Cancer Nutrition and Cachexia
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Questions and Answers

What is the approximate percentage of cancer patients that experience the cancer cachexia syndrome?

  • 70%
  • 90%
  • 20%
  • 50% (correct)

    • What is a significant consequence of weight loss in cancer patients?

  • Improved prognosis
  • Increased energy levels
  • Shorter survival (correct)
  • Enhanced nutrient absorption

    • What is a characteristic feature of cancer cachexia?

  • Rapid improvement in fatigue
  • Sudden onset of anemia
  • Progressive, involuntary weight loss (correct)
  • Voluntary weight gain

    • What is a common cause of cancer cachexia?

    <p>Anorexia</p> Signup and view all the answers

    What is the primary goal of nutrition support therapy in cancer patients?

    <p>To bypass oral intake and circumvent CCS-related anorexia</p> Signup and view all the answers

    What is a consistent effect of parenteral nutrition on cancer patients?

    <p>Weight gain</p> Signup and view all the answers

    What is a common symptom of cancer cachexia?

    <p>Fatigue</p> Signup and view all the answers

    When can cancer cachexia syndrome occur in cancer patients?

    <p>In both early and advanced stages of tumor growth</p> Signup and view all the answers

    In which patients is nutrition support therapy appropriate?

    <p>Malnourished patients undergoing hematopoietic cell transplantation</p> Signup and view all the answers

    When should parenteral nutrition be discontinued in patients undergoing hematopoietic cell transplantation?

    <p>When toxicities have resolved after stem cell engraftment</p> Signup and view all the answers

    What is the benefit of pharmacologic doses of parenteral glutamine in patients undergoing hematopoietic cell transplantation?

    <p>Benefit to patients undergoing hematopoietic cell transplantation</p> Signup and view all the answers

    Why should patients receiving hematopoietic cell transplantation undergo dietary counseling?

    <p>To reduce the risk of foodborne infections during neutropenia</p> Signup and view all the answers

    What is the purpose of nutrition screening in patients with cancer?

    <p>To identify patients who require formal nutrition assessment</p> Signup and view all the answers

    What is the grade of recommendation for nutrition support therapy in patients undergoing major cancer operations?

    <p>A</p> Signup and view all the answers

    What is the purpose of perioperative nutrition support therapy in moderately or severely malnourished patients?

    <p>To weigh the potential benefits against the potential risks</p> Signup and view all the answers

    When is enteral nutrition preferred over parenteral nutrition?

    <p>In patients with a functioning gastrointestinal tract</p> Signup and view all the answers

    What is the reason for not using nutrition support therapy routinely in patients undergoing major cancer operations?

    <p>Benefit only in severely malnourished patients</p> Signup and view all the answers

    What is the purpose of nutrition assessment in patients with cancer?

    <p>To develop a nutrition care plan</p> Signup and view all the answers

    What is the primary objective of initiating NST in advanced cancer patients?

    <p>To conserve or restore the best possible quality of life and control nutrition-related symptoms</p> Signup and view all the answers

    Which type of patients may demonstrate a favorable response to PN?

    <p>Those with a good performance status, such as Karnofsky score &gt;50</p> Signup and view all the answers

    What is the primary factor that affects the short- and long-term outcomes of hematopoietic cell transplantation?

    <p>Diagnosis and disease stage</p> Signup and view all the answers

    What is the effect of ω-3 fatty acid supplementation on prostaglandin synthesis?

    <p>It favors the production of prostaglandins in the 3-series (PGE3)</p> Signup and view all the answers

    Which of the following nutrients have been studied for their potential benefits in perioperative cancer patients?

    <p>Glutamine, arginine, and essential fatty acids</p> Signup and view all the answers

    What is the target dose of eicosapentanoic acid daily for ω-3 fatty acid supplementation?

    <p>2 g</p> Signup and view all the answers

    What is a common complication experienced by patients undergoing hematopoietic cell transplantation?

    <p>Mucositis and intense diarrhea</p> Signup and view all the answers

    Why should patients not use therapeutic diets to treat cancer?

