Importance Of Nutrition In Cancer Patients

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Importance of Nutrition In Cancer Patients

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Importance Of Nutrition In Cancer Patients

  1. 1. Importance of Nutrition in Oncology Patients
  2. 2. <ul><li>Cancer and its oncological treatment cause symptoms which increase the patients risk to suffer from MALNUTRITION . </li></ul><ul><li>This affects the patients health status negatively by </li></ul><ul><li>Increasing the Number of Complications </li></ul><ul><li>Reducing the TOLERANCE to the oncology treatment </li></ul><ul><li>Decrease of the patients Quality of Life </li></ul>2008 Sep-Oct;23(5):458-68.
  3. 3. <ul><li>MALNUTRITION is a common problem in cancer patients that has been recognized as an important component of adverse outcomes, including </li></ul><ul><li>Increased MORBIDITY and MORTALITY and </li></ul><ul><li>Decreased Quality of Life. </li></ul>Supplement 6: 20-7, 1998
  4. 4. Malnutrition and Cancer <ul><li>Diminished Tolerance Of Therapy </li></ul><ul><li>Lower Survival Rates </li></ul><ul><li>Diminished Quality Of Life </li></ul><ul><li>Longer Hospitalizations </li></ul>
  5. 5. <ul><li>Good nutrition practices can help cancer patients </li></ul><ul><li>MAINTAIN WEIGHT </li></ul><ul><li>The body's NUTRITION STORES </li></ul><ul><li>Improving QUALITY OF LIFE </li></ul>
  6. 6. <ul><li>Nutritional intervention should be considered as a supportive measure within the GLOBAL ONCOLOGY STRATEGY . </li></ul>2007 Jul;10(4):480-7
  7. 7. <ul><li>In curative oncology care, it contributes to </li></ul><ul><li>Reduced Postoperative Infection Rate </li></ul><ul><li>Better Control of Cancer-related Symptoms </li></ul><ul><li>Shortened Length of Hospital Stay and </li></ul><ul><li>Improved Tolerance to Treatment </li></ul>2007 Jul;10(4):480-7
  8. 8. <ul><li>In palliative care, the nutritional intervention focuses on controlling symptoms, thus improving Quality of Life . </li></ul>2007 Jul;10(4):480-7
  9. 9. <ul><li>Systemic Effects of Cancer on Nutrition </li></ul><ul><li>Guidelines for Nutritional Support </li></ul>Nutritional Issues in Cancer
  10. 10. Cancer-related Defects in Carbohydrate Metabolism <ul><li>Glucose intolerance </li></ul><ul><li>Insulin resistance </li></ul><ul><li>Abnormal insulin secretion </li></ul><ul><li>Delayed glucose clearance </li></ul><ul><li>Increased glucose production </li></ul><ul><li>Variably increased Cori cycle activity </li></ul>
  11. 11. Cancer-related Defects in Fat Metabolism <ul><li>Excess body fat depletion relative to protein loss </li></ul><ul><li>Decreased free fatty acids, and glycerol turnover </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Decreased serum lipoprotein lipase activity </li></ul>
  12. 12. Cancer-related Defects in Protein Metabolism <ul><li>Increased whole-body PROTEIN TURNOVER </li></ul><ul><li>Persistent muscle protein breakdown </li></ul><ul><li>Decreased plasma branched-chain amino acids </li></ul>
  13. 13. <ul><li>Guidelines for Nutritional Support </li></ul>
