2. Goals of PresentationGoals of Presentation
What is Cancer?What is Cancer?
Cancer statisticsCancer statistics
Diet Cancer RisksDiet Cancer Risks
Importance of Nutrition before TxImportance of Nutrition before Tx
Reasons for Nutritional Effects During TxReasons for Nutritional Effects During Tx
Nutrition after TxNutrition after Tx
Nutrition Screening and Assessment inNutrition Screening and Assessment in
OncologyOncology
Management of Symptoms NutritionallyManagement of Symptoms Nutritionally
Recommendations to help PreventRecommendations to help Prevent
CancerCancer
3. What is Cancer?What is Cancer?
Cancer is abnormal cell division andCancer is abnormal cell division and
reproduction that can spread throughoutreproduction that can spread throughout
the bodythe body
Three Stages: Initiation, Promotion, TumorThree Stages: Initiation, Promotion, Tumor
progression, includes metastasisprogression, includes metastasis
15. What May Cause Cancer?What May Cause Cancer?
Dietary Fat Intake-lung, colon, endometrial andDietary Fat Intake-lung, colon, endometrial and
ovarian Caovarian Ca
Alcohol Intake and Tobacco use-Head and NeckAlcohol Intake and Tobacco use-Head and Neck
CaCa
Increased Body weight and Lack of physicalIncreased Body weight and Lack of physical
activity-Esophageal cancer, colon and rectumactivity-Esophageal cancer, colon and rectum
cancer, breast cancer, endometrial cancer, livercancer, breast cancer, endometrial cancer, liver
cancer, gallbladder cancer, pancreatic andcancer, gallbladder cancer, pancreatic and
kidney cancer, non-hodgkin’s lymphoma,kidney cancer, non-hodgkin’s lymphoma,
leukemia, and multiple myelomaleukemia, and multiple myeloma
16. Reasons for Nutritional effects beforeReasons for Nutritional effects before
TreatmentTreatment
Tumors – A malignant tumor may alterTumors – A malignant tumor may alter
body composition and food intake.body composition and food intake.
Head and Neck CancersHead and Neck Cancers
Obstructing mass in the GIObstructing mass in the GI
PainPain
Emotions: Fear, anxiety, depressionEmotions: Fear, anxiety, depression
17. Reasons for Nutritional effectsReasons for Nutritional effects
during treatmentduring treatment
Nutritional Implications ofNutritional Implications of
ChemotherapyChemotherapy
Nutritional Implications ofNutritional Implications of
RadiationRadiation
18. Nutritional Implications ofNutritional Implications of
ChemotherapyChemotherapy
Chemotherapeutic Agents are toxic and have adverseChemotherapeutic Agents are toxic and have adverse
effects:effects:
Common Nutrition-Related Side Effects are:Common Nutrition-Related Side Effects are:
NauseaNausea
VomitingVomiting
AnorexiaAnorexia
MucositisMucositis
EsophagitisEsophagitis
FatigueFatigue
ConstipationConstipation
DiarrheaDiarrhea
Early fullness and decrease in appetiteEarly fullness and decrease in appetite
Altered sense of taste and smellAltered sense of taste and smell
19. Nutritional Implications of RadiationNutritional Implications of Radiation
Depends on location of radiation TxDepends on location of radiation Tx
Individuals receiving radiation therapyIndividuals receiving radiation therapy
to any part of the GI tract areto any part of the GI tract are
especially susceptible to nutrition-especially susceptible to nutrition-
related side effectsrelated side effects
20. Central Nervous System (brain andCentral Nervous System (brain and
spinal cord)spinal cord)
NauseaNausea
VomitingVomiting
FatiqueFatique
Loss of appetiteLoss of appetite
21. HEAD AND NECKHEAD AND NECK
XerostomiaXerostomia
Sore mouth and throatSore mouth and throat
DysphagiaDysphagia
MucositisMucositis
Alterations in taste and smellAlterations in taste and smell
FatigueFatigue
Loss of appetiteLoss of appetite
22. THORAX (esophagus, lung; alsoTHORAX (esophagus, lung; also
breasts if tx field involvesbreasts if tx field involves
