolic state, see increase in whole body protein turnover

Question 7

Metabolic factors that can be measured to determine cancer cachexia (3)

Answer 7

• low albumin levels
• hyperglycemia (increased endogenous production, opposite of starvation state)
• depletion of fat stores and hypertriglyceridemia (decreased lipoprotein lipase)

Question 8

Malnourished cancer patient differs greatly from those with…

Answer 8

….simple starvation, result is extreme difficulty in reversing malnourished state

Question 9

Interstitial pneumonitis

Answer 9

Scarring of the lungs brought on during chemo

Question 10

Tumor lysis syndrome

Answer 10

Acute kidney injury and electrolyte/metabolite imbalances brought on by massive cell lysis of tumor in treating cancer with chemo

Question 11

Dumping syndome

Answer 11

Chronic diarrhea and fecal incontinence from food moving through GI tract too quickly post gastrectomy, can reduce absorption of nutrients contributing to cancer cachexia

Question 12

Surgery and nutritional goals in cancer patients

Answer 12

A high calorie high protein diet prior to surgery may be indicated to regain lost weight to minimize malnutrition

Question 13

Unintentional weight loss >10% within 6 months signifies…

Answer 13

…substantial nutritional deficit and may indicate poor outcome

Question 14

Anthropometric technique

Answer 14

A physical exam technique to measure composition of human body (pinching skin to determine fat %)

Question 15

Appropriate 3 diagnostic labs for patients with suspected cancer cachexia

Answer 15

• albumin
• retinol binding proteins
• transferrin

Question 16

What is the preferred route of administration of nutrition if a patient is capable of doing so?

Answer 16

Oral (PO) intake

Question 17

Parental nutrition (Total or partial)

Answer 17

Delivery of calories and nutrition via a vein and pickline (usually subclavian into superior vena cava) done if the digestive system is not working (often use a “banana bag” or 2 each day), only recommended for pre-op or peri-op period if unable for short time to take enteral

Question 18

Enteral route

Answer 18

Involves absorption of food via the GI tract including oral, gastric/duodenal feedings, or rectal administration

Question 19

Nasogastric tube (NG)

Answer 19

An enteral route tube for a patient who can hopefully move to oral intake within a few weeks, used for short term use in hospital but must have concern for patient ripping it out

Question 20

Gastrostomy tube

Answer 20

An enteral route tube for a patient who cannot move to oral intake within few weeks, placed endoscopically/surgically under local anesthesia

Question 21

Parenteral nutrition improves body weight, total body fat, and minarals and vitamins, but does NOT improve…

Answer 21

….total protein absorption, or improve survival of cancer patients

Question 22

Which is preferred between a gastrostomy tube and a jejunostomy tube?

Answer 22

Gastrostomy unless the malignancy is in the stomach because jejunostomy tubes tend to cause diarrhea