Cancer nutrition

1. Nutrition care for cancer
By
Aya El-Alfy
Karim Asfour
Merna Anas
Ahmed Rizk
Sara Katat

3. Abnormalities in metabolism
• CHO metabolism
• * increased gluconeogenesis ( from A.As & lactate)
• *Decreased glucose tolerance & turn-over
• *Insulin resistance

4. Abnormalities in metabolism
• Lipid metabolism
• * Increased lipolysis
*Decreased lipogenesis
*Elevated triglycerides

5. Abnormalities in metabolism
• Protein metabolism
• * Ms wasting
• * Nitrogen depletion
• * increased whole body protein turn-over,
• increased liver & tumour protein synthesis

6. •
• About 50% cancer patients are malnourished & 20% die from
malnutritition rather than cancer itself.
• Therefore, Nutrition Support should be an integral component of
comprehensive Cancer Care during all cancer phases.

7. Purpose of Nutrition Care in Cancer
• 1* To restore or conserve nutritional status & body composition (prior
to, during, and after cancer treatment).
• 2* To minimize food-related discomfort associated with cancer &or
its treatment.
• 3* To improve quality of life & well being

8. Nutritional implications & cancer
therapies

9. Types of Treatment
• Surgery
• Chemotherapy
• Radiotherapy
• Hormone therapy
• ** therapies can be used alone or in combination

10. Surgery
• Increased need for calories
• If malnorished >> compromised wound healing & increased morbidity
& mortality
• The goal is to minimize the weight loss & prevent nutrient deficiency

12. Major Nutritional implications
Treatment Weight loss Fatigue N & Vom Oral
Mucositis
Taste
alteration
Constipation
Overall % 50-90% 70-100% 60-90% 80-100% 60-70% 40-50%
Chemotherap ** ** ** ** ** **
Radiation ** ** ** ** **
Surgery ** ** **
hormone ** ** **
** = Treatment in which side effect is common

13. Medical Nutrition therapy
• Phase I
• Prevention or reversal of
defeciencies
• Optimal body weight
• Minimize side effects
• Protection of immunity
• Consider medication interaction
issues
• Phase II
• Maintenance of body weight
• Incorporate healthy nutrition
habits for long term health
• Minimize recurrence risk
• Evaluate the risks & benefits of
nutrition – related supplements,
vitamins & herbs

15. Screening & Assessment
• All patients
• By all staff both in & out patient
• Best tool:
Patient- Generated Subjective
Global Assessment (PG-SGA)
** Referral must be done if pt is at
risk
• Full assessment including
-Anthropometric measures
-Lab analysis
- Med history detailed for the
tuour & for comorbidities
- Dietary intake & 24 hr recall & all
related symptoms
- ** Cachexia vs Starvation

16. Meal Planning
• 1- Description of the diet:
Appropriate food consistency depends on the severity of eating
problems, modifications that may be indicated include:
* High calorie – high protein diet
* Texture modification
* High or low fibre diet

17. Meal Planning
2- Energy – Protein requirement:
Use Mifflin-st Jeor Eqn
Or calculator
Or Quick method : 35-50 Kcal/Kg for hypermetabolic pts

19. Meal Planning
Activity factor ( Multiply REE by:)
• Hospitalized or ICU 1.05-1.1
• Chair or bed bound 1.2
• Little movement 1.4-1.5
• Seated work with requirement
to move 1.6-1.7
• Standing work 1.8-1.9
• Highly active 2-2.4
Stress factor
• Elective surgery 1-1.1
• Multiple bone fractures 1.1-1.3
• Cancer 1.1-1.45
• Fever 1.2 per 1 degree C over 37
• Sepsis 1.2-1.6

20. Protein needs
• Acc. to the status ..
• Normal protein needs: 0.8gm – 1gm / kg
• Non stressed 1- 1.5 gm/kg
• Bone marrow transplant 1.5 gm / kg
• Renal & hepatic modifications

22. Fluids & Micro nutrients
• Fluids:
30-35ml/kg ( non-renal)
• Vitamins & minerals:
Common deficiencies:
Cu, Zn, folate, Ca, Mg, Vits A, C &
D
Use of a daily multivit containing
<150% DRI may be beneficial

23. Anorexia Exercise if applicable
Corticosteroids
Make every mouthful count.. Together with the patient make a list of their
own tolerable foods or fluids
Quick nutrient snacks (high protein / calorie foods)
Taste alteration Add flavours
Candies or chew gums
Serve food cold
Rinse mouth with baking soda/clover/green tea
Xerostomia Hard candies
Frozen grapes
Moist foods
Plenty of fluids

24. Mucositis Visit dentist at least 2 weeks before treatment
Regularly check ur mouth for any changes
Brush regularly
Water sips continuously
IF happened:
-mashed foods
-drink with a straw
- Milk shakes & soft foods will help
- Avoid sour & citrus foods & drinks
- Avoid smoking
- Saliva stimulators (Salagan ..pilocarbine hydrochloride)
Nausea & Voimiting Sit up or Recline with a raised head 1 hr after eating
Avoid eating in a room with cooking odours
Suck on ice cube or peppermint candy
Smaller frequent meals
Ginger

25. Dihrrea BRAT diet
Zn
Constipation Whole grain
Bran
Olive oil
Prunes
dates