esophagus)esophagus)
DysphagiaDysphagia
HeartburnHeartburn
FatigueFatigue
Loss of appetiteLoss of appetite
23. Abdomen and PelvisAbdomen and Pelvis
(gastrointestinal system,(gastrointestinal system,
reproductive organs, prostate,reproductive organs, prostate,
colon, rectum, testicles)colon, rectum, testicles)
Nausea, vomitingNausea, vomiting
Diarrhea, cramping, bloating, gasDiarrhea, cramping, bloating, gas
Changes in urinary function (increasedChanges in urinary function (increased
frequency, burning sensation with urination)frequency, burning sensation with urination)
Acute colitis or enteritisAcute colitis or enteritis
Lactose intoleranceLactose intolerance
FatigueFatigue
Loss of appetiteLoss of appetite
24. Nutrition after TreatmentNutrition after Treatment
Maintain a healthy weightMaintain a healthy weight
Adopt a healthy lifestyleAdopt a healthy lifestyle
Eat a healthy dietEat a healthy diet
Limit alcoholLimit alcohol
25. SCREENING & ASSESSMENTSCREENING & ASSESSMENT
Weight loss as low as <5% body weightWeight loss as low as <5% body weight
can adversely affect prognosiscan adversely affect prognosis
Symptoms influencing weight loss include:Symptoms influencing weight loss include:
abdominal fullness, taste changes,abdominal fullness, taste changes,
nausea/vomiting, mouth drynessnausea/vomiting, mouth dryness
Quality of life may be a more appropriateQuality of life may be a more appropriate
outcome to measure when evaluatingoutcome to measure when evaluating
nutrition intervention during cancernutrition intervention during cancer
treatments.treatments.
26. Nutrition AssessmentNutrition Assessment
Female with Breast Ca has been receivingFemale with Breast Ca has been receiving
CT for 6 weeks.CT for 6 weeks.
Ht 5’6”Ht 5’6”
10/13/10-Wt 140#-; 10/20/10-Wt 136# -10/13/10-Wt 140#-; 10/20/10-Wt 136# -
BMI – 22BMI – 22
LabsLabs
Physical Activity-mostly sedentary for thePhysical Activity-mostly sedentary for the
past weekpast week
27. Nutrition Assessment cont’d…Nutrition Assessment cont’d…
Pt was screened on the first day Tx (Sept.8). Pt has maintained herPt was screened on the first day Tx (Sept.8). Pt has maintained her
current weight of 140 pounds for the last 6 months. Nutrition carecurrent weight of 140 pounds for the last 6 months. Nutrition care
plan management suggestions was given to this patient.plan management suggestions was given to this patient.
Pt has had weekly follow-ups. NCP notes indicate that pt has goodPt has had weekly follow-ups. NCP notes indicate that pt has good
appetite, with no complaint, Drinking high protein shakes daily (42gappetite, with no complaint, Drinking high protein shakes daily (42g
pro/shake), plenty of fluids, and maintaining weight of 140 pounds.pro/shake), plenty of fluids, and maintaining weight of 140 pounds.
On Oct 20On Oct 20thth
it is noted that pt decreased in weight by 4 pounds. 3%it is noted that pt decreased in weight by 4 pounds. 3%
wt loss in one week indicating significant wt. loss.wt loss in one week indicating significant wt. loss.
Pt c/o nausea and vomiting which occurred for 3 days in the pastPt c/o nausea and vomiting which occurred for 3 days in the past
week since her last Tx. Pt was vomiting at least 3x/day. On theweek since her last Tx. Pt was vomiting at least 3x/day. On the
fourth day she stopped vomiting but had loss of appetite.fourth day she stopped vomiting but had loss of appetite.
Please refer to h/o for Nutrition assessment form.Please refer to h/o for Nutrition assessment form.
28. Cancer PreventionCancer Prevention
Meeting nutrient needs and ExerciseMeeting nutrient needs and Exercise
American Cancer Society recommends:American Cancer Society recommends:
Eat a variety of healthful foods, with an emphasis on plant sources.Eat a variety of healthful foods, with an emphasis on plant sources.
