This document discusses various nutritional aspects of cancer care. It covers the importance of nutrition for cancer patients, common side effects that can impact nutrition like weight loss and fatigue, and nutritional strategies to manage these side effects. It also discusses malnutrition in cancer patients, the causes of malnutrition including decreased intake and increased nutrient needs/losses, and approaches for managing malnutrition like nutritional supplements. The document provides information on cancer-induced weight loss known as cachexia and management strategies. It also reviews enteral and parenteral nutrition options.

1. NUTRITIONAL ASPECTS
OF CANCER CARE
MOHAMED SABER, MSC
CLINICAL PHARMACY DEPARTMENT-SOH-LUXOR
CSSBB-ASQ-USA

2. OBJECTIVES
1. IMPORTANCE OF NUTRITION
2. PREVALENCE OF SIDE EFFECTS
3. NUTRITIONAL STRATEGIES
4. MALNUTRITION
5. CAUSES
6. MANAGEMENT
7. CANCER CACHEXIA
8. ENTERAL NUTRITION
9. PARENTRAL NUTRITION
10. CONCLUSION
11. REFERENCES

3. GOOD NUTRITION
IS IMPORTANT
– FEEL BETTER
– FIGHT FATIGUE
– MAINTAIN BODY WEIGHT
– CONSUME ENOUGH VITAMINS AND MINERALS
– IMPROVE STRENGTH AND ENERGY
– REDUCE RISK OF INFECTION
– MANAGE TREATMENT-RELATED SIDE
EFFECTS
– IMPROVE QUALITY OF LIFE
• Good nutrition can help people with cancer:

4. CANCER
NEED EXTRA
NUTRITION
Healthy Individual Individual With Cancer
Calorie
s
25-30 Cal/kg Maintenance: 25-35 Cal/kg
Gain: 30-40 Cal/kg
Protein 0.8 g/kg Maintenance: 1.5-2.5 g/kg
with severe stress
Healthy
Individual
Individual With
Cancer
Calories needed
per day for a
150-lb person
1703-2043
Maintenance: 1703-2383
Gain: 2043-2742Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier
Saunders; 2012:832-863.
Cal=Calorie, kg=kilogram, lb-pound

5. PREVALENCE
OF SIDE EFFECTS
Treatment
Weight
Loss Fatigue
Nausea/
Vomiting
Oral
Mucositis
Taste
Alterations Constipation
Overall %
50%-
90%
70%-
100%
30%-
90%
40%-
100%
35%-
70%
40%-
50%
Chemotherapy      
Radiation     
Surgery   
Immunotherapy   
= treatment in which side effect is common

6. WEIGHT LOSS
IS SIGNIFICANT
• 50%–90% OF PEOPLE WITH CANCER EXPERIENCE
WEIGHT LOSS
• A WEIGHT LOSS OF AS LITTLE AS 5% OF BODY
WEIGHT CAN CAUSE REDUCED RESPONSE TO
TREATMENT
• WEIGHT LOSS IS ASSOCIATED WITH POOR QUALITY
OF LIFE AND REDUCED SURVIVAL

7. CYCLE OF
MALNUTRITION
Infections and Medications
Decreased
Appetite
Mouth Sores Diarrhea
Eat Less
Lose
Weight
Lose Strength
CYCLE OF
MALNUTRITIO
N
Tire Out Quickly
Too Tired
to Cook
Too Tired
to Eat

8. NUTRITIONAL
STRATEGIES
FOR WEIGHT LOSS
• EAT SMALL, FREQUENT MEALS
• SERVE FAVORITE FOODS
• PLAN PHYSICAL ACTIVITY TO STIMULATE APPETITE
• USE MEDICAL NUTRITIONAL SHAKES AND DRINKS TO
PROVIDE EXTRA CALORIES AND PROTEIN

9. FATIGUE IS COMMON
• FATIGUE IS MOST COMMON SIDE EFFECT
• ASSOCIATED WITH TREATMENT, PAIN, STRESS, AND/OR
WEIGHT LOSS
• EFFECT ON NUTRITIONAL STATUS:
– WEIGHT GAIN/LOSS
– CHANGES IN CALORIE INTAKE
– FLUID AND ELECTROLYTE IMBALANCES

