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  • No single treatment or special diet exists to arrest cancer.Relation between cancer care and nutrition centers on prevention and therapy.
  • A mutant gene may be inherited or arise from environmental stimulus.
  • A well-balanced diet, including fruits, vegetables, and whole grains, is recommended for health promotion and disease prevention.
  • Lymphocytes develop early in life from a common stem cell in the bone marrow.
  • Development of the T cells and Bcells, lymphocyte components of the body’s immune system.
  • Nutrition support is needed to maintain the integrity of the immune system.Severely malnourished people show changes in the structure and function of their immune systems.
  • Careful, early use of vigorous nutrition support provides recovery of normal nutritional status and immunocompetence of cancer patients.
  • Each of these treatment modalities requires nutrition support.
  • Nutrition support is required before and after surgery.Changes in food texture or nutrient content may be required depending on surgical site or function of the organ involved.
  • Radiation to the abdominal area affects intestinal mucosa, causing loss of villi and, subsequently, absorption. Malabsorption problems follow.
  • A radiation treatment machine.
  • Side effects include:Food intolerance: nausea and vomiting, loss of normal taste sensations, lack of appetite, diarrhea, ulcers, malabsorption, stomatitisReduction in red and white blood cells and blood plateletsInterference with normal hair growth
  • The patient should be questioned carefully about any herb use, and possible interactions should be discussed.
  • Anorexia results in poor food intake.Increased metabolism results in increased nutrient and energy needs.Negative nitrogen balance results in more catabolism (breaking down of body tissues).
  • Case Study:Mrs. Bowen has been undergoing chemotherapy for cancer. She is 55 years old. She complains of nausea and that food tastes “funny.” She has lost 5 pounds from her normal weight of 130 lbs. (64 inches tall).
  • Chemotherapy agents are administered to the general circulation by the blood. The medications are highly toxic and also affect normal cells. This accounts for their side effects. Numerous problems such as nausea and vomiting, loss of normal taste sensations, anorexia, diarrhea, ulcers, malabsorption, and mucositis can develop within the gastrointestinal tract.
  • This is the first part of the fundamental process of identifying needs and planning care based on those needs.
  • Patients with hormone-related cancer, such as breast cancer, and those receiving high-dose steroids are at risk for weight gain.
  • Enteral or parenteral feedings should be used with patients who cannot meet their metabolic needs orally.
  • The nursing staff and other health care personnel play a major role in helping the patient meet nutrition requirements.
  • Ask students to name some of the factors that the dietitian considers when developing the MNT for the patient.
  • Energy: carbohydrate and fat intake frees up protein (essential amino acids and nitrogen) so that it can be used for tissue building.Vitamins and minerals: control protein and energy metabolism through their coenzyme roles.Adequate fluid intake: replace losses, help kidneys dispose of metabolic waste from destroyed cancer cells and toxic drugs.
  • Oral diet with supplementation is optimal when tolerated, especially in view of weight lossFood plan must include adjustments in food texture and temperature, food choices, and tolerancesTips for Nausea:Try smaller, more frequent meals.Eat more when feeling better.Eat drier foods with fluids in between.Try cold foods, saltier foods.Avoid fatty or overly sweet foods.Do not recline immediately after eating.Replace fluids and electrolytes.Use foods with pleasant aromas.
  • A well-planned diet provides energy and nutrient density in small quantities of food.
  • Nurses must assist in addressing loss of appetite, mouth problems, gastrointestinal problems, and pain/discomfort.
  • Surgical treatment of the GI tract brings its own MNT (see Chapter 22), and chemotherapy and radiation treatment can affect the mucosal cells that secrete lactase, creating lactose intolerance.
  • Children undergoing painful treatments particularly need effective pain management.
  • Bolus feedings via endoscopic gastrostomy tubes can be used for long-term nutrition support.
  • Smaller peripheral veins can be used when nutrient needs are not excessive.
  • If oral diet with nutrient supplementation cannot be maintained and she continues to lose weight, then enteral or parenteral nutrition may need to be considered.
  • Ask students how much exercise of moderate to vigorous intensity they get per week.
  • National Cancer Institute is the federal research body funded by the Department of Health and Human Services.
  • Like all viruses, HIV is a parasite that uses its host to replicate itself.
  • The individual course of HIV infection can vary widely among individuals.
