78 Questions
What is the approximate percentage of cancer patients that experience the cancer cachexia syndrome?
50%
What is a significant consequence of weight loss in cancer patients?
Shorter survival
What is a characteristic feature of cancer cachexia?
Progressive, involuntary weight loss
What is a common cause of cancer cachexia?
Anorexia
What is the primary goal of nutrition support therapy in cancer patients?
To bypass oral intake and circumvent CCS-related anorexia
What is a consistent effect of parenteral nutrition on cancer patients?
Weight gain
What is a common symptom of cancer cachexia?
Fatigue
When can cancer cachexia syndrome occur in cancer patients?
In both early and advanced stages of tumor growth
In which patients is nutrition support therapy appropriate?
Malnourished patients undergoing hematopoietic cell transplantation
When should parenteral nutrition be discontinued in patients undergoing hematopoietic cell transplantation?
When toxicities have resolved after stem cell engraftment
What is the benefit of pharmacologic doses of parenteral glutamine in patients undergoing hematopoietic cell transplantation?
Benefit to patients undergoing hematopoietic cell transplantation
Why should patients receiving hematopoietic cell transplantation undergo dietary counseling?
To reduce the risk of foodborne infections during neutropenia
What is the purpose of nutrition screening in patients with cancer?
To identify patients who require formal nutrition assessment
What is the grade of recommendation for nutrition support therapy in patients undergoing major cancer operations?
A
What is the purpose of perioperative nutrition support therapy in moderately or severely malnourished patients?
To weigh the potential benefits against the potential risks
When is enteral nutrition preferred over parenteral nutrition?
In patients with a functioning gastrointestinal tract
What is the reason for not using nutrition support therapy routinely in patients undergoing major cancer operations?
Benefit only in severely malnourished patients
What is the purpose of nutrition assessment in patients with cancer?
To develop a nutrition care plan
What is the primary objective of initiating NST in advanced cancer patients?
To conserve or restore the best possible quality of life and control nutrition-related symptoms
Which type of patients may demonstrate a favorable response to PN?
Those with a good performance status, such as Karnofsky score >50
What is the primary factor that affects the short- and long-term outcomes of hematopoietic cell transplantation?
Diagnosis and disease stage
What is the effect of ω-3 fatty acid supplementation on prostaglandin synthesis?
It favors the production of prostaglandins in the 3-series (PGE3)
Which of the following nutrients have been studied for their potential benefits in perioperative cancer patients?
Glutamine, arginine, and essential fatty acids
What is the target dose of eicosapentanoic acid daily for ω-3 fatty acid supplementation?
2 g
What is a common complication experienced by patients undergoing hematopoietic cell transplantation?
Mucositis and intense diarrhea
Why should patients not use therapeutic diets to treat cancer?
Because there is limited peer-reviewed literature on their efficacy or safety
What is the primary goal of nutrition support therapy in patients undergoing hematopoietic cell transplantation?
To support immune function and reduce infections
What is an example of a therapeutic diet that has been studied for cancer treatment?
Macrobiotic diet
What is the term used to describe the use of specific substances for effects beyond their nutrition role?
Nutritional pharmacology
What is a characteristic feature of cancer patients undergoing hematopoietic cell transplantation?
Elevated nutrient requirements and altered metabolism
What type of formulas may be beneficial in malnourished patients undergoing major cancer operations?
Immune-enhancing enteral formulas
What is the recommended duration of preoperative supplementation with immune-enhancing nutrients in malnourished patients undergoing major cancer operations?
5-7 days
What is a dose-limiting toxicity associated with hematopoietic cell transplantation?
Gastrointestinal tract complications
What is the potential effect of ω-3 fatty acid supplementation on weight loss in cancer patients?
It stabilizes weight
What is a complication that can occur in recipients of allografts?
Graft-versus-host disease
What is a potential benefit of home PN in carefully selected patients?
Both A and B
What is a consequence of mucositis and intense diarrhea in patients undergoing hematopoietic cell transplantation?
Prolonged period of minimal oral intake
What is a type of hematopoietic cell transplantation that involves high-dose chemotherapy with or without irradiation?
Conventional transplantation
In patients undergoing hematopoietic cell transplantation, what is a significant consequence of malnutrition?
Higher mortality
What is the primary indication for nutrition support therapy in patients undergoing hematopoietic cell transplantation?