10. NUTRITIONAL STRATEGIES
FOR FATIGUE
• HAVE SMALL, FREQUENT MEALS
• PREPARE MEALS IN QUANTITY WHEN FEELING WELL
• MAKE EASY-TO-PREPARE FOODS
• USE READY-TO-SERVE MEDICAL NUTRITIONAL
PRODUCTS FOR CONVENIENCE AND EXTRA NUTRITION

11. NAUSEA/VOMITING
• COMMON WITH CHEMOTHERAPY AND RADIATION
• EFFECT ON NUTRITIONAL STATUS:
– DEHYDRATION/ELECTROLYTE IMBALANCE
– LOSS OF APPETITE
– POOR INTAKE OF FOOD AND FLUID
– FOOD AVERSIONS
– WEIGHT LOSS

12. NUTRITIONAL
STRATEGIES
FOR NAUSEA/VOMITING
• EAT SMALL, FREQUENT MEALS AND SNACKS
• TRY COLD FOODS, ICE CHIPS, DRY FOODS, AND ROOM-
TEMPERATURE FOODS
• DRINK LIQUIDS BETWEEN MEALS TO AVOID FEELINGS
OF FULLNESS

13. NUTRITIONAL
STRATEGIES
FOR NAUSEA/VOMITING
(CONT’D)
• AVOID:
– GREASY, FATTY, OR SPICY FOODS
– STRONG FOOD ODORS
– VERY SWEET FOODS
– HOT FOODS
– DRINKING LIQUIDS WITH MEALS
– FAVORITE FOODS AROUND TREATMENT TIME

14. Oral Mucositis
• Inflammation of the mucous
membranes; red, burnlike sores
and ulcers
• Effect on nutritional status:
– Decreased dietary intake
– Dehydration
– Malnutrition and weight loss

15. Nutritional Strategies
for Oral Mucositis
• Select soft foods
• Use a straw to make swallowing easier
• Avoid acidic, spicy, and dry foods
• Use high-calorie drinks and/or medical
nutritional supplements

16. Taste Alterations
Are Significant
• Mouth blindness—bitter/metallic taste
• Meat aversions
• Reduced ability to taste salt and sugar

17. Taste Alterations Are
Significant (cont’d)
• Effect on nutritional status:
– Food aversions
– Loss of appetite
– Decreased dietary intake, especially of
protein
– Weight loss

18. STRATEGIES
FOR TASTE
ALTERATIONS
USE TART OR SOUR FOODS TO REDUCE METALLIC TASTE
SEASON FOODS WITH HERBS
SERVE FOODS COLD OR AT ROOM TEMPERATURE

19. CONSTIPATION
• CONSTIPATION IS COMMON, ESPECIALLY AMONG
PEOPLE TAKING OPIOID ANALGESICS
• EFFECT ON NUTRITIONAL STATUS:
– LOSS OF APPETITE
– DECREASED DIETARY INTAKE
– WEIGHT LOSS

20. NUTRITIONAL
STRATEGIES
FOR CONSTIPATION
• CHOOSE HIGH-FIBER FOODS
• DRINK PLENTY OF FLUIDS
• KEEP PHYSICALLY ACTIVE IF YOU ARE ABLE
• AVOID OR LIMIT GAS-FORMING FOODS
AND BEVERAGES

21. What is Malnutrition?
“A state of nutrition in which a
deficiency or excess of energy,
protein and other nutrients causes
measurable adverse affects on
tissue/body form, function and clinical
outcome”
DOH, 2002
• 1 in 4 adults admitted to hospital or
care homes at risk of Malnutrition.
Bapen 2007
• Estimated up to 80% of advanced ca
pts have malnutrition. Poole & Froggatt, 2002

22. CAUSES OF MALNUTRITION?
FOUR MAIN CAUSES:
• DECREASED DIETARY INTAKE
• INCREASED REQUIREMENTS
• INCREASED LOSSES OF NUTRIENTS
• IMPAIRED NUTRIENT DIGESTION /
ABSORPTION.

