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Jyothi Prasad

Manipal Hospital
Normal body cells grow, divide and die in an
orderly fashion

Cancer cells are different. They do not die, just


continue to divide and grow and spread
(Metastasis)

Cancer cells form as a result of damaged DNA

These damaged genes are passed on which


accounts for inherited cancer

In other cases, DNA can be damaged by an


outside source such as smoking
Anti tumor treatments have adverse
effects on Nutritional status

Severe anorexia and nausea results

Reduced energy intake

Increased energy expenditure

Weight loss is progressive

Negative energy balance


 Diminished tolerance of
therapy

 Lower survival rates

 Diminished quality of life

 Longer hospitalizations
Helps the patient feel better

Keeps up the strength and energy

Keeps up the weight and body’s store of nutrients

Helps the patient tolerate treatment related side


effects

Decrease the risk of infection

Being well nourished has been related to better


prognosis
● Prevent weight loss

● Preserve lean body mass

● Prevent macro and micro nutrient deficiencies

● Avoid complications secondary to nutrient


deficiencies

● Maximize the quality of life

Overall goal is to achieve and maintain weight


for height, avoiding even desired weight loss
during treatment and recovery
Medical Nutrition therapy in
Cancer

1. Nutrition before treatment


begins

2. Nutrition during treatment

3. Nutrition after treatment ends


 Healthy diet is vital for a person's body to work its best. This is
even more important for cancer patients.

 A person on healthy diet will go into treatment with reserves to


help keep up the strength, prevent body tissue from breaking
down, rebuild tissue, and maintain defenses against infection.

 People who eat well are better able to cope with side effects.
Some cancer treatments are actually much more effective if the
patient is well nourished and getting enough calories and protein
in his or her diet

 One should not be afraid to try new foods. Some foods which
have never tasted good may taste good now.
What can be done about nutritional
support?
Step 1: Assesment

History – Diagnosis, Medical surgical history, Weight history and change over
time, Current nutritional intake including intolerances and tolerances
Labs – Serum Albumin, Transferrin, Potassium etc

Step 2: Planning

Nutritional requirements – Specific to individual needs


Setting achievable goals

Step 3: Intervention

Symptom management
Nourishment

Step 4: Evaluate
Assess – Look for
Ask! signs
•Hair - dull, brittle, dry or
falls out easily

•Swollen glands in the neck


• Appetite - good/poor
•Skin - dry, rough, spotty, or
• Grazing or snacking sandpapery feel

• Special diets/ Practices •Sores and delayed wound


healing
• Food likes/dislikes
•Muscle wasting (decreased
• Quantity - calories in size & strength)

• Symptoms - mouth pain or •Edema of the lower


difficulties with chewing or extremities
swallowing •Abnormal heart rate,
rhythm, & blood pressure
• Vitamin/herb use •
•Enlarged liver or spleen

•Loss of balance or
coordination
Know your lab
results
Albumin (3.5-5 g/dL)

Mild depletion (2.8-3.4 g/dL)


Moderate depletion (2.1-2.7 g/dL)
Severe depletion (<2.1g/dL)

Total lymphocyte count (2500 mm3)

TLC (mm3) = WBC (mm3) x % lymphocytes


Mild depletion (<1500 mm3)
Moderate depletion (<1200 mm3)
Severe depletion (<800 mm3
Planning - Nutrient Calorie
Requirements

Estimating calorie requirements for patient losing weight


varies depending on metabolic stressors such as:

• Post operative status


• Metastatic disease
• Type of tumor

Estimated 35-45 kcal/kg body weight

Calorie consumption for weight gain


Nutrient Protein
Requirements

Protein requirement variables


•Present protein status
•Presence of metastatic disease

Most cancer patients have increased


requirements
-Mild to moderate protein depletion (Albumin <3.5)
1.0 to 1.5gms/kg body weight

-Moderate to severe protein depletion (Albumin <2.7)


