Cancer Medical Nutrition Therapy PDF

MEDICAL NUTRITION THERAPY FOR CANCER 1 NUT 422 Dr. Lama Mattar   According to estimates from the International Agency for Research on Cancer (IARC), in 2018 there...

MEDICAL NUTRITION THERAPY FOR CANCER 1 NUT 422 Dr. Lama Mattar   According to estimates from the International Agency for Research on Cancer (IARC), in 2018 there were 17.0 million new cancer cases INTRODUCTIO and 9.5 N million cancer deaths worldwide  1/3 of cancer deaths each year can be contributed to nutrition and lifestyle behaviors. 2 https://www.who.int/news-room/fact-sheets/detail/cancer  3 Shamseddine et al. 2014. Cancer Trends in Lebanon & Projections to 2020 CARCINOGENESIS Biologic multistage process that proceeds on a continuum.  Initiation: ◦ Transformation of the cell produced by interaction of chemicals, radiation or viruses with DNA  occurs rapidly. ◦ Resultant cell remains dormant for a variable period.  Promotion: ◦ Initiated cells multiply  neoplasm established.  Progression: ◦ Tumor cells aggregate and grow  fully malignant tumor with capacity for tissue invasion. ◦ Metastasis  spreading to distant tissues and organs.  There are also benign tumors. 4 CLASSIFICATION OF CANCER  Histology:  Carcinoma: cancer of the internal or external lining of the body: malignant neoplasm of the epithelial origin.  Sarcoma: it is the cancer originating in supportive and connective tissues such as bones, tendons, cartilage, muscle, and fat.  Grading:  It is used after identification of the cancer and its progression (from biopsy). Grade 1 Cells slightly abnormal and well differentiated Grade 2 Cells more abnormal and 5 moderately differentiated Grade 3 Cells very abnormal and poorly differentiated Grade 4 Cells immature and undifferentiated CLASSIFICATION OF CANCER Staging: It is the classification of the extent of the disease. Stage 0 Cancer in situ (limited to surface cells) Stage I Cancer limited to the tissue of origin, evidence of tumor growth Stage II Limited local spread of cancerous cells Stage III Extensive local and regional spread Stage IV Distant metastasis 6  Obesity and cancer Obesity increases the risk of cancer and its recurrence: NUTRITION IN  Colon, breast and prostate cancers. Physical activity reduces the risk of THE cancer. ETIOLOGY OF Excess body weight  increased amount CANCER of estrogens, androgens, insulin and insulin-like growth factors  cell and tumor growth. Regular PA helps to reduce body weight. 7  Food preservation can enhance carcinogens  N-nitrosocompounds NOC known as nitrosamines: ◦ Formed in smoked, salted and pickled foods cured with nitrates and nitrites. METHODS OF  Nitrates reduced to nitrites and then interact with dietary amines and FOOD amides to produce NOCs  N- nitrosation. ◦ Give hot dogs and luncheon meats their PRESERVATIO pink color. ◦ Also found in vegetables and drinking N water.  Acrylamide: ◦ Byproduct formed during frying, roasting and baking at very high temperatures. ◦ May be a carcinogen. 8  Calcium and Vitamin D Coffee and tea (green has more catechins than black tea: better) Folate and Folic Acid – affects DNA synthesis and repair NUTRIENTS Fruits and vegetables – especially non- FOR CANCER starchy vegetables – protective mostly against mouth, pharynx, larynx, esophagal PREVENTION and stomach cancers Soy and phytoestrogens – protective against breast and prostate cancer but should not be consumed in women already diagnosed with a hormone-sensitive cancer 1. Choose a diet rich in a variety of plant-based foods. 9 2. Eat plenty of vegetables and fruits. 3. Maintain a healthy weight and be physically active. 4. Drink alcohol only in moderation, if at all. 5. Select foods low in fat and salt. 6. Prepare and store food safely. 7. And always remember... Do not use tobacco in any form. NUTRITIONAL IMPLICATIONS OF CANCER: ADVERSE NUTRITIONAL EFFECTS  Effects of the treatment regimen AND  Psychological impact of cancer  Result is often weight loss, anorexia and depleted nutrient stores.  