1

Case #S1: Lymphoma Tieateu with Chemotheiapy

I. 0nueistanuing the Bisease anu Pathophysiology
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Lymphoma is a cancei of the Lymphatic System.

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-+.101&*.& :0&$ &$* -2%110- 10;.1 +, 2(3)$+3%4
The patient expeiiences many of the classic signs of lymphoma incluuing:
fevei, night sweats, lack of eneigy, unexplaineu weight loss, loss of
appetite, anu abnoimal lymph noues.
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nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

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7+*1 =&%;* >> 3*%.? %.7 $+: 7+*1 $*/ )$(10-%2 *@%30.%&0+. 16))+/&
&$014
Stage II lymphoma means that the cancei is founu in two oi moie lymph
noue gioups that is above oi below the uiaphiagm. This aiea is the thin
muscle below the lungs that helps bieathing anu sepaiates the chest fiom
the abuomen. Bei physical examination suppoits this fiom the abnoimal
lymph noues.

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3%20;.%.& -*221"
Suigeiy:
Suigeiy is useu moie often to uiagnose Non-Bougkin's Lymphoma
than foi tieatment. Suigeiy is most commonly useu to obtain a
biopsy sample anu foi tieatment.
Rauiation theiapy:
Tieatment that incluues iauiation anu high-eneigy x-iays to kill
cancei cells anu pievent theii giowth. The two types of iauiation
aie exteinal, using a machine outsiue the bouy to senu iauiation to
the cancei anu inteinal, which uses a iauioactive substance sealeu
in neeules oi catheteis placeu into oi neai the cancei.
Chemotheiapy:
Tieatment involving uiugs that stop the giowth of cancei cells by
killing them oi stopping them fiom uiviuing. Regional
chemotheiapy is one type wheie the chemotheiapy is placeu in
the spinal column, an oigan, oi bouy cavity that affects the cancei
in a specific aiea. The seconu type is calleu systemic
2
chemotheiapy, which is taken by mouth oi injecteu into the
muscle oi vein. This type of chemotheiapy enteis the blooustieam
anu ieaches cancei cells thioughout the bouy. The last is useu to
tieat ceitain types of lymphoma in the biain anu is calleu CNS
piophylaxis.
Biological theiapy:
A tieatment that fights cancei using the patient's immune system.
The tieatment iestoies, boosts, oi uiiects the bouy's natuial
uefenses against cancei by using substances maue by the bouy oi
maue in a laboiatoiy.
Bone maiiow tiansplant:
Bone maiiow tiansplant is a foim of tieatment useu foi patients
with B cell lymphoma. The tieatment uses monoclonal antibouy
Rituxan to clean out the cancei in the bone maiiow befoie the
haivest of the bloou stem cells which helps cleai the bouy's
iemaining lymphoma.
The Clevelanu Clinic: Biseases anu Conuitions.
Rush Neuical Centei: Non-Bougkin's Lymphoma-Bone Naiiow
Tiansplant Centei.

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%" #$%& +&$*/ -*221 0. &$* C+7( 3%( C* %,,*-&*7 C( *0&$*/ +/ C+&$
+, &$*1* &/*%&3*.&14
Chemotheiapy anu iauiation affects cells that aie fiequently
uiviuing, such as bone maiiow cells (ieu bloou cells, white bloou
cells, anu platelets), the epithelial lining of the gastiointestinal
tiact, lymph tissue, anu the cells of the haii follicles.
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7*1&/6-&0+. +, &$*1* -*2214
Siue effects of chemotheiapy aie causeu by toxicity to the cells anu
incluue nausea anu vomiting, thiombocytopenia, anemia, uiaiihea,
mucositis, anu alopecia. Effects of iauiation incluue uelayeu
wounu healing, fatigue, mucositis, uysgeusia, xeiostomia
seconuaiy to salivaiy glanu uestiuction, ouynophagia, seveie
esophagitis, chionic malabsoiption, anu uiaiihea.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