1.5 to 2.5gms/kg body weight
Vitamin & Mineral
requirements

The use of a multivitamin and


mineral supplement that
provides no more than 100% of
the recommended daily
allowances is generally
considered safe
Nutritional
Intervention

Assessment of diet intake

-Keep dietary intake record


- Compare weight changes with total calories consumed

-Use of Enteral products

-To increase calorie/protein intake


-Provide elemental source of nutrients for absorption

-Consider need for Enteral nutrition if Prognosis warrants. It is said that


it has lower risks of infection than parenteral nutrition. TPN can be
started if oral and enteral intake is impeded longer than 10 days
Summing up nutritional
needs
Regardless of the phase of treatment or recovery, they should be
instructed to consume a nutritionally adequate diet

Individualized nutrition intervention is encouraged

Sufficient energy and protein to maintain their nutrition stores and to


maintain their weight for height

Need for protein increases to repair and rebuild the tissues affected
by cancer therapy and to maintain a healthy immune system

If there is difficulty eating, a multi vitamin & mineral


supplementation that provides no more than 100% of the RDA is
considered safe

The effectiveness of antioxidants is still being studied and remains


controversial

Nutritional screening & assessment is mandatory and early


intervention is essential

Regardless of the route, nutritional goals should be specific,


achievable, & individualized in scope to encourage patient cooperation
Modes of Cancer
Treatment
• Surgery – Surgical excision of the diseased part

• Radiotherapy - Machine to send radiation towards the


cancer cells

• Chemotherapy- Drugs are used to stop the growth of


cancer cells

• Immunotherapy- Immune system is used to fight


cancer

• Bone Marrow & Stem cell transplantation -


Stem cells are removed from the bone marrow of the patient
or the donor and stored. These reinforced stem cells are
infused which grow into and restore body’s cells
Intermedia Secondary
ry Endocrine infections,
metabolite abnormaliti malignant lesions
s es

Nutritional Medication
abnormaliti s
es
Neurologic
al Appetite Cytokines
influences
Psychiatric,
psychological
influences

Learned Social, cultural


Food
aversions to & economic
intake factors
therapy

Physical
factors
Common Nutrition Impact
symptoms of Cancer
therapies

May slow digestion

May lessen the ability of the mouth,


stomach & throat to function properly

Adequate nutrition helps wound healing &


Surgery recovery

Patient may not be able to eat normally at


first

A high cal & protein diet is prescribed


prior if the patient is weak

Enteral nutrition is started if the patient


is not able to eat normally
♦Damages cancer cells and may also
affect normal healthy cells

♦Treatment of head, neck or chest may


Radiation cause may unpleasant side effects

♦Affects the digestive system

♦Affects the desire and ability to eat

Side effects are plenty

Chemotherapy Treatment affects the ability to eat

Desire and ability to eat will


Immunotherapy come down due to side effects
& Stem cell
Some eating suggestions for commonly seen side
effects
Evaluation
• Cardinal principle:
Individualize to needs of patient
• Short-term goal:
Improve nutritional status
• Long-term goal:
Normalize Nutrient Intake
Alleviate disease symptoms
• Outcomes???
Better Quality of life / Vigor
Fewer Crisis / Improved
Treatment Response
Overview of Nutrition in various stages of
cancer therapy
Nutrition after
treatment ends
To sum up

Early nutrition intervention in cancer patients is indicated

Pharmacological intervention is indicated in cancer cachexia

Preoperative TPN is indicated only in severely malnourished


patients

No indication for routine TPN use

Indiscriminate use of nutrition support is unjustified in cancer


patients especially in chemotherapy patients

Nutrition support should be individualized

Well nourished patients receiving chemotherapy respond better


to treatment
5 for the
road
Five things you should remember about
preventing cancer

Eats lots of fruits, vegetables, and whole


grains

Discover the pleasure of physical activity.

Stay tobacco free

Enjoy a low-fat diet

Protect yourself from the sun between 10:00


am and 4:00 pm.
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this?
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