Even small amounts of weight loss (5% in 1m >7.5% in 3m >10% in 6m 1 7 1 8  Energy: Indirect calorimetry  best Equations: Mifflin-St. Jeor H&B Stress factors from 1.1-1.6 NUTRITIONAL Protein: REQUIREMEN Extra needed to rebuild tissues affected by cancer therapy and to maintain a healthy immune system. TS Adequate energy should be provided in order for body to most effectively use protein. Mild stress: 1-1.2g/kg Hypercatabolic: 1.2-1.6g/kg Severely stressed: 1.5-2.5g/kg 19 CANCER TREATMENT AND NUTRITIONAL IMPLICATIONS: CANCER TREATMENT  Cure  Control  Palliate  Chemotherapy  Immunotherapy  Radiation therapy  Surgery  Steroid therapy  Hematopoietic Stem Cell Transplantation HSCT 20  Chemotherapy Immunotherapy  Use of chemical agents or Use of biologic response medications to treat cancer. modifiers as cytotoxic  Systemic therapy affecting the agents or stimulators of whole body: individual’s own natural defenses:  Target is malignant tissue Natural products but it affects normal cells too. made in quantities  Cells with rapid turnover  through cloning and genetic engineering. bone marrow, hair follicles, mucosa of GI α-interferon tract. Interleukin-2  Dietary intake and nutrition status can be adversely Side effects: fatigue, affected. chills, fever, flulike symptoms and decreased food intake. 2 1 Radiation therapy Surgery  Use of high-energy rays in Additional energy and multiple fractionated doses. protein requirements for wound healing and recovery.  Delivered externally. Nutritional effects depend on  Affects only tumor and site of surgery: Head and neck  impaired surrounding area. mastication and swallowing  Side effects depend on area Resection of parts of being treated. intestinal tract  impaired absorption  Nutritional implications are Resection of esophagus  mainly in region: impaired feeding route Resection of pancreatic  Head and neck cancer (Whipple’s  Thorax procedure)  malabsorption and diabetes  Abdomen and pelvis 2 2 COMMON SIDE EFFECTS Constipation Diarrhea Taste & smell alterations Nausea & vomiting Xerostomia Mucositis & stomatitis Dysphagia/ odynophagia Neutropenia 23  It affects approximately 10% of patients with advanced cancer (Engelking 2000) and as many as 90% (Arbuckle 2000) of certain populations of patients at some point during the disease trajectory of cancer. It can have a significant impact on DIARRHEA patient’s functional capacity and nutritional status. Assessment of severity of diarrhea. Nutritional history to see what foods are associated with diarrhea. 24 DIARRHEA Nutrition intervention: Restore normal fluid, electrolyte, and acid-base balance: Use of oral rehydration solutions IV hydration Decrease gastrointestinal motility Avoid clear liquids and other foods high in simple carbohydrates (eg, lactose, sucrose, or fructose) and sugar alcohols (sorbitol, xylitol, or mannitol) Avoid caffeine-containing products Avoid alcoholic beverages Avoid high-fiber and gas-producing foods such as nuts, beans, corn, broccoli, cauliflower, or cabbage. Stimulate the gastrointestinal tract by slow introduction of solid food without exacerbation of symptoms Low-fiber, low-fat, lactose-free nutrition therapy should guide initial food selections. Thicken consistency of the stool: Add soluble fibers such as banana flakes, apple powder, or other pectin sources Repopulate gastrointestinal tract with normal flora: 2 Probiotic and prebiotic supplementation Glutamine 5  75% of patients rank nausea as their most problematic symptom with 40% experiencing vomiting after chemotherapy despite administration of NAUSEA & antiemetic regimens (Morrow, 1998). VOMITING Nausea Vomiting Retching 26  Patterns of chemotherapy-induced nausea and vomiting: Acute: within the first 24 hours after receiving chemotherapy Delayed: occurring more than 24 hours after chemotherapy and can continue for up NAUSEA & to 6 to 7 days. VOMITING Breakthrough: Occurs during a cycle of chemotherapy despite prophylaxis. Anticipatory: Learned response after at least one cycle of chemotherapy Prolonged or delayed nausea and vomiting prevent adequate intake and can result in weight loss and wasting. 