23. CAUSES OF DECREASED INTAKE
• REDUCED APPETITE DUE TO CACHEXIA
/ DEPRESSION / ANXIETY
• SYMPTOMS OF ILLNESS – N&V, SORE
MOUTH, ABDO DISTENSION,
DIARRHOEA.
• TREATMENT SIDE EFFECTS
• TUMOUR / ASCITES PRESSING ON GI
TRACT REDUCING VOLUME AVAILABLE
AND CAUSING EARLY SATIETY
• TASTE CHANGES
• CONSTIPATION

24. CAUSES OF DECREASED INTAKE
• SOCIAL ISOLATION, SIGNIFICANT LIFE
CHANGE, MENTAL ILLNESS
• REPEATEDLY NBM FOR INVESTIGATIONS /
BIOPSIES
• DIFFICULTY WITH EATING / CHEWING E.G. ILL
FITTING DENTURES, POOR ORAL HYGIENE /
DYSPHAGIA
• DIFFICULTY WITH SELF FEEDING

25. CAUSES OF INCREASED REQUIREMENTS
• CACHEXIA
• MALIGNANCIES
• INFECTION
• WOUND HEALING
• POST OP PTS
• FRACTURES

26. LOSS OF NUTRIENTS
• VOMITING
• DIARRHOEA
• RENAL LOSSES
• HAEMORRHAGE
• WOUND
• FISTULA

27. IMPAIRED DIGESTION / ABSORPTION
• LACK OF DIGESTIVE ENZYMES E.G. CA PANCREAS,
PANCREATITIS, CF
• LOSS OF SURFACE AREA FOR ABSORPTION E.G. PTS WITH
RESECTIONS, COELIAC DISEASE
• RADIATION ENTERITIS

28. IMPACT:
• WEIGHT LOSS
• VITAMIN DEFICIENCY
• IMPAIRED IMMUNE FUNCTION
• DELAYED WOUND HEALING
• HIGHER RISK OF PRESSURE
SORES
• MUSCLE WASTING AND WEAKNESS
– IMPAIRING RESPIRATORY
FUNCTION, CARDIAC FUNCTION,

29. IMPACT CONT…
• INCREASED RISK OF POST OP
COMPLICATIONS.
• APATHY AND DEPRESSION –
VICIOUS CIRCLE.
• LETHARGY, TIREDNESS,
WEAKNESS.
• EST. 20% PEOPLE WITH
CANCER DIE FROM EFFECTS
OF MALNUTRITION RATHER

30. MANAGEMENT OF MALNUTRITION
• EARLY INTERVENTION IMPROVES OUTCOME.
• WARD CAN SCREEN WITH MUST, START FORTIFIED
DIETS, FOOD CHARTS, WEIGHT CHECKS, PROVIDE
ASSISTANCE.
• CLINICS – WEIGHT, HEIGHT, BMI, WEIGHT HISTORY,
RECENT FOOD INTAKE, CONSIDER PLANNED
TREATMENTS.
• REFER TO DIETITIAN USING MUST SCORE > 2,
ANYTHING LESS SHOULD BE MANAGED AT WARD
LEVEL.

32. MANAGEMENT OF MALNUTRITION
• TREAT SIDE EFFECTS RESTRICTING INTAKE
• TREAT DEPRESSION IF PRESENT
• MOUTH CARE – BE PROACTIVE!
• MODIFY DIET
• CONSIDER SUPPLEMENTS
• CONSIDER ARTIFICIAL NUTRITION IF APPROPRIATE

33. REFEEDING SYNDROME
• REFEEDING SYNDROME – “SEVERE FLUID
AND ELECTROLYTE SHIFTS AND RELATED
METABOLIC COMPLICATIONS IN
MALNOURISHED PTS UNDERGOING
REFEEDING.”
• DURING STARVATION THE BODY ADAPTS
TO SAVE ENERGY.
• ON REFEEDING: INCREASED INSULIN
RELEASE LEADS TO UPTAKE OF
GLUCOSE, PHOS AND K+ INTO CELLS.