  • Case Study:John is a 32-year-old male diagnosed with HIV, category B. He complains of fatigue, mouth sores, and diarrhea. He has lost 10 pounds from his usual ideal body weight.
  • Category B HIV is Symptomatic Conditions. After the extended “well” HIV-positive stage, associated infectious illnesses begin to invade the body. This period of opportunistic illnesses has killed enough host-protective T-lymphocytes to damage the immune system severely and lower the body’s normal disease resistance. Common symptoms include persistent fatigue, mouth sores from rush, night sweats, diarrhea, fever, unintentional weight loss, headaches, shingles, cervical dysplasia or carcinoma, new or unusual cough, unusual bruises or discoloration, and peripheral neuropathy.Yes, John exhibits several of these symptoms.
  • When the virus kills enough white cells to overwhelm the immune system, death occurs.
  • Recognize the infection early and provide rapid treatment for complications, including infections and cancers.
  • The virus has mutated to become resistant to some HIV drugs, such as protease inhibitors.
  • Ask students to identify three of the challenges to the development of an effective vaccine. (Degree of diversity of virus, ability of the virus to evade host’s immunity, lack of appropriate animal models)
  • The clinical dietitian on the AIDS team conducts this assessment and calculates daily nutrition needs.
  • Because of the patient’s weakened immune system, the prevention of food-borne illness is a priority.
  • Malnutrition suppresses cellular immune function, perpetuating the onset of opportunistic infections.
  • Body wasting may result from any of these causes, alone or in combination.
  • Patients with lipodystrophy continue to lose lean tissue while changes in fat mass are taking place.
  • Ask students to identify some possible food behaviors.
  • The goal is to make the least amount of changes necessary to promote optimal nutritional status.
  • Health care workers must examine their own stresses, values, fears, and preconceived judgments that can affect the provider-patient relationship.
  • Perform a comprehensive nutrition assessment.The MNT objective is to reduce or eliminate malnutrition and correct nutritional problems.Assist John in a patient-specific diet so that energy, protein, fluid, and micronutrient needs are met while not interfering with medication management.Gather and review food preferences so the nutrition plan is patient-specific.Review medications and be aware of sideeffects.Provide nutrition counseling, education, and supportive care.Continue to monitor and evaluate progress.
  • Transcript

    • 1. Williams' Basic Nutrition & Diet Therapy Chapter 23 Nutrition Support in Cancer and HIV/AIDS Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 1 14th Edition
    • 2. Lesson 23.1: Nutrition Support in Cancer  Environmental agents, genetic factors, and weaknesses in the body’s immune system can contribute to the development of cancer.  The strength of the body’s immune system relates to its overall nutritional status. 2Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 3. Process of Cancer Development (p. 471)  The nature of cancer  Multiple forms: highly variable nature  Second leading cause of death in United States  Cancer designates a malignant tumor neoplasm 3Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 4. The Cancer Cell (p. 472)  Orderly process of cell division is disrupted by mutation  Cancer is normal cell growth that has gone wrong  Tumors identified by:  Primary site of origin  Stage of tumor size and metastasis  Grade: level of aggressiveness 4Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 5. Causes of Cancer Cell Development (p. 473)  Dietary factors  Role is complex  Micronutrient imbalance linked to DNA damage and cancer 5Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 6. The Body’s Defense System (p. 473)  Two types of lymphocytes (defensive immune system cells)  T cells  B cells  T cells activate phagocytes  Phagocytes destroy invaders and antigens  B cells produce antibodies, which kill antigens 6Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 7. The Body’s Defense System (cont’d) (p. 473) 7Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 8. Relation of Nutrition to Immunity and Healing (p. 473)  Immunity  Balanced nutrition maintains immune system  Malnutrition reduces capacity of immune system via atrophy of organs and tissues involve in immunity  Nutrition vital in combatting sustained attacks of diseases (e.g., cancer) 8Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 9. Relation of Nutrition to Immunity and Healing (cont’d) (p. 473)  Healing  Strong tissue is fundamental to immune system  Tissue building and healing requires optimal nutrition  Vigorous MNT speeds recovery after surgery for cancer 9Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 10. Nutrition Complications of Cancer Treatment (p. 474)  Three major forms of therapy used to treat cancer  Surgery  Radiation  Chemotherapy 10Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 11. Surgery (p. 474)  All surgery requires nutrition support for the healing process  General condition of cancer patients often is weakened by the disease process 11Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 12. Radiation (p. 474)  