27 NAUSEA & VOMITING Antiemetic medication as prescribed before meals to allow adequate time to provide effective relief. Nutrition management is Clear liquids for the first 24 to 48 hours with graduated progression in meal plan to solid supportive: food as long as vomiting is controlled. low-fat, non odorous foods are generally Food suggestions for recommended since they clear the gastrointestinal tract more quickly and nausea without vomiting: strong odors can stimulate the vomiting reflex. If patient is retching eating small amounts of dry foods frequently without vomiting: throughout the day. 28 TASTE & SMELL ALTERATIONS 75% of Taste Different Some report It may be patients alterations  terms: metallic due to Zn Hypogeusia  reporting changes in decreased taste taste. deficiency. alterations the usual sensitivity in taste patterns of Ageusia  absence (Bernhardso taste of taste sensation n 2008). perception Dysgeusia  that are distortion of Assess for to type, normal taste unique specific foods and the person duration. experiencing Assess for foods them: that patient prefers. 29 TASTE & SMELL ALTERATIONS If foods are too sweet, addition of sour sauces, lemon, or salt may decrease sweetness. Marinating meats in fruit juice or sweet wine may disguise bitter taste. If red meats are too bitter, try poultry, fish, or nonmeat sources of protein. Plastic utensils may be helpful for metallic taste in food. 3 0 MUCOSITIS & STOMATITIS Mucositis  inflammatory, erosive, and ulcerative lesions that develop in the mucous membranes from cytotoxic chemotherapeutic agents or radiation therapy. Mucosal tissue covers the entire area from the oral cavity to the anus Oral mucositis  involving the mouth and oropharyngeal cavity. Stomatitis  similar to mucositis but also includes inflammation of the periapsides and periodontium. Symptoms: dryness, hoarseness, ulcerative lesions, bleeding and pain. Use of analgesics. Appropriate mouth care  to decrease the likelihood of a secondary infection and to promote healing. 31  MUCOSITIS & STOMATITIS Nutrition intervention: Soft moist foods that aren’t dry, rough or course. Avoid irritants such as tobacco; alcohol; and spicy, coarse, or acidic foods such as tomatoes, oranges, and other citrus. Foods that are eaten cool or at room temperature may be better tolerated. Consumption of small, frequent meals with nutrient-dense foods. Use a straw to minimize fluid contact with affected surface area. Sucking on ice chips or popsicles numb the area. Nutrition supplements may be necessary to provide adequate nutrition. Honey has been shown to have potential in ameliorating the potential for severity of mucositis for patients undergoing radiation therapy. Patients were advised to take 20 mL pure honey 15 minutes before, 15 minutes after, and six hours postradiation therapy. 3 2 XEROSTOMIA Subjective sensation of dry mouth. Most common in head and neck radiation therapy  Irradiation of the salivary glandscan cause xerostomia with a decrease in salivary flow noted after only approximately 1 week of treatment. Treatment: Artificial saliva  moistens oral mucosa, facilitates speaking, chewing, and swallowing Available as sprays, lozenges, gels, and swabs Nutrition intervention: Increase fluid intake to facilitate ease of chewing and swallowing Limit sucrose-containing foods and carbohydrate foods that stick to teeth to decrease risk of caries Limit coffee, tea, and alcohol, as these may exert drying effect 33  Dysphagia  difficulty swallowing Odynophagia  pain while swallowing Delay in the passage of food or fluids from the mouth to the stomach. DYSPHAGIA/ Affects up to 25% of cancer patients (McDonnell 1999). ODYNOPHAGI Nutrition intervention: Monitor for adequacy of fluid as and A nutrient intake because eating plan may be restrictive. Enteral nutrition may be necessary to provide adequate supplementary nutrition. 34 NEUTROPENIA Absolute neutrophil count of