Malnutrition and inability to ingest/absorb adequate nutrients
What is the recommended duration for the definition of 'prolonged period of time' in the context of nutrition support therapy?
7-14 days
What is a potential benefit of enteral nutrition in patients undergoing hematopoietic cell transplantation?
Decreased risk of severe GVHD
What is the recommended approach to parenteral nutrition in patients undergoing hematopoietic cell transplantation?
Discontinue as soon as toxicities have resolved after stem cell engraftment
What is a potential benefit of pharmacologic doses of parenteral glutamine in patients undergoing hematopoietic cell transplantation?
Beneficial effects
Why is nutrition screening recommended in patients undergoing hematopoietic cell transplantation?
To identify those who require formal nutrition assessment
What is a characteristic feature of patients undergoing hematopoietic cell transplantation?
They are at high risk of malnutrition
What is a potential effect of malnutrition in patients undergoing hematopoietic cell transplantation?
Increased morbidity
Why is enteral nutrition recommended in patients undergoing hematopoietic cell transplantation?
In patients with a functioning gastrointestinal tract and inadequate oral intake
What is the benefit of perioperative nutrition support therapy in moderately or severely malnourished cancer patients?
Decreasing morbidity and mortality
When is nutrition support therapy not recommended as an adjunct to chemotherapy?
In well-nourished patients receiving chemotherapy
What is the outcome of using nutrition support therapy in patients undergoing head and neck, abdominal, or pelvic irradiation?
Increased risk of infection and detrimental effect on patient survival
In what patients is nutrition support therapy appropriate?
Malnourished patients receiving active anticancer treatment who are unable to ingest and/or absorb adequate nutrients for a prolonged period of time
What is the primary consideration when deciding to initiate nutrition support therapy in terminally ill cancer patients?
All of the above
What is the duration of perioperative nutrition support therapy administration in moderately or severely malnourished cancer patients?
7-14 days preoperatively
What is the effect of enterally administered GLN on morbidity and mortality?
It has no effect on morbidity and mortality
What is the benefit of nutrition support therapy in patients receiving active anticancer treatment?
Improvements in weight and nitrogen balance
What is the primary reason for not using nutrition support therapy as an adjunct to chemotherapy in well-nourished patients?
Associated increase in the risk of infection
What is the benefit of parenterally administered GLN?
Improved nitrogen balance and shorter length of hospital stay
What is the outcome of using nutrition support therapy in patients with advanced cancer?
Rarely indicated and potentially detrimental
What is the recommended dietary counseling for patients undergoing hematopoietic cell transplantation?
Avoiding high-risk foods during the period of neutropenia
What is the rationale for providing dietary restrictions on high-risk foods during neutropenia?
To reduce the risk of infection
What is the primary criterion for initiating nutrition support therapy in patients receiving active anticancer treatment?
Anticipated inability to ingest and/or absorb adequate nutrients for a prolonged period of time
What is the impact of high dextrose PN on the incidence of GVHD?
It increases the incidence of GVHD
What is the role of nutrition support therapy in patients with GVHD?
To improve nutrition status during GVHD
What is the effect of GLN in PN on the length of hospital stay?
It has no effect on the length of hospital stay
What is the benefit of GLN in PN according to a recent Cochrane review?
Fewer bloodstream infections
What is the current limitation of providing parenteral GLN?
Lack of commercial availability of intravenous formulation
What is the need for further research on dietary restrictions in neutropenic HCT patients?
To assess the impact of dietary restrictions on infectious risk
What is the effect of PN on lean body mass?
Minimal
What is the purpose of this paper?
To examine the literature and develop guidelines for NST in adult cancer patients
What is a concern regarding the use of NST in cancer patients?
That it may stimulate tumor growth and metastasis
What is the effect of EN on body composition?
It causes weight gain and improves nitrogen balance
What is the effect of NST on nutrition indices in cancer patients?
It has a minimal effect
What is the purpose of nutrition screening in patients with cancer?
To identify patients who require formal nutrition assessment
What is the benefit of ω-3 fatty acid supplementation in cancer patients?
It helps stabilize weight
What is the grade of recommendation for nutrition support therapy in patients undergoing major cancer operations?
A
What is the purpose of perioperative nutrition support therapy in moderately or severely malnourished patients?
To reduce the risk of complications
What is the recommendation for nutrition support therapy in malnourished patients undergoing hematopoietic cell transplantation?