34. PARENTERAL NUTRITION
• INTRAVENOUS NUTRITION
• IF THE GUT WORKS – USE IT!
• USED TO MEET PATIENTS REQUIREMENTS
WHERE THE GUT IS NOT WORKING
• SHORT AND LONG TERM INDICATIONS E.G.
ENTEROCUTANEOUS FISTULAE, POST-OP
ILEUS, SEVERE MAL-ABSORPTION, SHORT
BOWEL SYNDROME, RADIATION ENTERITIS
ETC
• REQUESTED VIA THE NUTRITION TEAM

35. CANCERINDUCEDWEIGHT LOSS (CACHEXIA)
• WEIGHT NOT MAINTAINED DESPITE NORMAL DIET
• COMPLEX COMBINATION OF METABOLIC ABNORMALITIES.
• PARTICULARLY PREVALENT WITH SOLID TUMOURS.
• ADEQUATE NUTRITION HAS LITTLE OR NO EFFECT
• EARLY VISIBLE SIGN OF DETERIORATION
• ASSOCIATED WITH ANOREXIA AND EARLY SATIETY

36. AETIOLOGY OF CACHEXIA
 MANY DIFFERENT FACTORS
oCYTOKINE INVOLVEMENT
 PRO-INFLAMMATORY CYTOKINES
IMPLICATED IN METABOLIC
DISTURBANCES
 TNF, IL-1, IL-6, IL-8 AND LIF
 MEDIATE ACUTE PHASE PROTEIN
RESPONSE (APPR)
 CAUSES INCREASED SYNTHESIS OF
PROTEINS BY THE LIVER E.G. CRP
 REQ. AMINO ACIDS FROM LEAN BODY
TISSUE CAUSING WEIGHT LOSS
 CRP ELEVATED IN 45 % OF CA PANC
PTS AT DIAGNOSIS. FALCONER ET AL. 1994

37. METABOLIC CHANGES CAUSING REE
Metabolically
Inefficient
Recycling of
glucose
APPR
Lipogenesis
Lipoprotein
lipase
Protein
synthesis
Protein
catabolism
Whole body
Protein
turnover
Glucose
Production/
turnover
REE
PIF
REE = resting energy expenditure
PIF = proteolysis inducing factor
APPR: Acute phase protein response

38. SUMMARY OF CACHEXIA

39. MANAGEMENT OF CACHEXIA
• TEAM APPROACH.
• CURE THE CANCER – NOT ALWAYS
POSSIBLE.
• INCREASE NUTRITIONAL INTAKE – DIET
AND SUPPLEMENTS TO MEET THE DEFICIT.
• REDUCE EFFECTS OF FACTORS LISTED
PREVIOUSLY THROUGH CANCER
TREATMENTS, PHARMACOLOGY, DIETARY
INTERVENTIONS, INVOLVEMENT OF OTHER
AHPS ETC.
• IMPROVE NUTRITIONAL STATUS.
• IMPROVE QUALITY OF LIFE.

40. ENTERAL NUTRITION
INDICATION: HEMODYNAMICALLY STABLE PATIENTS AT RISK OF
MALNUTRITION IN WHOM IT IS ANTICIPATED THAT ORAL
FEEDINGS WILL BE INADEQUATE FOR AT LEAST 1–2 WEEKS.

41. EN CONTRAINDICATIONS
1. COMPLETE INTESTINAL OBSTRUCTION
2. GI FISTULA (IF A FEEDING TUBE CANNOT BE
PLACED AWAY FROM THE FISTULA OR IF
HIGH-OUTPUT FISTULA, WHICH IS DEFINED AS
GREATER THAN 500 ML/DAY OF OUTPUT)
3. EXTREME SHORT BOWEL
4. SEVERE DIARRHEA OR VOMITING
5. HEMODYNAMIC INSTABILITY OR INTESTINAL ISCHEMIA.
6. PARALYTIC ILEUS (HOWEVER, MANY PATIENTS CAN
BE FED THROUGH THE SMALL BOWEL,
DESPITE AN ILEUS)

42. EN ADMINISTRATION ROUTES
1. OROGASTRIC TUBES
2. NG TUBES
3. NASODUODENAL
4. NASOJEJUNAL
5. GASTROSTOMY TUBES(ALSO KNOWN AS PEG)
6. JEJUNOSTOMY TUBES

43. EN DELIVERY
CONTINUOUS INFUSION USING AN ENTERAL FEEDING
PUMP IS MOST COMMONLY USED IN
HOSPITALS
CYCLIC FEEDINGS ARE ADMINISTERED CONTINUOUSLY
FOR 10–12 HOURS (OVERNIGHT)
INTERMITTENT BOLUS FEEDING OF 100–300 ML
FOR 30–60 MINUTES EVERY 4–6 HOURS CAN
ONLY BE USED FOR FEEDING TUBES ENDING IN THE
STOMACH