    <p>Because there is limited peer-reviewed literature on their efficacy or safety</p> Signup and view all the answers

    What is the primary goal of nutrition support therapy in patients undergoing hematopoietic cell transplantation?

    <p>To support immune function and reduce infections</p> Signup and view all the answers

    What is an example of a therapeutic diet that has been studied for cancer treatment?

    <p>Macrobiotic diet</p> Signup and view all the answers

    What is the term used to describe the use of specific substances for effects beyond their nutrition role?

    <p>Nutritional pharmacology</p> Signup and view all the answers

    What is a characteristic feature of cancer patients undergoing hematopoietic cell transplantation?

    <p>Elevated nutrient requirements and altered metabolism</p> Signup and view all the answers

    What type of formulas may be beneficial in malnourished patients undergoing major cancer operations?

    <p>Immune-enhancing enteral formulas</p> Signup and view all the answers

    What is the recommended duration of preoperative supplementation with immune-enhancing nutrients in malnourished patients undergoing major cancer operations?

    <p>5-7 days</p> Signup and view all the answers

    What is a dose-limiting toxicity associated with hematopoietic cell transplantation?

    <p>Gastrointestinal tract complications</p> Signup and view all the answers

    What is the potential effect of ω-3 fatty acid supplementation on weight loss in cancer patients?

    <p>It stabilizes weight</p> Signup and view all the answers

    What is a complication that can occur in recipients of allografts?

    <p>Graft-versus-host disease</p> Signup and view all the answers

    What is a potential benefit of home PN in carefully selected patients?

    <p>Both A and B</p> Signup and view all the answers

    What is a consequence of mucositis and intense diarrhea in patients undergoing hematopoietic cell transplantation?

    <p>Prolonged period of minimal oral intake</p> Signup and view all the answers

    What is a type of hematopoietic cell transplantation that involves high-dose chemotherapy with or without irradiation?

    <p>Conventional transplantation</p> Signup and view all the answers

    In patients undergoing hematopoietic cell transplantation, what is a significant consequence of malnutrition?

    <p>Higher mortality</p> Signup and view all the answers

    What is the primary indication for nutrition support therapy in patients undergoing hematopoietic cell transplantation?

    <p>Malnutrition and inability to ingest/absorb adequate nutrients</p> Signup and view all the answers

    What is the recommended duration for the definition of 'prolonged period of time' in the context of nutrition support therapy?

    <p>7-14 days</p> Signup and view all the answers

    What is a potential benefit of enteral nutrition in patients undergoing hematopoietic cell transplantation?

    <p>Decreased risk of severe GVHD</p> Signup and view all the answers

    What is the recommended approach to parenteral nutrition in patients undergoing hematopoietic cell transplantation?

    <p>Discontinue as soon as toxicities have resolved after stem cell engraftment</p> Signup and view all the answers

    What is a potential benefit of pharmacologic doses of parenteral glutamine in patients undergoing hematopoietic cell transplantation?

    <p>Beneficial effects</p> Signup and view all the answers

    Why is nutrition screening recommended in patients undergoing hematopoietic cell transplantation?

    <p>To identify those who require formal nutrition assessment</p> Signup and view all the answers

    What is a characteristic feature of patients undergoing hematopoietic cell transplantation?

    <p>They are at high risk of malnutrition</p> Signup and view all the answers

    What is a potential effect of malnutrition in patients undergoing hematopoietic cell transplantation?

    <p>Increased morbidity</p> Signup and view all the answers

    Why is enteral nutrition recommended in patients undergoing hematopoietic cell transplantation?

    <p>In patients with a functioning gastrointestinal tract and inadequate oral intake</p> Signup and view all the answers

    What is the benefit of perioperative nutrition support therapy in moderately or severely malnourished cancer patients?

    <p>Decreasing morbidity and mortality</p> Signup and view all the answers

    When is nutrition support therapy not recommended as an adjunct to chemotherapy?

    <p>In well-nourished patients receiving chemotherapy</p> Signup and view all the answers

    What is the outcome of using nutrition support therapy in patients undergoing head and neck, abdominal, or pelvic irradiation?

