How to Control of Your Appetite and Weight Loss


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Prepared by Veronica A. Ward, Oncology Nurse Clinical Inquiry Specialist at Dana-Farber Cancer Institute's Phyllis F. Cantor Center. This presentation offers information for cancer patients on how to control appetite and weight loss -- whether you're looking to maintain weight or lose weight. Learn about common causes of weight loss, symptoms to watch out for and report, and how to maintain good nutrition during and after cancer treatment.

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How to Control of Your Appetite and Weight Loss

  1. 1. TAKE CONTROL OF YOUR APPETITE & WEIGHT LOSS Veronica A. Ward Oncology Nurse Clinical Inquiry Specialist DFCI Nursing Department – Phyllis F. Cantor Center July 12, 2012
  2. 2. WEIGHT LOSS PRIOR TO ANDDURING CANCER TREATMENTMalnutrition – too little or too much nutrients in the bodyCommon Causes of Malnutrition Anorexia - decreased appetite or loss of desire to eat Cachexia - progressive loss of appetite that causes a decrease in energy levels leading to muscle loss and weight loss
  3. 3. WHAT DOES WEIGHT LOSS AFFECT? Physical – Loss of Function Psychosocial / Well-Being - Mood Treatment Delays Quality of Life
  4. 4. INTERNAL CAUSES OF WEIGHT LOSS Cancer disease Digestion - delayed emptying of the stomach Weakened immune system Muscle and fat injury Stress / anxiety / depression / mood changes
  5. 5. OTHER CAUSES OF WEIGHT LOSS Lack of nutrients and vitamins in the body Treatment side effects Medications side effects
  6. 6. DIFFERENCES IN PATIENTS WITH CANCER Very subjective - Personal food choices and personal experiences with the body
  7. 7. DIFFERENCES IN PATIENTS WITH CANCER A very different experience for cancer patients“Some days I feel great, other days I am tired and have no desire to eat”“ I seem to have different taste buds and food tastes funny to me and it‟s just not the same”“ I feel like I have to shovel food down my throat to get something in”“ I dislike using the G tube and want „real‟ food”
  8. 8. WHAT TO REPORT Unintentional weight loss over a period of 3 months Decreased desire to eat or decreased food intake (under 1500 calories/day) Fever Muscle and fat loss Decreased energy levels or fatigue Leg swelling Changes with smell - “Odors bother me.”
  9. 9. OTHER THINGS TO REPORT OR RECOGNIZEStomach: Diarrhea Constipation Lactose intolerance Belly swelling Difficulty eating rich or heavy foods Feeling of fullness after eating something or “bloating” Decreased fluid intake Nausea and/or vomiting Stomach or belly pain
  10. 10. OTHER THINGS TO REPORT OR RECOGNIZEMouth: Mouth pain Dry mouth Mouth sores Taste changes - “Things taste funny”Throat: Throat pain Problems swallowing or chewing
  11. 11. OTHER THINGS TO REPORT OR RECOGNIZEMental: Family and/or friends pressuring me to eat Depression, sadness, increased stress or anxiety Personal concerns about weight – “I am very thin-looking” Lack of Appetite - “Just did not feel like eating”
  12. 12. WHAT HELPS  Lifestyle changes Change meal size and frequency –  Emotional support from family, 5-6 small meals/snacks friends, co-workers, or daily therapists Nutritional shakes and  Decrease stress, anxiety, drinks and/or sadness Consultation and education with nutritionists, nursing, & medical staff
  13. 13. DECREASE STRESSWhat are some of the things you enjoy or love to do? Social activities or hobbies Sports or physical activities Entertainment Pursue relaxation techniques Travel Pamper, relax & re-energize!
  14. 14. FAMILY AND FRIENDSYour family and social network is your foundation! Provide help & positive support Listen, provide feedback, ask questions with your loved-one Attend appointments and treatment visits “Home is where the heart is”
  15. 15. WORK Prioritize responsibilities and pace yourself Colleague and co-worker support Delegate as needed Have you had your break today? Employee Assistance Program (EAP)
  16. 16. NUTRITION DURING AND AFTERCANCER TREATMENT 2 Priorities During Treatment  Prevent Weight Loss  Maintain Muscle Mass Answer?  Individualized nutrition plan based on your likes, dislikes, lifestyle, symptoms and concerns.  A registered dietitian, social worker, and nursing staff are key resources for helping maximize your cancer treatment.