44. BENEFIT OF EN
• EN IS PREFERRED IN PATIENTS WITH A
FUNCTIONAL GI TRACT BECAUSE IT IS
ASSOCIATED WITH A LOWER RISK OF INFECTION
THAN PN.
• EARLY ADMINISTRATION OF EN IS ASSOCIATED
WITH DECREASED INFECTION AND SHORTER
LENGTH OF STAY.
• GI MUCOSAL ATROPHY OCCURS WITH AN
ABSENCE OF EN.

45. EN FORMULATIONS
• DIEASE SPECIFIC

46. EN COMPLICATIONS
• IMPROPER TUBE PLACEMENT OR DISPLACEMENT
• CLOGGED FEEDING TUBES
• ASPIRATION PNEUMONIA
• DIARRHEA COMMON WITH ELEMENTAL PRODUCTS
BECAUSE OF A HIGHER OSMOLALITY
• CONSTIPATION
• DEHYDRATION
• NASOPHARYNGEAL EROSIONS, EPISTAXIS
• SINUSITIS
• ELECTROLYTE ABNORMALITIES ARE MOST LIKELY TO
OCCUR IN PATIENTS WHO DEVELOP REFEEDING
SYNDROME

47. EN MONITORING
• BLOOD GLUCOSE CONCENTRATION
• HEAD OF BED ELEVATION TO 30–45 DEGREES
• GASTRIC RESIDUALS ARE CHECKED, AND INFUSION RATE
IS GENERALLY HELD OR REDUCED IF THE
RESIDUAL AMOUNT EXCEEDS 250–500 ML
• GI TOLERANCE
• PRE-ALBUMIN WEEKLY.
• SERUM NA AND OTHER ELECTROLYTES
• WOUND HEALING IS A SIGN OF ADEQUATE NUTRITIONAL
THERAPY.

48. EXAMPLE TO DEVELOP EN

49. DRUG ADMINISTRATION USING
ENTERAL ACCESS
• LIQUIDS ARE PREFERABLE, AND THEY SHOULD BE
DILUTED WITH 2–3 TIMES THE MEDICATION
VOLUME, WITH STERILE WATER FOR IRRIGATION.
• TAKE CARE OF DIARRHEA
• FLUSH WITH 20 ML OF WATER BEFORE AND AFTER DRUG
ADMINISTRATION.
• DO NOT CRUSH SUSTAINED-RELEASE OR ENTERIC-COATED
PILLS.
• MIX CRUSHED TABLETS OR CAPSULE CONTENTS WITH 10–15 ML
OF STERILE WATER FOR INJECTION, AND ADMINISTER EACH
DRUG SEPARATELY.
• MAY NEED TO DISCONTINUE TUBE FEEDINGS
BEFORE AND AFTER DRUG ADMINISTRATION TEMPORARILY
TO PREVENT REDUCED BIOAVAILABILITY (E.G.,
FLUOROQUINOLONES, PHENYTOIN, WARFARIN,
BISPHOSPHONATES)
• CONSIDER FEEDING TUBE LOCATION AND SUBSEQUENT DRUG

50. PARENTRAL NUTRITION
• PN IS THE ADMINISTRATION OF INTRAVENOUS NUTRITION IN
PATIENTS WITH A NONFUNCTIONING OR INACCESSIBLE GI
TRACT

51. INDICATIONS FOR PN
• SEVERE PANCREATITIS
• PERITONITIS
• SEVERE INFLAMMATORY BOWEL DISEASE (E.G., CROHN
DISEASE, ULCERATIVE COLITIS)
• EXTENSIVE BOWEL RESECTION (E.G., SHORT BOWEL
SYNDROME) CAUSING MALABSORPTION OR MALDIGESTION
• COMPLETE BOWEL OBSTRUCTION
• SEVERE INTRACTABLE VOMITING OR DIARRHEA
• INABILITY TO MEET FULL NUTRITIONAL NEEDS BY ENTERAL
ROUTE ALONE (CAN USE PN AS SUPPLEMENT TO EN)

