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Questions and Answers
What is the approximate percentage of cancer patients that experience the cancer cachexia syndrome?
What is a significant consequence of weight loss in cancer patients?
What is a characteristic feature of cancer cachexia?
What is a common cause of cancer cachexia?
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What is the primary goal of nutrition support therapy in cancer patients?
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What is a consistent effect of parenteral nutrition on cancer patients?
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What is a common symptom of cancer cachexia?
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When can cancer cachexia syndrome occur in cancer patients?
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In which patients is nutrition support therapy appropriate?
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When should parenteral nutrition be discontinued in patients undergoing hematopoietic cell transplantation?
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What is the benefit of pharmacologic doses of parenteral glutamine in patients undergoing hematopoietic cell transplantation?
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Why should patients receiving hematopoietic cell transplantation undergo dietary counseling?
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What is the purpose of nutrition screening in patients with cancer?
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What is the grade of recommendation for nutrition support therapy in patients undergoing major cancer operations?
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What is the purpose of perioperative nutrition support therapy in moderately or severely malnourished patients?
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When is enteral nutrition preferred over parenteral nutrition?
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What is the reason for not using nutrition support therapy routinely in patients undergoing major cancer operations?
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What is the purpose of nutrition assessment in patients with cancer?
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What is the primary objective of initiating NST in advanced cancer patients?
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Which type of patients may demonstrate a favorable response to PN?
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What is the primary factor that affects the short- and long-term outcomes of hematopoietic cell transplantation?
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What is the effect of ω-3 fatty acid supplementation on prostaglandin synthesis?
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Which of the following nutrients have been studied for their potential benefits in perioperative cancer patients?
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What is the target dose of eicosapentanoic acid daily for ω-3 fatty acid supplementation?
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What is a common complication experienced by patients undergoing hematopoietic cell transplantation?
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Why should patients not use therapeutic diets to treat cancer?
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What is the primary goal of nutrition support therapy in patients undergoing hematopoietic cell transplantation?
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What is an example of a therapeutic diet that has been studied for cancer treatment?
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What is the term used to describe the use of specific substances for effects beyond their nutrition role?
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What is a characteristic feature of cancer patients undergoing hematopoietic cell transplantation?
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What type of formulas may be beneficial in malnourished patients undergoing major cancer operations?
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What is the recommended duration of preoperative supplementation with immune-enhancing nutrients in malnourished patients undergoing major cancer operations?
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What is a dose-limiting toxicity associated with hematopoietic cell transplantation?
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What is the potential effect of ω-3 fatty acid supplementation on weight loss in cancer patients?
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What is a complication that can occur in recipients of allografts?
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What is a potential benefit of home PN in carefully selected patients?
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What is a consequence of mucositis and intense diarrhea in patients undergoing hematopoietic cell transplantation?
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What is a type of hematopoietic cell transplantation that involves high-dose chemotherapy with or without irradiation?
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In patients undergoing hematopoietic cell transplantation, what is a significant consequence of malnutrition?
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What is the primary indication for nutrition support therapy in patients undergoing hematopoietic cell transplantation?
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What is the recommended duration for the definition of 'prolonged period of time' in the context of nutrition support therapy?
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What is a potential benefit of enteral nutrition in patients undergoing hematopoietic cell transplantation?
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What is the recommended approach to parenteral nutrition in patients undergoing hematopoietic cell transplantation?
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What is a potential benefit of pharmacologic doses of parenteral glutamine in patients undergoing hematopoietic cell transplantation?
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Why is nutrition screening recommended in patients undergoing hematopoietic cell transplantation?
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What is a characteristic feature of patients undergoing hematopoietic cell transplantation?
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What is a potential effect of malnutrition in patients undergoing hematopoietic cell transplantation?
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Why is enteral nutrition recommended in patients undergoing hematopoietic cell transplantation?
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What is the benefit of perioperative nutrition support therapy in moderately or severely malnourished cancer patients?
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When is nutrition support therapy not recommended as an adjunct to chemotherapy?
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What is the outcome of using nutrition support therapy in patients undergoing head and neck, abdominal, or pelvic irradiation?
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In what patients is nutrition support therapy appropriate?
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What is the primary consideration when deciding to initiate nutrition support therapy in terminally ill cancer patients?
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What is the duration of perioperative nutrition support therapy administration in moderately or severely malnourished cancer patients?
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What is the effect of enterally administered GLN on morbidity and mortality?
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What is the benefit of nutrition support therapy in patients receiving active anticancer treatment?
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What is the primary reason for not using nutrition support therapy as an adjunct to chemotherapy in well-nourished patients?
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What is the benefit of parenterally administered GLN?
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What is the outcome of using nutrition support therapy in patients with advanced cancer?
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What is the recommended dietary counseling for patients undergoing hematopoietic cell transplantation?
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What is the rationale for providing dietary restrictions on high-risk foods during neutropenia?
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What is the primary criterion for initiating nutrition support therapy in patients receiving active anticancer treatment?
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What is the impact of high dextrose PN on the incidence of GVHD?
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What is the role of nutrition support therapy in patients with GVHD?
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What is the effect of GLN in PN on the length of hospital stay?
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What is the benefit of GLN in PN according to a recent Cochrane review?
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What is the current limitation of providing parenteral GLN?
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What is the need for further research on dietary restrictions in neutropenic HCT patients?
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What is the effect of PN on lean body mass?
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What is the purpose of this paper?
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What is a concern regarding the use of NST in cancer patients?
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What is the effect of EN on body composition?
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What is the effect of NST on nutrition indices in cancer patients?
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What is the purpose of nutrition screening in patients with cancer?
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What is the benefit of ω-3 fatty acid supplementation in cancer patients?
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What is the grade of recommendation for nutrition support therapy in patients undergoing major cancer operations?
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What is the purpose of perioperative nutrition support therapy in moderately or severely malnourished patients?
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What is the recommendation for nutrition support therapy in malnourished patients undergoing hematopoietic cell transplantation?
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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.
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Description
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.