Involves high-energy radiographs targeted on the cancer site  Often kills surrounding healthy cells as well as cancerous cells  Nutrition problems driven by site and intensity of radiation treatment  Sense of taste may be affected, prompting efforts to enhance food appearance and aroma 12Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 13. Radiation (p. 474) 13Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 14. Chemotherapy (p. 474)  Highly toxic drugs administered via the bloodstream to kill cancer cells  Normal, healthy cells also affected  Bone marrow  Gastrointestinal  Hair loss 14Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 15. Drug-Nutrient Interactions (p. 475)  Use of monoamine oxidase inhibitors (pretreatment antidepressant drugs) requires tyramine-restricted diet  Antineoplastic drugs have drug-nutrient interactions  Some patients use herbs to prevent or treat cancer, can have food-drug interactions 15Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 16. Medical Nutrition Therapy in the Patient with Cancer (p. 475)  General systemic effects of cancer  Anorexia, loss of appetite  Increased metabolism  Negative nitrogen balance  Specific effects related to cancer  Depending on location and nature of tumor 16Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 17. Case Study  Mrs. Bowen has been undergoing chemotherapy for cancer. She is 55 years old. She complains of nausea and that food tastes “funny.” She has lost 5 pounds from her normal weight of 130 lbs. (64 inches tall). 17Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 18. Case Study (cont’d)  Give a rationale as to why Mrs. Bowen is currently feeling nauseated and why she feels that food tastes funny. 18Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 19. Basic Objectives of Nutrition Plan (p. 477)  Nutrition screening and assessment  Primary responsibility of clinical dietitian  Other members of health care team may take part 19Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 20. Basic Objectives of Nutrition Plan (cont’d) (p. 477)  Nutrition intervention  Prevent weight loss  Maintain lean body mass  Prevent unintentional weight gain  Identify and manage treatment-related side effects 20Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 21. Prevention of Catabolism (p. 477)  MNT to meet increased metabolic demands of disease process  Medications used to:  Increase appetite  Reduce nausea  Prevent protein degradation  Increase caloric intake 21Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 22. Relief of Symptoms (p. 477)  Stress management  Pain management  Relaxation techniques  Psychological support  Physical activities 22Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 23. Nutrition Monitoring and Evaluation (p. 478)  Dietitian develops customized MNT plan for patient  Plan is evaluated regularly with patient and family  Plan adjusted as needed 23Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 24. Medical Nutrition Therapy (p. 478)  Energy: cancer places great metabolic demands  Protein: essential amino acids and nitrogen for rebuilding  Vitamins and minerals: at least to DRI standards  Fluid: to replace losses, remove waste products, meet drug needs 24Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 25. Case Study (cont’d)  What nutritional recommendations may assist Mrs. Bowen? 25Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 26. Nutrition Management (p. 479)  Enteral: oral diet with supplementation  Preferred route  Adjust to maximize palatability  Maximize energy and nutrient density 26Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 27. Enteral: Oral Diet with Supplementation (p. 479)  Loss of appetite  Major issue with cancer  Can lead to cachexia  Requires vigorous program of eating that does not depend on appetite 27Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 28. Enteral: Oral Diet with Supplementation (cont’d) (p. 482)  Oral complications  Ensure basic mouth care  Frequent small snacks rather than traditional meals  Strong seasonings, high-protein drinks  GI problems  Avoid hot, sweet, fatty, spicy foods as needed  Small, frequent feedings of soft to liquid foods  Antinausea drugs 28Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 29. Pain and Discomfort (p. 482)  Pain and discomfort  Severe pain controlled and comfortable position  Pain medication as needed  Preventive therapy to avoid constipation 29Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 30. Enteral: Tube Feeding (p. 483)  When gastrointestinal tract can be used but patient is unable to eat  Indications include inadequate oral intake, oral route contraindicated, comatose  Some patients can be fed overnight, allowing them to be free from tube during day 30Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 31. Parenteral Feeding (p. 483)  When gastrointestinal tract cannot be used  Peripheral vein feeding (for brief period)  Central vein feeding (for extended period) 31Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 32. Case Study (cont’d)  If Mrs. Bowen continues to lose weight, what might be necessary? 32Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 33. Cancer Prevention (p. 483)  American Cancer Society, World Cancer Research Fund, American Institute for Cancer Prevention  Be as lean as possible within normal range  Adopt a physically active lifestyle  Consume a healthy diet  Limit alcohol consumption  Do not rely on supplements 33Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 34. Cancer Prevention (cont’d) (p. 484)  U.S. Food and Drug Administration claims approved for labels  Low total fat may reduce risk of some cancers  Fiber-containing grain products, fruits and vegetables may reduce risk of some types of cancer  Fruits and vegetables may reduce risk of some types of cancer  Ongoing cancer research: foods that may increase or reduce risk of:  Breast cancer  Gastric cancer  Colorectal cancer  Prostate cancer 34Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 35. Lesson 23.2: Nutrition Support in HIV/AIDS  Nutrition problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS.  The progressive effects of the human immunodeficiency virus (HIV), through its three stages of white T-cell destruction, have many nutrition implications and often require aggressive medical nutrition therapy. 35Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 36. Process of AIDS Development (p. 485)  Evolution of human immunodeficiency virus  First case identified in 1959  By late 1970s and early 1980s had spread to Europe and United States  Underlying infectious agent identified in 1983  Parasitic nature  Viruses contain only shreds of genetic material  They invade a host cell and use it to make copies of itself 36Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 37. Transmission and Stages of Disease Progression (p. 487)  Modes of transmission  Three distinct stages  Primary infection and extended latent period of HIV incubation  HIV-related diseases  AIDS 37Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 38. Case Study  John is a 32-year-old male diagnosed with HIV, category B. He complains of fatigue, mouth sores, and diarrhea. He has lost 10 pounds from his usual ideal body weight. 38Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 39. Case Study (cont’d)  Describe Category B HIV.  Does John exhibit signs and symptoms common to Category B? 39Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 40. CD4+ T-Lymphocyte Conditions (p. 487)  Terminal stage of HIV infection: AIDS  Rapidly declining T-lymphocyte counts  Kaposi’s sarcoma  Protozoan parasites  Cytomegalovirus 40Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 41. Medical Management of Patient with HIV/AIDS (p. 489)  Delay progression of the infection and improve the immune system  Prevent opportunistic illnesses  Recognize the infection early 41Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 42. Drug Therapy (p. 489)  Effective drug therapy is difficult because of highly evolved nature of virus  Several drugs approved by FDA  Highly active antiretroviral therapy is current primary drug regimen 42Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 43. Vaccine Development (p. 492)  Vaccine would train body’s immune system to identify and destroy HIV virus  Vaccine undergoing trials in Thailand considered somewhat effective  CDC and NIH working with other worldwide agencies to coordinate development of effective vaccine 43Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 44. Medical Nutrition Therapy (p. 493)  Assessment  Anthropometry  Biochemical tests  Clinical observations  Diet observations  Environmental, behavioral, and psychological assessment  Financial assessment 44Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 45. Medical Nutrition Therapy (cont’d) (p. 493)  Intervention  No specific nutrient recommendations for patient with HIV  Reduce or eliminate malnutrition  Correct nutrition problems identified in assessment 45Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 46. Wasting Effects of HIV Infection on Nutritional Status (p. 493)  Severe malnutrition, weight loss  Decreased appetite, insufficient energy intake in addition to elevated resting energy expenditure  Major weight loss, eventual cachexia 46Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 47. Causes of Body Wasting (p. 494)  Inadequate food intake  Malabsorption of nutrients  Disordered metabolism  Lean tissue wasting 47Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 48. Lipodystrophy (p. 494)  Gaining of fat in neck and abdomen  Concurrent loss of fat in face, buttocks, arms, legs  Treatment with antiretroviral therapy may be causative factor  Other risk factors 48Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 49. Nutrition Counseling, Education, and Supportive Care (p. 495)  Should focus on:  Appropriate, adequate food intake  Food behaviors  Symptoms that may affect food intake  Benefits and risks of supplemental nutrients  Nutritional strategies for symptom management 49Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 50. Counseling Principles (p. 495)  Motivation for dietary changes  Rationale for nutrition support  Provider-patient agreement on plan  Development of manageable steps for change 50Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 51. Personal Food Management Skills (p. 495)  Identify community programs (e.g., Meals on Wheels)  Provide psychosocial support 51Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
    • 52. Case Study (cont’d)  Make nutrition recommendations for John. 52Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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