52. INTRAVENOUS INFUSION OF PN
• PN IS USUALLY ADMINISTERED THROUGH A CENTRAL LINE.
• A PERIPHERAL VEIN IS USED FOR PN ADMINISTRATION, THE
OSMOLARITY MUST NOT EXCEED 900 MOSM/L.
• PERIPHERAL ADMINISTRATION IN PATIENTS WHEN CENTRAL
INTRAVENOUS ACCESS IS UNAVAILABLE AND THE NEED FOR PN
IS EXPECTED TO BE LESS THAN 2 WEEKS.
A. FINAL DEXTROSE CONCENTRATION SHOULD BE 10% OR LESS.
B. FINAL AA CONCENTRATION SHOULD BE 2.5%–4%.
C. CA CONCENTRATION SHOULD BE 5 MEQ/L OR LESS.
D. POTASSIUM CONCENTRATION SHOULD BE 80 MEQ/L OR LESS.
• IN HOSPITALIZED PATIENTS, PN IS TYPICALLY ADMINISTERED AS A
CONTINUOUS INFUSION
• AMBULATORY PATIENTS MAY PREFER A CYCLIC PN

53. 2*1OR3*1

54. NUTRITIONAL COMPONENTS OF
PN FORMULATION
• DEXTROSE 4.3 KCAL/G
• FAT EMULSION IS AVAILABLE AS 10% OR 20% AND CONTAINS
ABOUT 10 KCAL/G; ALSO AVAILABLE AS A 30%
• AA AVAILABLE AS 3%–20% AND PROVIDE 4 KCAL/G
• ELECTROLYTES ARE ADDED TO MAINTAIN PHYSIOLOGIC SERUM
CONCENTRATIONS.
• MULTIVITAMINS AND TRACE ELEMENTS ARE ADDED ON THE
BASIS OF THE RECOMMENDED DAILY AMOUNT.

55. DEVELOPING A PN REGIMEN FOR
ADMINISTRATION THROUGHA
CENTRAL INTRAVENOUS LINE
• DETERMINE CALORIC REQUIREMENTS.
• PERMISSIVE UNDERFEEDING INVOLVES THE ADMINISTRATION
OF ABOUT 80% OF CALORIC REQUIREMENTS, IT CAN BE
CONSIDERED INITIALLY
• CONSIDER BEE
• DETERMINE FLUID REQUIREMENTS, UOP
• DO NOT USE PN FOR FLUID REPLACEMENT, BUT FOR
MAINTENANCE FLUID ONLY.

56. DEVELOPING A PN REGIMEN FOR
ADMINISTRATION THROUGHA
CENTRAL INTRAVENOUS LINE
• DETERMINE PROTEIN (AA) REQUIREMENTS. ACC. TO STRESS
• PATIENTS WITH KIDNEY DYSFUNCTION MAY NEED A PROTEIN
RESTRICTION TO PREVENT UREMIA.
• CALCULATE REMAINING CALORIES, AND ADMINISTER ABOUT
20%–30% OF TOTAL CALORIES AS LIPID AND THE REMAINDER
AS DEXTROSE ( HEPATIC OXIDATION LIMIT.)

57. • ESTIMATE A DAILY MAINTENANCE AMOUNT OF
ELECTROLYTES, VITAMINS, AND TRACE ELEMENTS.. AVOID
REPLACING ELECTROLYTE DEFICIENCIES USING PN IN
ACUTELY ILL PATIENTS.
• STANDARD TRACE ELEMENTS CONTAIN SELENIUM,
CHROMIUM, COPPER, MANGANESE, AND ZINC.
• WATER/LIPID SOLUBLE VITAMINS.
DEVELOPING A PN REGIMEN FOR
ADMINISTRATION THROUGHA
CENTRAL INTRAVENOUS LINE

58. MEDICATION ADDITIVES IN PN
DO NOT ADD THE FOLLOWING TO PN:
•CEFTRIAXONE (PRECIPITATES WITH CA),
•PHENYTOIN (CAN CHANGE THE PH OF PN),
•MEDICATIONS CONTAINING PROPYLENE GLYCOL OR ETHANOL
AS DILUENTS (E.G., FUROSEMIDE, DIAZEPAM, LORAZEPAM,
DIGOXIN, PHENYTOIN, ETOPOSIDE), IRON DEXTRAN (TRIVALENT
CATIONS DESTABILIZE THE LIPID
•ONLY REGULAR INSULIN IS COMPATIBLE WITH PN.