    <p>Increased risk of infection and detrimental effect on patient survival</p> Signup and view all the answers

    In what patients is nutrition support therapy appropriate?

    <p>Malnourished patients receiving active anticancer treatment who are unable to ingest and/or absorb adequate nutrients for a prolonged period of time</p> Signup and view all the answers

    What is the primary consideration when deciding to initiate nutrition support therapy in terminally ill cancer patients?

    <p>All of the above</p> Signup and view all the answers

    What is the duration of perioperative nutrition support therapy administration in moderately or severely malnourished cancer patients?

    <p>7-14 days preoperatively</p> Signup and view all the answers

    What is the effect of enterally administered GLN on morbidity and mortality?

    <p>It has no effect on morbidity and mortality</p> Signup and view all the answers

    What is the benefit of nutrition support therapy in patients receiving active anticancer treatment?

    <p>Improvements in weight and nitrogen balance</p> Signup and view all the answers

    What is the primary reason for not using nutrition support therapy as an adjunct to chemotherapy in well-nourished patients?

    <p>Associated increase in the risk of infection</p> Signup and view all the answers

    What is the benefit of parenterally administered GLN?

    <p>Improved nitrogen balance and shorter length of hospital stay</p> Signup and view all the answers

    What is the outcome of using nutrition support therapy in patients with advanced cancer?

    <p>Rarely indicated and potentially detrimental</p> Signup and view all the answers

    What is the recommended dietary counseling for patients undergoing hematopoietic cell transplantation?

    <p>Avoiding high-risk foods during the period of neutropenia</p> Signup and view all the answers

    What is the rationale for providing dietary restrictions on high-risk foods during neutropenia?

    <p>To reduce the risk of infection</p> Signup and view all the answers

    What is the primary criterion for initiating nutrition support therapy in patients receiving active anticancer treatment?

    <p>Anticipated inability to ingest and/or absorb adequate nutrients for a prolonged period of time</p> Signup and view all the answers

    What is the impact of high dextrose PN on the incidence of GVHD?

    <p>It increases the incidence of GVHD</p> Signup and view all the answers

    What is the role of nutrition support therapy in patients with GVHD?

    <p>To improve nutrition status during GVHD</p> Signup and view all the answers

    What is the effect of GLN in PN on the length of hospital stay?

    <p>It has no effect on the length of hospital stay</p> Signup and view all the answers

    What is the benefit of GLN in PN according to a recent Cochrane review?

    <p>Fewer bloodstream infections</p> Signup and view all the answers

    What is the current limitation of providing parenteral GLN?

    <p>Lack of commercial availability of intravenous formulation</p> Signup and view all the answers

    What is the need for further research on dietary restrictions in neutropenic HCT patients?

    <p>To assess the impact of dietary restrictions on infectious risk</p> Signup and view all the answers

    What is the effect of PN on lean body mass?

    <p>Minimal</p> Signup and view all the answers

    What is the purpose of this paper?

    <p>To examine the literature and develop guidelines for NST in adult cancer patients</p> Signup and view all the answers

    What is a concern regarding the use of NST in cancer patients?

    <p>That it may stimulate tumor growth and metastasis</p> Signup and view all the answers

    What is the effect of EN on body composition?

    <p>It causes weight gain and improves nitrogen balance</p> Signup and view all the answers

    What is the effect of NST on nutrition indices in cancer patients?

    <p>It has a minimal effect</p> Signup and view all the answers

    What is the purpose of nutrition screening in patients with cancer?

    <p>To identify patients who require formal nutrition assessment</p> Signup and view all the answers

    What is the benefit of ω-3 fatty acid supplementation in cancer patients?

    <p>It helps stabilize weight</p> Signup and view all the answers

    What is the grade of recommendation for nutrition support therapy in patients undergoing major cancer operations?

    <p>A</p> Signup and view all the answers

    What is the purpose of perioperative nutrition support therapy in moderately or severely malnourished patients?

    <p>To reduce the risk of complications</p> Signup and view all the answers

    What is the recommendation for nutrition support therapy in malnourished patients undergoing hematopoietic cell transplantation?

    <p>It is recommended for malnourished patients</p> Signup and view all the answers

    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.

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