  14. 14. <ul><li>Step 1 - Assessment </li></ul><ul><ul><li>History </li></ul></ul><ul><ul><li>Labs </li></ul></ul><ul><li>Step 2 - Planning </li></ul><ul><ul><li> Nutritional requirements </li></ul></ul><ul><ul><li> Setting achievable goals </li></ul></ul><ul><li> Step 3 - Intervention </li></ul><ul><ul><li>Symptom Management </li></ul></ul><ul><ul><li>Nourishment </li></ul></ul><ul><li>Step 4 - Evaluation </li></ul>
  15. 15. Assess - Ask! <ul><li>Ask about: </li></ul><ul><li>APPETITE - good/poor </li></ul><ul><li>GRAZING or snacking </li></ul><ul><li>SPECIAL DIETS / practices </li></ul><ul><li>FOOD likes/dislikes </li></ul><ul><li>QUANTITY - calories in </li></ul><ul><li>SYMPTOMS - mouth pain or difficulties with chewing or swallowing </li></ul><ul><li>VITAMIN /herb use </li></ul>
  16. 16. Assess - Ask! <ul><li>Beware of: </li></ul><ul><li>Living arrangements </li></ul><ul><ul><li>Alone? </li></ul></ul><ul><ul><li>Housebound? </li></ul></ul><ul><ul><li>Vigor? </li></ul></ul><ul><li>Income level </li></ul><ul><li>Alcohol use </li></ul><ul><li>Mental status </li></ul>
  17. 17. Assess - Look for signs! <ul><li>HAIR - dull, brittle, dry or falls out easily </li></ul><ul><li>SWOLLEN GLANDS in the neck </li></ul><ul><li>SKIN - dry, rough, spotty, or sandpapery feel </li></ul><ul><li>SORES and delayed wound healing </li></ul><ul><li>MUSCLE WASTING (decreased size & strength) </li></ul><ul><li>EDEMA of the lower extremities </li></ul><ul><li>ABNORMAL HEART RATE , rhythm, & blood pressure </li></ul><ul><li>ENLARGED LIVER or spleen </li></ul><ul><li>LOSS OF BALANCE or coordination </li></ul>
  18. 18. Assess - Regular weighing! < 20 = malnutrition possible < 18 = malnutrition likely Weight (kg)/height(m) 2 BMI (Body Mass Index) Significant weight loss is greater than: 1% - 2% in 1 week 5% in 1 month 7.5% in 3 months 10% in 6 months Amount of weight change divided by usual weight x 100 Percent Weight Change >120 % IBW is obese 110% - 120% IBW is over weight 90% - 110% IBW is normal range 80% - 90% IBW is mildly underweight <80% IBW is moderately underweight Ideal Body Weight (BMI) Men: 106 lbs. For the first 5' of height plus 6 lbs. For each additional inch. Women : 100 lbs. For the first 5' of height plus 5 lbs. For each additional inch. Weight Interpretation Standard Criteria
  19. 19. Assess - Know lab results! <ul><li>Albumin (3.5-5 g/dL) </li></ul><ul><ul><li>Mild depletion (2.8-3.4 g/dL) </li></ul></ul><ul><ul><li>Moderate depletion (2.1-2.7 g/dL) </li></ul></ul><ul><ul><li>Severe depletion (<2.1g/dL) </li></ul></ul><ul><li>Total lymphocyte count (2500 mm 3) </li></ul><ul><ul><li>TLC (mm 3 ) = WBC (mm 3 ) x % lymphocytes </li></ul></ul><ul><ul><li>Mild depletion (<1500 mm 3 ) </li></ul></ul><ul><ul><li>Moderate depletion (<1200 mm 3 ) </li></ul></ul><ul><ul><li>Severe depletion (<800 mm 3 ) </li></ul></ul>
  20. 20. Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Calories per day </li></ul><ul><li>Normal: 30 cal/kg (for adults) - average activity levels </li></ul><ul><li>28 cal/kg in starvation - due to slowed metabolism & decreased calorie needs </li></ul><ul><li>32 cal/kg in elective surgery - mildly increased needs   </li></ul><ul><li>40 cal/kg in polytrauma; significantly increased needs </li></ul><ul><li>50 cal/kg in sepsis or severe stress; highly increased needs </li></ul>