59. PN COMPLICATIONS
1. CATHETER-RELATED INFECTIONS
2. CATHETER INSERTION COMPLICATIONS (E.G.,
PNEUMOTHORAX)
3. PERIPHERAL VENOUS THROMBOPHLEBITIS (SHOULD BE
ROTATED EVERY 3 DAYS.)
4. FLUID IMBALANCE
5. HYPERGLYCEMIA CAN LEAD TO NOSOCOMIAL AND WOUND
INFECTIONS.
6. GUT ATROPHY
7. OVERFEEDING CAN CAUSE HEPATIC STEATOSIS,
HYPERCAPNIA (ELEVATED CO2), HYPERGLYCEMIA

60. PN COMPLICATIONS
8. ESSENTIAL FATTY ACID DEFICIENCY. CAN OCCUR WITHIN 1–
3 WEEKS OF A LIPID-FREE PN
9. REFEEDING SYNDROME CAN OCCUR IN ACUTELY (CAN
INCLUDE CRITICALLY ILL PATIENTS) OR CHRONICALLY
MALNOURISHED PATIENTS BY INITIATING EN OR PN.
10. ALUMINUM TOXICITY MORE LIKELY TO OCCUR IN PATIENTS
ON LONG-TERM PN OR IN THOSE WITH RENAL
DYSFUNCTION

61. CONCLUSION
• NO QUICK FIX TO NUTRITION SUPPORT FOR PATIENTS.
• NOT NECESSARILY ABOUT PT GAINING WEIGHT.
• AIMING TO IMPROVE QUALITY OF LIFE FOR THE PT AND
REASSURE ANXIOUS RELATIVES.
• PROACTIVE APPROACH IS BEST.
• EARLY REFERRAL AND INTERVENTION IMPROVES
OUTCOME FOR THE PATIENT.
• FOOD FIRST APPROACH

62. REFERENCES:
• DOH. NUTRITION SCREENING IN QUALITY OF CARE 2002.
• MCWHIRTER J. P., PENNINGTO NC. R. , INCIDENCE & RECOG NITIO NO F
MALNUTRITIO NINHO SPITAL. BR MED J1 9 9 4: 30 8 : 9 45-9 48 .
• POOLE K, FROGATT K, WEIGHT LOSS IN ADVANCED CANCER – A
LITERATURE REVIEW. MACMILLAN CANCER RELIEF, 2002.
• TISDALE MJ, BIOLOGY OF CACHEXIA, J NATL CANCER INST 1997:23:
1763-73.
• FALCONER JS, PLESTER CE, ET AL. CYTOKINES, THE ACUTE-PHASE
RESPONSE, AND RESTING ENERGY EXPENDITURE IN CACHEXIC
PATIENTS WITH PANCREATIC CANCER. ANN SURG 1994;219(4): 325-31.
• TISDALE MJ, METABOLIC ABNORMALITIES IN CACHEXIA AND
ANOREXIA. NUTRITION 2000;6:D164-74.
• BILLINGSLEY KG, ALEXANDER HR. THE PATHOPHYSIOLOGY OF
CACHEXIA IN ADVANCED CANCER AND AIDS. IN: BRUERA E AND

63. REFERENCES
• WIGMORE SJ ET AL. THE EFFECT OF
POLYUNSATURATED FATTY ACIDS ON THE
PROGRESS OF CACHEXIA ON THE PROGRESS
OF CACHEXIA IN PATIENTS WITH PANCREATIC
CANCER. NUTRITION, 1996;12.
• BRISTOL CANCER HELP, 2006
WWW.BRISTOLCANCERHELP.ORG.UK.
• GERSON INSTITUTE, 2006 WWW.GERSON.ORG.
• NATIONAL CANCER INSTITUTE, 2006
HTTP://WWW.CANCER.GOV/CANCERTOPICS/PDQ/
CAM/LAETRILE.
• WELEDA, 2006 WWW.ISCADOR.COM.
• CANCERHELP, 2008
HTTP://WWW.CANCERHELP.ORG.UK/HELP/DEFAU
LT.ASP?PAGE=31060.