Eat 5 or more servings of a variety of vegetables and fruits eachEat 5 or more servings of a variety of vegetables and fruits each
day.day.
Choose whole grains in preference to processed (refined) grainsChoose whole grains in preference to processed (refined) grains
and sugars.and sugars.
Limit consumption of red meats, especially those high in fat andLimit consumption of red meats, especially those high in fat and
processed.processed.
If you drink alcoholic beverages, limit consumption.If you drink alcoholic beverages, limit consumption.
ExerciseExercise
Adopt a physically active lifestyle.Adopt a physically active lifestyle.
Maintain a healthful weight throughout lifeMaintain a healthful weight throughout life
Choose foods that help you maintain a healthful weight.Choose foods that help you maintain a healthful weight.
29. ReferencesReferences
Key TJ, Schatzkin A, Willett WC, Allen NE, Spencer EA, Travis RC. Diet, nutrition and theKey TJ, Schatzkin A, Willett WC, Allen NE, Spencer EA, Travis RC. Diet, nutrition and the
prevention of cancer.prevention of cancer. Public Health NutrPublic Health Nutr. 2004;7:187-200.. 2004;7:187-200.
Lacey k, Pritchett E. Nutrition Care process and model; ADA adopts road map to quality care andLacey k, Pritchett E. Nutrition Care process and model; ADA adopts road map to quality care and
outcomes.outcomes. J Am Diet AssocJ Am Diet Assoc. 2003;103:1061-1072. 2003;103:1061-1072
Rubin H. Cancer cachexia: its correlations and causes.Rubin H. Cancer cachexia: its correlations and causes. Proc Natl Acad SciProc Natl Acad Sci USA. 2003;100:5384-USA. 2003;100:5384-
5389.5389.
Elliott L, Molseed L, (2006).Diet, Cancer Risk, and Cancer Prevention. In McCallum PD, (Eds),Elliott L, Molseed L, (2006).Diet, Cancer Risk, and Cancer Prevention. In McCallum PD, (Eds),
Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2ndnd
edition (pp.28-30).USA:Americanedition (pp.28-30).USA:American
Dietetic Association.Dietetic Association.
Elliott L, Molseed L, (2006).Changes in Carbohydrate, Lipid, and Protein Metabolism in Cancer.Elliott L, Molseed L, (2006).Changes in Carbohydrate, Lipid, and Protein Metabolism in Cancer.
In McCallum PD, (Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2In McCallum PD, (Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2ndnd
editionedition
(pp.19-24). USA:American Dietetic Association.(pp.19-24). USA:American Dietetic Association.
Elliott L, Molseed L, (2006).Tips for Managing Nutrition Impact Symptoms. In McCallum PD,Elliott L, Molseed L, (2006).Tips for Managing Nutrition Impact Symptoms. In McCallum PD,
(Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2(Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2ndnd
edition (pp.241-245).edition (pp.241-245).
USA:American Dietetic Association.USA:American Dietetic Association.
(2010).Cancer statistics. .Retrieved Oct. 19, 2010 from the World Wide Web:(2010).Cancer statistics. .Retrieved Oct. 19, 2010 from the World Wide Web:
http://www.cancer.org/Search/index?QueryText=cancer+statistics+2010&x=52&y=19htthttp://www.cancer.org/Search/index?QueryText=cancer+statistics+2010&x=52&y=19htt
(2010).What is Cancer?. Retrieved Oct. 23, 2010 from the World Wide Web:(2010).What is Cancer?. Retrieved Oct. 23, 2010 from the World Wide Web:
http://www.aicr.org/site/PageServer?pagename=tellmeabout_what_is_cancerhttp://www.aicr.org/site/PageServer?pagename=tellmeabout_what_is_cancer??
Oncology Nutrition, A Dietetic Practice Group of the American Dietetic Association.Oncology Nutrition, A Dietetic Practice Group of the American Dietetic Association.
(2010).Oncology Nutrition Links. Retrieved Oct. 23, 2010 from the World Wide Web:(2010).Oncology Nutrition Links. Retrieved Oct. 23, 2010 from the World Wide Web:
USA:American Dietetic AssociationUSA:American Dietetic Association
Editor's Notes
Cancer is a disease of the cells, the basic building blocks of our bodies. Their lives and behavior are controlled by genetic instructions that are present in every cell of the body. Those instructions tell our cells when and how to grow, reproduce and die.
If those instructions get garbled, a cell might start behaving and reproducing in an uncontrolled way. When that happens, we call it cancer.
All cancers start or initiate from a single cell that undergoes many changes. Some of those changes are permanent alterations to the DNA called mutations.
Luckily, our bodies have a host of defensive strategies for making sure damaged or mutated cells never get the chance to reproduce.
It’s because a potentially cancerous cell has to make it past so many of these natural defenses that the process of cancer development can take a long time-years, even decades. Over our lifetimes, thousands and thousands of damaged cells get disposed of before they can cause any harm.
But if a cell does manage to get past our defenses and start multiplying without control, it can form a mass of abnormal cells called a tumor. This is the promotion.
Not all tumors are dangerous. Those that arise and then go quiet are call benign. But malignant or cancerous tumors can spread into surrounding tissues, damaging nearby cells or organs. This would be the progression of the disease.
Compared to the peak rate of 215.1 per 100,000 in 1991, the cancer death rate decreased 17% to 178.4 in 2007. Rates for other major chronic diseases decreased substantially during this period.
Despite a continuing decline in the cancer death rate from 2006 to 2007, there was an increase in the recorded number of cancer deaths in 2007 as a result of the aging and growth of the US population. The number of cancer deaths increased by 2,788 in men and 199 in women, resulting in a net increase of 2,987 cancer deaths.
African Americans have higher cancer death rates than whites for numerous cancer sites. Death rates for myeloma and cancers of the prostate, larynx, stomach, oral cavity, esophagus, liver, small intestine, colon and rectum, lung and bronchus, and pancreas are all higher in African American men than in white men.
The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer.
Presently, the risk of an American man developing cancer over his lifetime is one in two. The leading cancer sites are prostate, lung, and colon and rectum.
Approximately one in three women in the United States will develop cancer over her lifetime. The leading sites are breast, lung, and colon and rectum.
.
The 5-year relative survival rate for cancer is 69% among whites and 59% among African Americans (taking normal life expectancy into consideration). For many sites, survival rates in African Americans are 10% to more than 20% lower than in whites. This is due, in part, to African Americans being less likely to receive a cancer diagnosis at an early, localized stage, when treatment can improve chances of survival. Additional factors that contribute to the survival differential include unequal access to medical care and tumor characteristics not related to stage at diagnosis.
The survival rates for all cancers combined and for certain site-specific cancers have improved significantly since the 1970s, due, in part, to both earlier detection and advances in treatment. Survival rates markedly increased for cancers of the prostate, breast, colon, rectum, and for leukemia. With new treatment techniques and increased utilization of screening, there is hope for even greater improvements in the near future.
The American Cancer Society recommends that individuals eat five or more servings of vegetables and fruits a day for cancer prevention. Fruit and vegetable consumption may protect against cancers of the mouth and pharynx, esophagus, lung, stomach, and colon and rectum. However, there has been little improvement in consumption since the mid-1990s. About one in four adults was eating the recommended servings in 2007.
The American Cancer Society recommends that adults engage in at least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity is preferable. However, similar to trends in nutrition, there has been little change in leisure-time physical activity during the 1990s. About one-fourth of adults do not engage in any leisure-time physical activity. Even more striking is that almost half of adults with less than a high school education do not participate in any leisure-time physical activity. It should be noted that leisure-time physical activity, as presented in this graph, does not reflect job-related physical activity for the currently employed population.
While there has been little change in leisure-time physical activity since the early 1990s, data from other sources illustrates long-term social changes have contributed to reduced total physical activity in US adults, including reduced leisure time for physical activity, shifts from using walking as a mode of transportation to increased reliance on automobiles, and shifts to more sedentary or mechanized work.
People who become overweight in childhood and adolescence are more likely to be overweight or obese as adults. With at least half of the overweight children becoming overweight adults, future adult populations are at increased risk for developing cancer and other serious chronic diseases.
The prevalence of obese children and adolescents has increased since the 1970s, with the most dramatic increases occurring in the late 1980s and 1990s. In fact, over the past three decades the proportion of obese children has more than doubled among children 2-5 years and 6-11 years, and tripled among adolescents 12-19 years. More recently, however, no changes in obesity prevalence was observed between 1999-2000 and 2007-2008.
This slide highlights the obesity epidemic as mentioned in the previous slide. In 2008, over 55% of adults in all states, including District of Columbia, were overweight or obese, compared to none in 1992.
DIETARY FAT
There are studies in progress focusing on the following issue related to dietary fat intake and the cancer process:
Total fat intake related to total energy intake, obesity, percentage body fat, body fat distribution, and sex-hormone levels.
Dietary fat intake related to the intake of fat-soluble carcinogens, especially animal fat.
Types of dietary fat (saturated, n-6-polyunsaturated, n-3-fats) and the types of cancer progression.
Historically, ecological studies have identified associations between total fat intake and lung, colon, endometrial, and ovarian cancers.
ALCOHOL INTAKE AND TOBACCO USE
The risk of developing squamous cell carcinoma of the head and neck has consistently been related to alcohol consumption, smoking, and tobacco use. Possible relationships between moderate alcohol intake and cancers of the colon, stomach, pancreas, liver and breast have also been identified. Alcoholic beverages may be contaminated with such carcinogens as N-Nitroso compounds (micotoxins, urethane), inorganic arsenic, and asbestos; alcohol can also act as a solvent for other carcinogens. Additionally, people who consume excessive alcohol may displace micronutrients, such as folate and vitamins C and E, which have been associated with decreased cancer risk. However, moderate alcohol intake (1 to 2 servings per day) may decrease risk of other chronic diseases, such as cardiovascular disease.
Increased BODY WEIGHT AND Lack of PHYSICAL ACTIVITY:
A BMI of 40 or greater, which is indicative of obesity, increases the risk of cancer for women by 62% and men by 52%. The following cancers are increased by obesity and overweight:
Esophageal cancer, colon and rectum cancer, breast cancer, endometrial cancer, liver cancer, gallbladder cancer, pancreatic and kidney cancer, non-hodgkin’s lymphoma, leukemia, and multiple myeloma
MALIGNANT TUMORS
A malignant tumor may alter body composition by initiating a sequence of events that leads to altered CHO, lipid, and protein metabolism.
The presence of tumor may alter the individual’s ability and desire to eat, the body composition and the adverse effects of traditional tx modalities can act to further impair nutritional status.
Malignant tumors can alter enzyme activity and the immune system. The results are changes in CHO, lipid, and protein metabolism that can contribute to fluid imbalance, acid-base imbalance, and changes in the concentration of electrolytes, vitamins and/or minerals. These metabolic abnormalities can impair nutritional status and contribute to cancer-related cachexia by depleting fat, protein, water, and mineral stores. Cancer-related cachexia occurs in approximately two-thirds of patients with malignant disease.
Cancer-related Cachexia is inversely related with the length of survival and implies a poor prognosis. In cancer-related cachexia, cytokines, which mediate interactions between cells and regulate cell and tissue functions, affect gastric motility and emptying by altering the signals that regulated satiety.
Cytokines contribute to the growth and spread of cancers by causing normal cells to produce additional cytokines that continue the malignant process.
I WILL DISCUSS and focus on THE CHANGES IN PROTEIN METABOLISM
Increased protein breakdown and, to a lesser extent decreased protein synthesis is what causes muscle wasting in cancer patients.
Not sure if I should say this
Negative nitrogen balance may be present in individuals with cancer, because of the increased turnover of whole-body protein and amino acid.
Studies on protein metabolism in subjects with cancer demonstrated that muscle tissue degradation is elevated in the entire body and that this response is similar to other conditions, such as infection and injury. TNF (one of many cytokines that is produced chiefly by monocytes and macrophages in response especially to endotoxins (endotoxin, toxic substance bound to the bacterial cell wall and released when the bacterium ruptures or disintegrates. Endotoxins consist of lipopolysaccharide and lipoprotein complexes. The protein component determines its foreign (antigenic) nature; the polysaccharide component determines the antibody type that can react with the endotoxin molecule to produce an immune reaction. (Endotoxins are rarely fatal, although they often cause fever.) and that mediates inflammation and induces the destruction of some tumor cells and the activation of white blood cells.) seems to mediate many of the changes in nitrogen metabolism associated with cancer-related cachexia. Studies of cancer in animals found an increased release of protein from skeletal muscle, which enhances muscle protein breakdown and activates the ATP ubiquitin-dependent pathway-one of the main pathways responsible for protein catabolism in skeletal muscle. The muscle wasting that occurs in cancer-related cachexia decreases whole-body nitrogen and increases total tumor nitrogen.
HEAD AND NECK
For individuals with head and neck cancers, the location of the tumor may impede appropriate mastication and swallowing long before a diagnosis is made. These individuals often experience substantial weight loss before diagnosis and are at a very high risk for mal-nutrition and postoperative complications. Impaired nutrition intake-combined with poor dietary habits and histories of tobacco and alcohol abuse-contributes to the high incidence of malnutrition in this population. Weight loss of 10% or more during the 6 months before diagnosis may lead to a significantly higher rate of complications after surgical removal and reconstruction in these patients and may lead to reduced survival rates.
Individuals with head and neck cancer must be monitored closely throughout treatment and for up to 1 year after tx. After and during intensive radiation therapy and chemotherapy, individuals may experience swallowing difficulties (dysphagia and odynophagia) or dry mouth (xerostomia) and may need additional modifications to the consistency and texture of foods and beverages for 1 year or more.
GASTROINTESTINAL CANCERS
Gastrointestinal cancers include esophageal cancer, gastric cancer, pancreatic cancer, liver cancer, carcinoma of the gall bladder, carcinoma of the bile duct, cancer of the small bowel, and colorectal cancer. For most GI cancers, surgery is the primary treatment modality,
Individuals who have had GI surgeries may experience a wide range of nutritional complications.
For example:Esophagastric – Gastro-paresis, Fluid electrolyte imbalance, Anastomotic Leak which is the breakdown of a suture line in a surgical anastomosis with leakage of gastric or intestinal fluid.
Pain and emotions of fear, anxiety and depression- decreases appetite. Patient may become depressed due to their dx. I have had many patients who will say that they lost weight due to they ‘didn’t feel like eating’, some may admit it is due to their diagnose. Most of the time family members will tell me that the patient hasn’t had much of an appetite since they were diagnosed.
NUTRITIONAL IMPLICATIONS OF CHEMOTHERAPY
Toxicities and adverse effects of Chemotherapeutic Agents are potent and have a potential to cause many adverse events. Toxicities and side effects are often a result of damage to rapidly dividing cells. The actions of chemotherapeutic agents can be cytotoxic to normal cells as well as to malignant cells, in particular those cells with a rapid turnover, such as bone marrow, hair follicles, and oral and intestinal mucosa. Adverse effects range from mold to life-threatening. Dosage adjustments or discontinuation of therapy may be indicated, depending on tolerance to the chemotherapy regimen.
Another side effect of chemotherapy is myelosuppression. This is the most common dose-limiting toxicity of chemotherapy. When bone marow production is interrupted by CT, leukopenia (a decrease in the number of white blood cells) and neutropenia (a decrease in the number of neutrophils) can occur. Neutropenia is a substantial predisposing factor to infection in cancer patients.
Nadir is defined as the lowes value of blood counts and usually occurs withing 7-14 days after CT administration.
The following are the symptoms, the potential secondary Problems and we will go over a few Tips for Symptoms Management later in the presentation.
Nausea & Vomiting may cause anorexia, weight loss, dehydration, electrolyte imbalance.
Anorexia, weight loss, cachexia, electrolyte imbalances.
Mucositis – is mouth sores, oral mucositis, or esophagitis. This can range from a red, sore mouth and/or gums to open sores that can cause a patient to be unable to eat. the 2ndary problem can be Anorexia, weight loss, cachexia, electrolyte imbalances, bloating, nausea
Fatigue- inability to cook for oneself and take care of oneself.
Constipation-infrequent hard dry stool. 2ndary problem -Nausea, bloating, anorexia, weight loss.
*Diarrhea- cramping, bloating gas – dehydration, electrolyte imbalances, malabsorption, anorexia, and weight loss.
Loss of appetite – Anorexia, weight loss, cachexia, electrolyte imbalances, bloating, nausea
Xerostomia – dry mouth, difficulty chewing and swallowing, decreased intake of food
Sore mouth and Throat – difficulty chewing and swallowing, decreased intake of food and liquids. Dysphagia, – is difficulty swallowing. Decreased intake of food, weight loss
Altered sense of taste and smell- this can affect the enjoyment of food, pt may have trouble eating as much as they should to maintain health and strength.
Heartburn -is an irritation of the esophagus that causes burning discomfort in the chest just behind the chest bone. Heartburn can occur in association with chemotherapy drugs also.
Early (satiety) fullness and decrease in appetite – Pt gets full fast and not as hungry. Anorexia, weight loss, cachexia, electrolyte imbalances., bloating, nausea.
The side effects of radiation therapy are specific to the area irradiated, total dosage, duration, and whether the radiation is given in combination with another form of treatment, such as chemotherapy.
Individuals receiving radiation therapy to any part of the GI tract are especially susceptible to nutrition-related side effects
Nausea & Vomiting may cause anorexia, weight loss, dehydration, electrolyte imbalance.
Fatigue- inability to cook for oneself and take care of oneself.
Loss of appetite – Anorexia, weight loss, cachexia, electrolyte imbalances, bloating, nausea
Xerostomia – dry mouth, difficulty chewing and swallowing, decreased intake of food
Sore mouth and Throat – dificulty chewing and swallowing, decreased intake of food and liquids. Anorexia, weight loss, cachexia, electrolyte imbalances.
Dysphagia, – is difficulty swallowing. Decreased intake, weight loss
Mucositis – is mouthsores, oral mucositis, or esophagitis. This can range from a red, sore mouth and/or gums to open sores that can cause a patient to be unable to eat. Anorexia, weight loss, cachexia, electrolyte imbalances, bloating, nausea
Alterations of taste and smell- this can affect the enjoyment of food, pt may have trouble eating as much as they should to maintain health and strength.
Heartburn -is an irritation of the esophagus that causes burning discomfort in the chest just behind the chest bone. Heartburn can occur in association with chemotherapy drugs also.
Changes in urinary function (increased frequency, burning sensation with urination- (cystitis) may occur when radiation therapy is delivered to the pelvic region, as with treatment for bladder or prostate cancers. Symptoms may not occur for many months after tx. There is no tx to reverse this condition but one approach nutritionally can help. This is for the patient to drink plenty of fluids to help flush the bladder and prevent cystitis.
Acute colitis or enteritis- colitis is inflammation in the colon or the rectum, symptoms may be pain, cramping, diarrhea and or bleeding from the rectum….. Enteritis is an inflamed intestine and can cause diarrhea.
Lactose intolerance- decrease in lactase enzymes used to digest the lactose in dairy products. Can cause bloating, pain, cramps, gas, loose stools or diarrhea, vomiting.
You can maintain a healthy weight by burning as many calories as you eat. To lose weight, you need to burn more calories than you eat.
The healthiest way to reduce the number of calories in your diet is to limit your intake of sugars, fats, and alcohol. These provide a lot of calories but have few or no essential nutrients.
It is recommended for the patient to speak to their doctor, nurse or dietitian about your ideal healthy weight and how to achieve it after treatment.
ADOPT AN ACTIVE LIFESTYLE
To help achieve and maintain your healthy weight, you should adopt a physically active lifestyle.
Physical activity can help you improve your energy level, reduce stress, and control your weight. All of these benefits can begin with moderate activity.
Moderate activities have a brisk pace, and you should be able to talk while doing them. This includes walking, biking, housework, and gardening.
It is never too late to start being physically active, but you should talk with your doctor , nurse or dietitian before starting an exercise program.
EAT A HEALTHY DIET
You know a healthy diet is important. But what is a “healthy diet?” Eating healthy means:
Eating portions of foods an beverages that will help you maintain a healthy weight.
Eating 5 or more servings of vegetables and fruits each day.
Choosing whole grains instead of processed or refined grains and sugars.
Limiting the amount of processed foods and red meats that you eat.
LIMITING ALCOHOL
Alcohol increases the irik of cancers of the mouth, esophagus, pharynx, larynx, and liver. It also increases the risk of breast cancer in women.
Cancer risk increases with the amount of alcohol consumed. For cancers of the mouth, esophagus, and larynx, risk increases greatly with intake of more than two drinks per day.
For this reason, you should limit intake to no more than 2 drinks per day for men and 1 drink a day for women, if you drink at all.
A drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.
The terms nutrition screening and assessment are often used interchangeably. As described by Lacey and Pritchett Nutrition Care Process and model, nutrition screening is the identification of an individual’s nutrition, health, functional, and behavioral status. Nutrition screening initiates nutrition assessment, which is the first step of the Nutrition Care Process.
In the oncology setting, health care professionals consider nutrition screening to be the identification of cancer-related malnutritin and cachexia and/or associated nutrition impact symptoms. B/c the etiology of cancer-related malnutrition and cachexia is multifactorial, and b/c many of these factors are manageable, especially when identified and treated early in the course of the disease, it is therefore, essential that nutrition issues be addressed at diagnosis and throughout the course of cancer care.
It is recommended nutrition consultation for persons with cancer, those at risk of malnutrition, those without malnutrition but in need of counseling (ie. For management of treatment-related side effects), and those at risk of developing treatment-related side effects. A further recommendation includes completing a nutrition assessment upon initial contact and providing individualized advice both verbally and in written format. The assessment and intervention should be shared with the multidisciplinary team, as well as with patients and their care givers. Finally, outcomes of nutrition intervention, including weight, nutrition impact symptoms, and individual satisfaction, should be measured and documented, consistent with the Nutrition Care Process.
Initially, pt was screened on Sept. 08, 2010 and according to pt she has maintained her weight for the past 6 months.
Pt has lost 4% of her weight in 1 week.
C/o Nausea, and loss of appetite.
Nutritional solutions to these complaints will be: Please refer to h/o.
Advise patient to exercise safety in handling food (neutropenic precautions).
Provide tips for managing nausea and vomiting, improving appetite, maintaining weight, and incorporating nutritionally dense foods into daily eating plan.
Provide tips for managing treatment-related fatigue. For example, the patient should use easy to prepare foods and seek assistance from friends and family in meal planning and preparation.
Consider use of a low fiber diet to aid in management of diarrhea management. RD’s should note that constipation is common with antiemetic agents, so we need to take this into consideration when prescribing low fiber diets.
Encourage the intake of fluids for adequate hydration.
Encourage the avoidance of high-fat, greasy, or fried foods.
Encourage open communication with the health care team with regard to any nutrition problems encountered and efficacy of management suggestions.
Pt very weak from n/v, and lack of nutrition and fluids.
Achieving a balance among all dietary factors, while meeting nutrient needs, is paramount of cancer prevention. Food choices based on the principles of variety and moderation, combined with physical activity can really enhance immune system response and the role of homeostasis in the maintenance of health.
Basically, the maintenance of health through diet and exercise enhances defense systems and may extend the incubation period of latent cancer cells and the ability of cells to detoxify and inhibit the cancer process.
It has been speculated that it is the association between increased physical activity and improved dietary intake that decreases risk for cancer.