  21. 21. Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Protein per day </li></ul><ul><li>0.8 g/kg (for adults Normal) - average activity levels </li></ul><ul><li>1.5 - 2 g/kg with fever, fracture, infection, wound healing </li></ul><ul><li>1.5 - 2 g/kg for protein repletion </li></ul><ul><li>1.5 - 3 g/kg for Cachexia or burns </li></ul>
  22. 22. Plan and Set Achievable Goals <ul><li>Rule-of-Thumb Guidelines </li></ul><ul><li>Protein required per day based on albumin level </li></ul><ul><li>If albumin is 3.5 g/dL, protein requirement is 0.8 g/kg </li></ul><ul><li>If albumin is 2.8 - 3.5 g/dL, protein requirement is 1 - 1.2 g/kg </li></ul><ul><li>If albumin is 2.1 - 2.7 g/dL, protein requirement is 1.2 -1.5 g/kg </li></ul><ul><li>If albumin is <2.1g/dL, protein requirement is 1.5 - 2 g/kg </li></ul>
  23. 23. Symptom Management <ul><li>Strategies for Patients </li></ul><ul><ul><li>Patient teaching </li></ul></ul><ul><li>Pharmacological Interventions </li></ul><ul><li>SUPPLEMENTS </li></ul><ul><li>Coping Strategies </li></ul><ul><ul><li>Spiritual </li></ul></ul><ul><ul><li>Support Groups </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><li>Total Parenteral Nutrition (TPN) </li></ul>
  24. 24. Evaluation <ul><li>Cardinal principle: </li></ul><ul><ul><li>Individualize to needs of patient </li></ul></ul><ul><li>Short-term goal: </li></ul><ul><ul><li>Improve Nutritional Status </li></ul></ul><ul><li>Long-term goal: </li></ul><ul><ul><li>Normalize Nutrient Intake </li></ul></ul><ul><ul><li>Alleviate disease symptoms </li></ul></ul><ul><li>Outcomes??? </li></ul><ul><ul><li>Better Quality of life / Vigor </li></ul></ul><ul><ul><li>Fewer Crisis / Improved Treatment Response </li></ul></ul>
  25. 25. <ul><li>SLIMFIT Provides </li></ul><ul><li>AMINO FUEL 900 </li></ul>
  26. 26. <ul><li>High Energy Hydrolysed Starches </li></ul>AMINO FUEL 900 contains
  27. 27. <ul><li>High Biological Value Proteins </li></ul><ul><li>  </li></ul>AMINO FUEL 900 contains
  28. 28. <ul><li>Mono-unsaturated Fatty Acids & Poly-unsaturated Fatty Acids </li></ul><ul><li>  </li></ul>AMINO FUEL 900 contains
  29. 29. <ul><li>High in Calorie </li></ul>AMINO FUEL 900 contains
  30. 30. <ul><li>Malnourished cancer patients commonly have increased whole body protein turnover and subsequent body nitrogen loss </li></ul>1998;48:69-80
  31. 31. Nutrient Information * With milk Nutrient Content 40 gms 100 gms Units Carbohydrate Protein Fats Saturated MUFA PUFA Cholesterol Fiber Energy Moisture 19.63 12.86 7.34 3.82 2.57 0.95 1.19 240 200 (400)* 49.08 32.16 18.34 9.54 6.42 2.38 2.97 600 500 (1000)* gms gms gms         mg k/cals 3 - 4 %
  32. 32. Amino Fuel 900 Ensure Protein per Dose Gm. Protein Comparison
  33. 33. Amino Fuel 900 Ensure Price per Dose Rs. Price Comparison
  34. 34. <ul><li>Vanilla </li></ul><ul><li>Chocolate </li></ul><ul><li>Raspberry </li></ul><ul><li>Mango </li></ul><ul><li>Pineapple </li></ul><ul><li>Lemon </li></ul>Flavours
  35. 35. ONCE or TWICE Daily or as needed 4 SCOOPS (40 gm) in 200 ml of Water or Milk Dose
  36. 36. Let Food Be Your Medicine And Medicine Be Your Food - Hippocrates, 337 BC
  37. 37. <ul><li>THANK YOU </li></ul>

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