It is recommended for malnourished patients
Study Notes
Nutrition Status in Cancer Patients
- Malnutrition and weight loss are common in cancer patients and can be contributors to mortality
- Cancer cachexia syndrome (CCS) is a condition characterized by progressive, involuntary weight loss, anorexia, and fatigue
- CCS is observed in approximately 50% of cancer patients and can occur at any stage of cancer diagnosis
- Weight loss is a significant prognostic factor in cancer patients, with shorter survival times in patients who experience pretreatment weight loss
Nutrition Support Therapy (NST)
- NST involves bypassing oral intake to circumvent CCS-related anorexia
- Parenteral nutrition (PN) can cause weight gain, improve nitrogen balance, and increase body fat, but has minimal effect on lean body mass
- Enteral nutrition (EN) can also cause weight gain and improve nitrogen balance, but its effects on body composition are less consistent
- NST has less of an effect on nutrition indices in cancer patients compared to non-cancer patients, likely due to changes in macronutrient metabolism
Guidelines for NST in Adult Cancer Patients
- Patients with cancer are nutritionally at-risk and should undergo nutrition screening to identify those who require formal nutrition assessment
- NST should not be used routinely in patients undergoing major cancer operations, but may be beneficial in moderately or severely malnourished patients if administered for 7-14 days preoperatively
- NST should not be used routinely as an adjunct to chemotherapy or radiation therapy
- NST is appropriate in patients receiving active anticancer treatment who are malnourished and unable to ingest/absorb adequate nutrients for a prolonged period of time
- ω-3 fatty acid supplementation may help stabilize weight in cancer patients experiencing progressive, unintentional weight loss
Guidelines for NST in Hematopoietic Cell Transplantation
- All patients undergoing hematopoietic cell transplantation with myeloablative conditioning regimens are at nutrition risk and should undergo nutrition screening
- NST is appropriate in patients undergoing hematopoietic cell transplantation who are malnourished and unable to ingest/absorb adequate nutrients for a prolonged period of time
- Enteral nutrition should be used in patients with a functioning gastrointestinal tract in whom oral intake is inadequate
- Pharmacologic doses of parenteral glutamine may benefit patients undergoing hematopoietic cell transplantation
- Patients should receive dietary counseling regarding foods that may pose infectious risks and safe food handling during the period of neutropenia### Hematopoietic Cell Transplantation (HCT) and Nutrition
- HCT patients are at risk of malnutrition due to underlying disease, conditioning regimen, and treatment-related toxicities.
- Malnutrition can lead to increased morbidity and mortality in HCT patients.
Graft-Versus-Host Disease (GVHD)
- Acute GVHD occurs in the first few months post-transplant and targets the skin, liver, and gastrointestinal tract.
- Chronic GVHD can develop several months to years post-transplant and involve single or multiple organs.
- Moderate to severe GVHD results in profound and prolonged immunosuppression.
Nutrition Interventions
- Nutrition screening is essential for HCT patients to identify those at risk of malnutrition and develop a nutrition care plan.
- Nutrition support therapy (NST) is appropriate for malnourished HCT patients who are unable to ingest and/or absorb adequate nutrients for a prolonged period.
- Enteral nutrition (EN) should be used in patients with a functioning gastrointestinal tract and inadequate oral intake.
- Pharmacologic doses of parenteral glutamine may benefit HCT patients.
- Dietary counseling is necessary for HCT patients to avoid foods associated with infectious risks during neutropenia.
Impact of Nutrition on HCT Outcomes
- Malnutrition is associated with poor outcomes in HCT patients, including increased morbidity and mortality.
- Obesity may also have a negative influence on HCT outcomes.
- Nutrition support therapy is necessary for HCT patients who develop moderate to severe GVHD accompanied by poor oral intake and/or significant malabsorption.
Research Gaps
- The role of pre-transplant nutrition intervention on HCT outcomes is unknown.
- Limited data are available on the impact of NST on the incidence of GVHD.
- More research is needed to determine the appropriate dose and timing of parenteral glutamine supplementation.
- Systematic research is required to examine the effect of dietary restrictions on infectious risk in HCT patients.
Learn about the impact of nutrition on cancer patients' quality of life and the symptoms of cancer cachexia, a syndrome characterized by progressive weight loss. Understand the causes and clinical features of this condition.
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