II. 0nueistanuing the Nutiition Theiapy
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&$* -%.-*/ )%&0*.&"
Cachexia: Incluues involuntaiy weight loss, tissue wasting,
inability to peifoim uaily activities, anu metabolic alteiations.
Nutiition anu meuical status can be impacteu by alteiations in
glucose, amino aciu piotein, anu lipiu metabolism.
S
Nausea anu vomiting: Causes incluue chemotheiapy, iauiation,
naicotic analgesics, ouois anu uelayeu gastiic emptying.
Eaily satiety: 0ccuis when patients cannot eat veiy much because
of getting full quickly. The piimaiy cause of eaily satiety is uelayeu
gastiic emptying.
Nucositis: Also known as stomatitis, uesciibeu by iiiitations anu
inflammation of the epithelial cells lining the uI tiact. Causes of
mucositis incluue viial, bacteiial, anu fungal infections, iauiation,
stem cell tiansplant theiapy, anu giaft-veisus-host uefense.
Biaiihea: Antineoplastic agents taiget cells that have the highest
ieplication iate anu theiefoie cause uiaiihea.
Bysgeusia: Alteiations in taste that have a piofounu effect on an
inuiviuual's ability to ingest an auequate amount of nutiition.
Xeiostomia: Reuuceu saliva piouuction can be a siue effect of
iauiation anu chemotheiapy, uehyuiation, chionic giaft-veisus-
host uisease of the uI tiact, meuications, anu aging.
Anoiexia: Lack of appetite anu ieuuceu foou intake fiequently
occuis in cancei patients because of hoimone changes, uepiession,
fatigue, anu meuicine.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.
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%.7 )/+&*0." N@)2%0. &$* /%&0+.%2* ,+/ &$01" >1 &$01 &/6* ,+/ *D*/(
-%.-*/ )%&0*.&4
Cancei patients iequiie auuitional eneigy because of the metabolic
alteiations that leau to incieaseu eneigy expenuituie. These alteiations
aie causeu by highei levels of C-ieactive pioteins, fibiinogen, white bloou
cells, anu pio-inflammatoiy cytokines. Biochemical abnoimalities occui
because of insulin iesistance, incieaseu glucose synthesis,
gluconeogenesis, incieaseu Coii cycle activity, anu uecieaseu glucose
toleiance anu tuinovei. The changes in caibohyuiate metabolism causes
the futile cycle to occui anu iesults in incieaseu eneigy expenuituie.
Auuitionally, pioteins tuinovei is incieaseu causing an incieaseu tumoi
uemanu foi amino acius anu incieaseu piotein losses. Nuscle wasting
also occuis as a iesult of incieaseu piotein catabolism oi uecieaseu
piotein synthesis. This is not tiue foi eveiy patient as the inuiviuual, anu
the stage anu type of cancei influence each case.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.
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,/+3 -$*3+&$*/%)( %.7 /%70%&0+. &$*/%)(" O+/ *%-$? 7*1-/0C* &$* .6&/0&0+.
&$*/%)( /*-+33*.7%&0+.1 &$%& :+627 C* %))/+)/0%&* &+ %1101& 0. &/*%&3*.& +,
&$%& 1(3)&+3"
Nausea anu vomiting:
o Small, low-fat meals the moining of
4
o Avoiu fiieu anu gieasy foous
o Avoiu favoiite foous
o Cleai liquiu uiet, electiolyte-foitifieu beveiages, non-aciuic
fiuit uiinks, avoiu cieamy nutiitional uiinks
Biaiihea
o Biink small amounts fiequently
o Avoiu laige amounts of fiuit juice
o Nutiitional beveiage
o Foous high in soluble fibei
Nucositis:
o Eat soft, non-fibious, non-aciuic foous
o Avoiu hot foous
o Encouiage liquius, non-aciuic juices, high kilocaloiie, high
piotein shakes anu supplements.
Eaily satiety:
o Small, fiequent nutiient-uense meals
o Beveiages between meals anu shoulu cotain nutiients
o Avoiu high-fibei anu iaw vegetables anu use pio-kinetics
Belayeu Wounu Bealing
o Incieaseu caloiie anu piotein intake
o Consume foous with vitamins A, C, E
o Auequate zinc anu iion intake
Bysgeusia
o Avoiu metal utensils, uiink fiom glass
o Inciease spices anu flavois
o Incoipoiate othei high-piotein foous if aveision to meats
exists
Xeiostomia
o Reuuce uiyness with aitificial saliva anu mouth
moistuiizeis
o 0se uels, lozenges, anu mouthwashes
o Sugai-fiee gum anu soui-flavoieu haiu canuy
Esophagitis
o Nay cause mucositis, xeiostomia, anu ouynophagia seveie
enough to tempoiaiily uiscontinue iauiation
Behyuiation
o Patient may neeu intiavenous fluius foi hyuiation &
electiolyte coiiection
o TPN may be necessaiy to pievent weight loss anu coiiect
electiolyte imbalance
III. Nutiition Assessment
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%))/+)/0%&* &+ 61* 0. 7*&*/30.0.; .6&/0&0+.%2 /01F ,+/ &$01 )%&0*.&4
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BNI: 19.4 kgm
2
(cuiient weight: 12u pounus anu height: S'6")