  17. 17. HOW TO CHOOSE PROTEIN SOURCES For anorexia-cachexia syndrome: Protein is strongly recommended for lean body muscle mass growth. For a healthy, survival diet: High calorie, high protein, low fat, low carb diet but if have trouble eating, eat what you love! Use protein-rich nutritional shakes to supplement current diet in tolerated amounts as a source of additional nutritional intake. Not all protein supplements provide adequate nutrients. However, incorporating liquid protein supplementation is better than not having any nutrients at all. Choose foods and recipes that are familiar to you, that also smell and taste good to you Adjust temperature of foods to determine what works for you and your belly Eat to live and thrive!
  19. 19. READY-TO-DRINK PROTEIN SHAKES EAS AdvantEdge*Muscle Milk Light* Carb Control  Lactose-free  Sugar-free  Gluten-free  Flavors:  Sugar-free Chocolate  Flavors: Fudge, Chocolate, Strawberry Vanilla Crème, Cream, French Banana, Vanilla, Dark Strawberry, & Chocolate, & Café Latte Café Caramel  20 grams  17 grams protein, low carb. protein, low carb, & low fat & low fat * DO NOT ENDORSE SPECIFIC PRODUCTS  160 calories – THESE ARE EXAMPLES approx.
  20. 20. CLINICAL RESEARCH: ORAL SUPPLEMENTSAdams, L.A., Shepard, N., Caruso, R.A., Norling, M.J., Belansky, H., & Cunningham, R.S. (2009). Putting Evidence Into Practice: Evidence- based interventions to prevent and manage anorexia. Clinical Journal of Oncology Nursing, 13, 95–102. doi: 10.1188/09.CJON.95-102American Dietetic Association. (2007). ADA oncology evidence-based nutrition practice guideline. Updated October 2007. U.S.A.: American Dietetic Association. Taken on August 2, 2011, from:, C., Spiro, A., Ahern, R., & Emery, P.W. (2012). Oral nutritional interventions in malnourished patients with cancer: A systematic review and meta-analysis. Journal of the National Cancer Institute, 104 (5), 371- 85.Baldwin, C., Spiro, A., McGough, C., Norman, A.R., Gillbanks, A., Thomas, K., Cunningham, D., O‟Brien, M., & Andreyev, H.J. (2011). Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: A randomised controlled trial. Journal of Human Nutrition and Dietetics, 24 (5), 431-440. doi: 10.1111/j.1365-277X.2011.01189.x.
  21. 21. MONITORING Weight & Body Mass Index (BMI) Nutrition Screening Tool Symptom Management: Symptom review Treatment: Review of medications and side effects Lab Tests:  Pre-albumin - to assess protein-calorie malnutrition  Albumin – to assess general health status  C-reactive protein – to check for systemic inflammation Activities and Functional Ability CT scan – lumbar spine Frequency of monitoring will vary based on severity of appetite changes and weight loss
  22. 22. DFCI PILOT STUDY ON ANOREXIA Date: TBD Study: Pre-treatment education and nutritional supplementation intervention By: DFCI Cantor Center for Nursing Research & Patient Care Services & DFCI Nutrition Department Education & Pre-treatment menu planning: Dietary plan tailored to the individual with personal, social and cultural needs in mind
  23. 23. DFCI PILOT STUDY ON ANOREXIA Monitoring, Support & Guidance: Registered Nutritionists, Therapists, Social Worker, Nursing & Medical Staff Goals: (1) Patient self-report about weight loss (2) To prevent protein malnutrition and potential muscle-wasting
  24. 24. RESOURCES: ONCOLOGY WEB SITES FORINDIVIDUALS WITH WEIGHT LOSS American Cancer Society  USDA  Food-A-Pedia, Food Tracker, & Weight Manager  Oncology Nursing Society  Book: Nutrition and Cancer: Practical Tips and Tasty Recipes for Survivors ($16.95 from ONS) National Cancer Institute  Patient/page1
  25. 25. RESOURCES: COOKBOOKS ON CANCER NUTRITION “Eating Well Through Cancer” by Holly Clegg and Gerald Miletello, M.D. “Nutrition and Cancer: Practical Tips and Tasty Recipes for Survivors” by Oncology Nursing Society “The Cancer-Fighting Kitchen: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery” by Rebecca Katz and Mat Edelson* DO NOT ENDORSE SPECIFIC PRODUCTS – THESE ARE EXAMPLES
  26. 26. LIFESTYLE CONSIDERATIONS:“YOU HAVE CONTROL!”Personal exploration Food Exercise or physical activity Your changing body Family, friend and/or partner support“When I let go of what I am, I become what I might be.” –Lao Tzu
  27. 27. DISCUSSION AND QUESTIONSQuestions? Veronica Ward, DNP, OCN, ANP-BC e-mail: