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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

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

 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


Decrease the risk of infection

Being well nourished has been related to better

● Prevent weight loss

● Preserve lean body mass

● Prevent macro and micro nutrient deficiencies

● Avoid complications secondary to nutrient


● 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

1. Nutrition before treatment


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
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

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

• 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
Know your lab
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

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

Protein requirement variables

•Present protein status
•Presence of metastatic disease

Most cancer patients have increased

-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

The use of a multivitamin and

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

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
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


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
• 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


• 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
al Appetite Cytokines

Learned Social, cultural

aversions to & economic
intake factors

Common Nutrition Impact
symptoms of Cancer

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


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
• 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


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
Five things you should remember about
preventing cancer

Eats lots of fruits, vegetables, and whole


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.
Have you heard
Thank you for listening