%0BW: 92.S%
Bouy Nass Inuex is calculateu using the patient's cuiient bouy weight
anu height to assess the weight classification. 0sual bouy weight is
useu to compaie the patient's cuiient bouy weight to usual bouy
weight to assess the nutiitional iisk anu health complications. 0sual
bouy weight is theiefoie the most appiopiiate to use in ueteimining
the nutiitional iisk foi the patient.

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The main cause of the weight changes is uue to the patient's uiagnosis of
cancei, consiueieu to be a pathological factoi. The patient is expeiiencing
a uecieaseu appetite, most likely causeu by eaily satiety anu metabolic
alteiations. Patient also appeais uehyuiateu, which may be an auuitional
cause of hei ueciease in weight.

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%.7 C+7( -+3)+10&0+.? 201& )+110C2* .6&/0&0+. )/+C2*31 610.; &$*
70%;.+1&0- &*/3"
NI-1.1 -Bypeimetabolism (incieaseu eneigy neeus)
NI-1.4 -Inauequate eneigy intake
NI-2.1 -Inauequate oial fooubeveiage intake
NC-S.2 -Involuntaiy weight loss

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7*&*/30.*7 &$* %))/+)/0%&* 2*D*2 +, )/+&*0."
Piotein neeus: S4.S g-81.7Sg
The piotein neeus weie ueteimineu using the guiuelines of 1.u-
1.Sgkg foi nonstiesseu cancei patients. The piotein intake of the
patient shoulu be closei to 1.Sgkg oi appioximately 7S-8ug.

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,+/362%P-%2-62%&0+. 3*&$+7 (+6 61*7 %.7 *@)2%0. &$* /%&0+.%2* ,+/
610.; 0&" #$%& :*0;$& YWQ# +/ -6//*.& C+7( :*0;$&Z 1$+627 (+6 61*
&+ %--6/%&*2( -%2-62%&* &$* )%&0*.&91 *.*/;( .**714
Eneigy neeus: 16SS kcal-19u7.S kcal
The nutiient neeus of the cancei patient weie calculateu using the
foimula foi slightly hypeimetabolic patients oi those patients who
neeu to gain weight, oi aie anabolic, which is Su-SS kcalkg. The
patient neeus appioximately Su-SS kcalkg because of involuntaiy
weight loss anu cuiient uisease state. When calculating the eneigy
neeus the patient's cuiient bouy weight was useu.
6

c. Intake Bomain
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.6&/0&0+.%2 0.&%F*4
The patient's uietaiy infoimation can be useu to complete the Subjective
ulobal Assessment. This is a goou measuiement of the nutiitional iisks of
the patient anu has a high sensitivity anu specificity. This infoimation will
help to uiscovei the nutiitional status of the patient anu the fuithei
uietaiy iecommenuations.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

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$*/ 616%2 0.&%F*4
When asking about the usual intake of the patient it woulu be impoitant
to finu out what kinu of foous can be toleiateu, anu special types of uiets
that she is cuiiently on oi has been on incluuing alteinative uiets, heibal
theiapy, oi nutiitional supplements. Although the uoctoi has listeu that
she is cuiiently not taking any vitamins oi mineials, it woulu be
impoitant to confiim that she has not taken anything that woulu be
incluueu in the categoiy. Also, knowing whethei oi not she has tiieu any
liquiu nutiitional supplements available on the maiket anu if she piefeis
oi uislikes a paiticulai kinu.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

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&$01 )%&0*.&91 616%2 0.&%F* 01 %7*M6%&* &+ 3**& $*/ .**71" N@)2%0."
Patient uoes not pioviue any kinu of inuication of seiving size, making it
haiu to uo a complete analysis of hei eneigy anu nutiient intake. The
infoimation pioviueu about hei usual uiet is enough to get a geneial iuea
of hei uietaiy patteins. The best way to assess clients uiet woulu be a
foou fiequency suivey. The clients uiet seems to be high in iefineu
caibohyuiates, simple sugais, anu low in fiuits, vegetables, whole giains,
uaiiy anu piotein. The quality of hei uiet seems to be low in nutiient
uense foous anu shoulu focus on ieuucing simple caibohyuiates when
appetite incieases.

0sual:
Bieakfast: colu ceieal, toast oi uoughnut, skim milk, juice
Lunch: Sanuwich oi salau, fiozen yoguit, chips oi pietzels, soua
PN: Neat (eats only chicken anu fish), 1-2 vegetables incluuing
salau, iceu tea, oi skim milk
Snack: popcoin, occasional pizza, soua, juice, iceu tea

7
Caibohyuiate: 4-S
Baiiy: 2
Fiuit: 1
Piotein: 1
vegetables: 2-S

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%7*M6%&* &+ 3**& $*/ .**714 N@)2%0."
Bietaiy analysis softwaie shoulu be useu to calculate the patient's
nutiition intake fiom 24-houi iecall. The amount of foou consumeu in the
past 24 houis is much below the iecommenuation anu eneigy neeus.
Benise neeus to inciease eneigy intake uiastically. Patient will be
piesciibeu to enteial feeus at night in oiuei to inciease caloiic intake.


8
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0.&%F* %.7 16C1*M6*.&2( $*/ .6&/0&0+.%2 1&%&614
The patient is going to begin a chemotheiapy iegimen (CB0P) which will
most likely affect hei uietaiy intake anu hei hyuiation status. Siue effects
that aie associateu with the tieatment of lymphoma aie nausea anu
vomiting, uiaiihea, mouth soies, anu fatigue fiom low ieu bloou cell
counts. These siue effects will uiiectly affect hei nutiitional status anu
make it uifficult to obtain auequate eneigy, piotein, anu nutiient intake
along with hyuiation.
Ameiican Cancei Society

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%,,*-& $*/ 70*&%/( 0.&%F*4
Patient is expeiiencing uecieaseu appetite anu uiy mucous membianes.
The patient's uecieaseu appetite is a common siue effect of the stage II
uifuse laige B-cell lymphoma. Foitunately the patient is not yet at an
extieme iisk of malnutiition but hei cuiient nutiitional state may woisen
if a uiet iegimen is not planneu. Biy mucous membianes is causing an
ongoing cough that may affect the thioat anu complications with
swallowing.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

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)+110C2* .6&/0&0+. )/+C2*31 610.; &$* 70%;.+1&0- &*/3"
NI-S.S -Inauequate piotein-eneigy intake
NI-S1.1 -Inauequate fat intake
NI-S2.1 -Inauequate piotein intake
NI-SS.1 -Inauequate caibohyuiate intake

u. Clinical Bomain
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%" #$0-$ 2%C1 :022 /*,2*-& %-6&* -$%.;*1 0. )/+&*0. 1&%&61 D*/161
-$/+.0- -$%.;*14 #$(4
visceial piotein is assesseu by seium pioteins, albumin,
tiansfeiiin, piealbumin, ietinol binuing piotein, anu fibionectin.
Acute changes in piotein status aie ieflecteu by piealbumin,
tiansfeiiin, ietinol binuing piotein, anu fibionectin levels. These
seium pioteins each have a shoitei half-life than albumin anu aie
theiefoie moie sensitive to acute changes. Albumin has a half-life
of 17-21 uays anu is often a goou inuicatoi of chionic changes.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

9
C" #$0-$ %/* %D%02%C2* ,+/ &$01 )%&0*.&4 R+.107*/0.; $*/
70%;.+101? :$0-$ 2%C1 :+627 .+& C* %))/+)/0%&* &+ 61* &+
*D%26%&* )/+&*0. 1&%&614
Total piotein anu Albumin levels aie available, inuicating low
piotein levels. Because of patient's conuition, Fibionectin levels
woulu not be appiopiiate.

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2%C+/%&+/( D%26*" #+627 (+6 /*M6*1& %770&0+. .6&/0&0+. 2%C14


A
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e

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Auuitional lab values to be oiueieu shoulu be piealbumin anu
tiansfeiiin levels to evaluate shoit-teim piotein status. C-Reactive
Pioteins shoulu also be lookeu at to inuicate level of inflammation.

5!" >7*.&0,( *%-$ +, &$* 7/6;1 &$%& &$* )%&0*.& 01 )/*1-/0C*7? %.7 .+&* &$*
)+110C2* .6&/0&0+.%2 107* *,,*-&1 +, *%-$" >. ;*.*/%2? :$%& 30;$& (+6
&*22 &$01 )%&0*.& &+ *@)*-& ,/+3 /*-*0D0.; $*/ -$*3+&$*/%)(4

Biugs Possible Nutiitional Siue Effect(s)
Cyclophosphamiue Nausea anu vomiting, loss of appetite, soies in mouth,
uiaiihea
Boxoiubicin Nausea anu vomiting, soies in the mouth, anu possible
alleigic ieactions
vinciistine Nausea anu vomiting, soies in the mouth, constipation, loss
of appetite
Pieunisone Loss of calcium fiom bones, uiy mouth anu soie thioat,
weight gain,
RETIC Bone Naiiow Activity
Bigh because of chionic
uisease
NCv
(Nean coipusculai volume)
Size of RBC
Low: Nay inuicate iion
ueficiency
BuB (Bemoglobin) Low: Chionic uisease state
BCT (Bematociit)

Low: Possible uehyuiation
NCBC
(Nean Coipusculai
Bemoglobin Concentiation)
Low: Possible anemia
WBC Bigh: Bisease fighting
Feiiitin Bigh: Iion ueficiency oi
because of uisease
1u

Ameiican Cancei Society

22. Fiom this infoimation gatheieu within the clinical uomain, list possible
nutiition pioblems using the uiagnostic teim.
Involuntaiy weight loss NC-S.2

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70*& &$%& E*.01*91 %6.& $%1 16;;*1&*7" ^$01 70*& /*-+33*.71 %
-2*%.10.; )/+&+-+2 :0&$ ,/*M6*.& -+,,** *.*3%1 :0&$ % 70*& &$%&
,+-61*1 )/03%/02( +. % 20M607 30@&6/* 3%7* ,/+3 ,/60&1? D*;*&%C2*1?
%.7 /%: -%2,91 20D*/" 8/1" 80&-$*22 01 -+.-*/.*7 &$%& E*.01* -%..+&
*D*. &+2*/%&* 7/0.F0.; &$* 30@&6/* %.7 /*76-*1 &+ *D*. -+.107*/
*7*3%1" T+: :+627 (+6 %7D01* &$01 )%&0*.& %.7 $*/ )%/*.&1
/*;%/70.; %7$*/*.-* &+ &$01 \%.&0[-%.-*/] 70*&4 #$%& 1&*)1 :+627
(+6 16;;*1& ,+/ &$*3 %1 &$*( /*1*%/-$ %.7 3%F* %))/+)/0%&*
7*-010+.1 ,+/ -%/*4 #$( 3%( -%.-*/ )%&0*.&1 C* *1)*-0%22(
D62.*/%C2* &+ .6&/0&0+. %.7 3*70-%2 M6%-F*/(4

It is impoitant foi Benise anu hei paients to unueistanu the essence of
obtaining piopei nutiition while battling hei uisease. The uiet is not
cieuible anu is not a goou option foi Benise. As they ieseaich they neeu
to look at ieseaich baseu infoimation such as iesouices fiom The
Ameiican Cancei Society oi the National Institutes of Bealth. These
websites will pioviue cieuible infoimation about nutiitional status of
cancei patients anu foous that can be taigeteu to ensuie neeus aie met.
Cancei patients aie especially susceptible to nutiition anu meuical
quackeiy because they have a weakeneu immune system, uecieaseu
eneigy, anu incieaseu metabolism. In oiuei foi Benise to be stiong
enough to toleiate the chemotheiapy anu fight hei cancei, optimal
nutiition is impeiative.

Iv. Nutiition Biagnosis
5A" =*2*-& &:+ $0;$[)/0+/0&( .6&/0&0+. )/+C2*31 %.7 -+3)2*&* &$* _N=
1&%&*3*.&"
1. Inauequate oial foou intake ielateu to uecieaseu appetite anu fatigue
as eviuence by 24-houi iecall, iecent weight loss of 1u pounus, anu
geneial appeaiance.
2. Involuntaiy weight loss ielateu to inauequate eneigy intake as
eviuence by iecent weight loss of 1u pounus, anu 24-houi iecall.

v. Nutiition Inteivention
5G" O+/ *%-$ +, &$* _N= 1&%&*3*.&1 &$%& (+6 $%D* :/0&&*.? *1&%C201$ %.
07*%2 ;+%2 YC%1*7 +. &$* 10;.1 %.7 1(3)&+31Z %.7 %. %))/+)/0%&*
0.&*/D*.&0+. YC%1*7 +. *&0+2+;(Z"
11
1. uoal: Inciease foou intake thiough nutiition theiapy to impiove
nutiitional status.
Inteivention: Nouify foou intake to 4 small feeuings of Suu caloiies;
inciease nutiient uensity; pioviue eviuence-baseu infoimation
iegaiuing nutiitional neeus uuiing tieatment foi lymphoma anu
piopei foou choices.
2. uoal: Pievent auuitional weight loss anu ensuie auequate eneigy
intake.
Inteivention: Ensuie high piotein supplement two times pei uay in
between feeuings.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

`>" X6&/0&0+. 8+.0&+/0.; %.7 ND%26%&0+.
5I" T+: :+627 (+6 ,+22+: 6) +/ *D%26%&* &$* 0.&*/D*.&0+.1 (+6 $%D*
7*&*/30.*74
The inteivention will be evaluateu by use of a foou log that patient will
use to iecoiu intake of foou anu beveiages. Weight shoulu be measuieu
anu iecoiueu uaily to assess compliance anu iuentify necessaiy
mouifications. Patient will expiess an unueistanuing of nutiitional neeus
uuiing chemotheiapy anu awaieness of symptoms that may occui at the
stait of tieatment.
!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA;
Wauswoith Cengage Leaining; 2u11.

5K" #$%& &()*1 +, .6&/0&0+. *76-%&0+. :+627 C* 03)+/&%.& &+ )/+D07* ,+/
E*.01*4 #$*. :+627 0& C* %))/+)/0%&* &+ )/+D07* &$01 *76-%&0+.4
#$%& ,%-&+/1 30;$& 0.&*/,*/* :0&$ &$* )%&0*.&91 /*-*)&0+. +,
.6&/0&0+. *76-%&0+.4
Benise shoulu ieceive nutiition euucation to leain how to piopeily
uocument oial intake in a foou log, awaieness of symptoms that occui at
the stait of chemotheiapy, anu the impoitance of small meals anu
obtaining piopei eneigy anu nutiients uuiing tieatment. Benise shoulu
also be pioviueu with a list of foous that aie goou foi patients
expeiiencing nausea oi appetite loss anu euucation on meal
ieplacements. Foou anu uiug inteiactions shoulu also be uiscusseu with
patient.
National Cancei Institute

5S" #$%& 01 % 2+:[30-/+C0%2 +/ 2+:[C%-&*/0%2 70*&4 #$( 3%( E*.01* .**7
&+ ,+22+: ,++7 1%,*&( ;607*20.*1 76/0.; 0336.+16))/*110+.4
Benise shoulu consiuei following a low-miciobial uiet uuiing the initial
two months of chemotheiapy to ieuuce the iisk of ueveloping a foou-
ielateu infection. Immunosuppiession uuiing chemotheiapy causes a
weakeneu immune system that incieases potential infections potential
12
souices of oiganisms known to cause infection. A low-miciobial uiet
meet the Recommenueu Bietaiy Intakes of the National Reseaich Council
foi all nutiients when following a well-balanceu uiet. ueneial
consiueiations incluue:
Biscaiu any foou with molu
Bo not puichase a piouuct aftei the expiiation uate
All foous must be stoieu anu hanuleu piopeily
0C Bavis Cancei Centei

5U" H*-*.&2( ;26&%30.* $%1 C**. % -+3)+.*.& +, 1*D*/%2 -20.0-%2 &/0%21 &+
/*76-* ;%1&/+0.&*1&0.%2 -+3)20-%&0+.1 +, C+&$ -$*3+ %.7 /%70%&0+.
&$*/%)(" #$%& 01 ;26&%30.*4 #$%& 01 &$* /%&0+.%2 ,+/ 0&1 61*4
ulutamine is an amino aciu that has been stuuieu to ueteimine if it can
effectively ieuuce cancei tieatment siue effects such as mucositis,
neuiopathy, aithialgia, myalgia, anu uiaiihea. The stuuies conuucteu
have not founu stiong enough eviuence to concluue that an association
uoes exist. The closest association that has been founu is between the
occuiience of mucositis anu use of glutamine. Fuithei ieseaich neeus to
be completeu to accuiately assess the coiielation.
Caiing4Cancei

Refeiences:

ABA Eviuence Libiaiy (2uu6). Nutiition Biagnosis.

Cancei Tieatment Centeis foi Ameiica. B-Cell Lymphoma.

Inteinational Bietetics anu Nutiition Teiminology (IBNT) Refeience Nanual:
Stanuaiuizeu Language foi the Nutiition Caie Piocess. S
iu
Eu. Chicago, IL:
Ameiican Bietetics Association; 2u11.

Nacmillan Cancei Suppoit (2u1u). Neuiastinal laige B-cell lymphoma.

National Cancei Institute (2uu9). Eating Bints.

National Cancei Institute (2u11). Nutiition in Cancei Caie.

!"#$%#%&' )*+$,-. ,'/ 0,#*&-*.1%&2&3.. 2
nu
eu. Belmont, CA; Wauswoith Cengage
Leaining; 2u11.

The Clevelanu Clinic. Auult Non-Bougkins Lymphoma.