MNT for Cancer PDF

MNT for Cancer MNT for Cancer From: Krause and Mahan’s Food and the Nutrition Care Process Allison Charny, MS, RDN, CDCES, CDN Cancer ◼ 100 + variations of cancer (CA) ◼ # 2 killer in the US ◼ 1:2 M, 1:3 F Americans will get some type of CA ◼ Cancer deaths: 30 % connected to nutrition,...

MNT for Cancer MNT for Cancer From: Krause and Mahan’s Food and the Nutrition Care Process Allison Charny, MS, RDN, CDCES, CDN Cancer ◼ 100 + variations of cancer (CA) ◼ # 2 killer in the US ◼ 1:2 M, 1:3 F Americans will get some type of CA ◼ Cancer deaths: 30 % connected to nutrition, inactivity, overweight, alcohol. Another 30% connected to tobacco  Preventable  Supported by epidemiologic studies ◼ Survival rate up: ~ 67% Causes of Cancer Pathophysiology Treatment Nutrition and Cancer ◼ Nutrition may affect the development of cancer at any stage ◼ Nutrition may be affected by  cancer  treatment (radiation, chemotherapy, surgery)  current health and nutritional status of the pt Nutrition and the Etiology of Cancer ◼ Dietary carcinogens: naturally occurring and added in food preparation and preservation ◼ Inhibitors of carcinogenesis: antioxidants, phytochemicals ◼ Enhancers of carcinogenesis: fat, grilled meat Nutrition and the Etiology of Cancer: Energy, Weight and Physical Activity ◼ Energy restriction:  inhibits cancer and extends life span in animals ◼ Overweight:  connected to cancers of GI tract and organs, breast, endometrium, kidney, colon, rectum, others  increases risk of cancer recurrence and decreases survival ◼ Physical activity:  inversely associated with cancer Nutrition and the Etiology of Cancer: ◼ Alcohol: 1/day F; 2/day M ◼ Fat: obesity; ↓red meat, dairy; ↑omega 3s ◼ Carbohydrates: ↑fiber, ↓sugars, and ↓glycemic index ◼ Sweeteners: GRAS ◼ Protein: ↑ plant-based diet ↓meat ◼ Methods of food preparation and preservation: meat, at high heat; nitrates / nitrites ◼ Other toxins Nutrition and Cancer Prevention: ◼ Coffee and tea: may have CA preventive properties ◼ Calcium and Vitamin D: adequate levels linked to lower CA ◼ Soy / phytoestrogens: protect breast CA pre-adult; protect against prostate CA ◼ Folate: Higher may be linked to less pancreatic CA, but an increase in others ◼ Fruits and vegetables: 3+ serv veg, 2+ serv fruit / day ~ ½ c = 1 serv Veg and Fruit that Fight Cancer (& Others Table 35-3) Color Phytochemical Veg and Fruits Red Lycopene Tomatoes and tomato products, pink grapefruit, watermelon Red/purple Anthocyanins, Berries, grapes, red wine, polyphenols prunes Orange α-, β-carotene Carrots, mangoes, pumpkin Orange/yellow β-cryptoxanthin, Cantaloupe, peaches, flavonoids oranges, papaya, nectarines Yellow/green Lutein, zeaxanthin Spinach, avocado, honeydew, collard and turnip greens Green Sulforaphanes, indoles Cabbage, broccoli, Brussels sprouts, cauliflower White/green Allyl sulphides Leeks, onion, garlic ACS & AICR Guidelines for CA Prevention (Box 35-1) ACS AICR ◼ 1. Adopt physical activity ◼ 1.Normal body weight ◼ 2.Physically active ◼ 3.Limit energy dense food ◼ 2. Achieve / maintain ◼ 4.Eat mainly plant foods healthy weight ◼ 5.Limit meat; avoid processed meats ◼ 3. Variety of healthy ◼ 6.Limit alcohol colorful plant foods ◼ 7.Limit salt; avoid moldy cereals / legumes ◼ 8.Meet nutrient needs via diet ◼ 4. Limit alcohol ◼ 9.Breastfeeding encouraged ◼ 10. CA survivors: follow above Definitions, Dx, Staging ◼ Neoplasm, Benign, Malignant, Metastasis ◼ Classification of Cancers  Carcinoma – cancers of epithelial tissue  Sarcoma – muscle, bone, nerves, fat, blood vessels  Hematapoietic – blood, bone marrow, lymph  Cancers due to infection – cervical (HPV), stomach (H.Pylori), hapatic (HBV) ◼ Diagnosis: Symptoms, lab tests-blood, tissue, imaging studies ◼ Staging: I, II, III, IV; TNM Staging Medical Treatment ◼ Chemotherapy ◼ Immunotherapy or Biotherapy ◼ Hormone Therapy ◼ Antiangiogenic Therapy ◼ Radiation Therapy ◼ Surgery ◼ Hematopoietic Cell Transplant (HCT) Chemotherapy ◼ Use of drugs/chemicals to induce a toxic effect tumors  Antibiotics, alkaloids, alkylating agents, antimetabolites  Often several agents given in cycles ◼ Normal cells (“high turnover”) also affected ◼ Can depress immune function ◼ Nutrition Impact Symptoms: Table 35-8 Biotherapy / Immunotherapy ▪ Bio therapy drugs - Stimulate natural defenses (indirect) ▪ Cytokines, antibodies, vaccines ▪ Nutrition Impact: anorexia, N, V ▪ Hematopoietics - Stimulate marrow to produce red blood cells (i.e. Procrit) or neutrophils (i.e. Neulasta) ▪ Nutrition Impact: flu-like symptoms Angiogenic & Hormonal Therapies ◼ Anti-Angiogenic ◼ Hormonal  Reduces growth of  Reduces growth of new blood vessels hormone sensitive to prevent tumor breast or prostate invasion CA  Avastatin  Tamoxifen, Lupron Radiation Therapy ◼ Disrupts chemical bonds to form DNA; prevents tumor growth ◼ Effects of radiation is specific to the region being irradiated ◼ Normal cells affected also ◼ Can depress immune function ◼ Nutrition Impact Symptoms: Table 35-9 Oral Mucositis  Radiation Therapy: Nutrition Impact Table 35-9 ◼ CNS: N, V, fatigue, ↓appetite ◼ Head and neck: Xerostomia, sore mouth/throat, mucositis, dyspahgia, odynophagia, fatigue, ↓appetite ◼ Thorax: dyspahgia, odynophagia, heartburn, fatigue, ↓appetite ◼ Abdomen: changes in bowel (malabsorption) and urinary function, lactose intolerance, N, V, fatigue, ↓appetite Surgery: Nutrition Impact Table 35-10 ◼ Head and neck: N, V, chew/swallow difficulty, sore/dry mouth, change in taste/smell ability ◼ Esophageal: dysphagia, reflux ◼ Stomach: dumping syndrome ◼ Pancreatic: malabsorption, hyperglycemia ◼ Intestinal: malabsorption syndromes Bone Marrow Transplant (HCT) ◼ For malignancies related to:  Leukemia, lymphoma, aplastic anemia ◼ Replacement of Bone Marrow  from compatible donor or self - with tissue from hematopoietic stem cells (bone marrow)  to establish a graft and production of normal cellular components ◼ Preparation for infusion of bone marrow  Chemo tx  Sometimes total body irradiation ◼ to  immune reaction and  malignant cells ◼ Neutropenic precautions ◼ Side-effects: 2˚ chemo / radiation Medical Nutrition Therapy (MNT) for CA ◼ Goals  Prevent/correct nutritional deficiencies  Minimize loss of LBM / weight  Minimize nutrition side-effects of CA treatments  Increase quality of life ◼ Optimal nutritional status may help  reduce infection  tolerate therapy better Nutritional Care Process ADIME ◼ Screen for risk of nutrition problems  SGA, MST, MSTC, MUST ◼ Assessment of nutritional status  Hxs: med, social, diet: appetite, oral intake, vit/min supplements, nutrition impact symptoms, CIM  NFPE  Anthropometrics: maintain LBM, BMI  Labs ◼ Nutrition Dx: inadequate intake, malnutrition, altered GI function (see p 770) ◼ Intervention  Minimize effects of nutrition impact symptoms ◼ Monitoring & Evaluation Nutrient Needs Energy: Indirect calorimetry Standardized equations Repletion/ hypermetabolism: 25-35 kcal/kg/day (Table 35-5) Protein: Nonstressed cancer patient: 1 to 1.2 g/kg Hypercatabolic cancer patient: 1.2 or more g/kg Severely stressed cancer patient: 1.5 or more g/kg Hematopoietic stem cell transplant patient: ~1.5 g/kg Micronutrients: From food; MVI = 100% DRI if needed Fluid: 20-40 ml/kg or 1 ml/kcal Medical Nutrition Therapy Interventions: ◼ Effects on Appetite ◼ CA Cachexia ◼ Pharmacologic therapies for cachexia, anorexia ◼ Energy, Pro, Fat, CHO Metabolism ◼ Other Metabolic Abnormalities Depletion of Nutrient Stores Factors Affecting Appetite Depletion of Nutrient Stores CA Cachexia ◼ Cancer cachexia  Syndrome ◼ Wt loss ◼ Anorexia ◼ Asthenia ◼ Anemia ◼ Problems of pro, CHO, fat metabolism  Related to production of cytokines ◼ Increases energy expenditure Nutrition Interventions Table 35-6 Symptom Nutrition Intervention *sfm = small, frequent meals ◼ Nausea ◼ sfm, ↓high-fat, ↓food odors ◼ Vomiting ◼ Replace fluids / electrolytes ◼ Anorexia ◼ Sfm, ↑kcal/pro, app stim, NS ◼ Dysphagia, Odynophagia ◼ Soft, moist, ↓spicy acidic, temp, ↑kcal/pro ◼ Dysgeusia ◼ Fortify flavor, texture, appeal ◼ Xerostomia ◼ Moist, fluids, gum, mints, ice ◼ Diarrhea ◼ Low lactose, low-fat, ↑ soluble fiber ◼ Fatigue ◼ Easy-to-eat foods ◼ Neutropenia ◼ Avoid raw, uncooked foods Other Nutritional Interventions ◼ Medications: appetite stimulants, anti- emetics, anti-diarrhea, oral lidocaine, others ◼ Tube feeding  Choice of formula based on condition ◼ Parenteral nutrition  Functioning gut? ◼ Palliative care Complementary & Integrative Medicine (CIM) ◼ ~ 40-50% of CA patients use a form of CIM ◼ Supplements (most common CIM) ◼ Orthomolecular Medicine (correct imbalances / deficiencies)acupuncture, mind/body, massage ◼ Further study on efficacy of CIM needed ◼ National Center for Complementary and Integrative Health ◼ Natural Medicines Comprehensive Database