Nutrition Intervention in Childhood Cancer PDF

Nutrition Intervention in Childhood Cancer NUTR470 CHAPTER 6: Learning Objectives Students will understand the clinical presentation and dietary treatment options for pediatrics. Students will understand the main risk factors of developing cancer among pediatrics. Student...

Nutrition Intervention in Childhood Cancer NUTR470 CHAPTER 6: Learning Objectives Students will understand the clinical presentation and dietary treatment options for pediatrics. Students will understand the main risk factors of developing cancer among pediatrics. Students will understand the late complications that are particularly important in children.  Definition Disorder of cell growth and regulation. No limits for cellular replication Cancer Production of cells that Fridsittmainly serve no purpose Leukemia Epidemiology diet is notinitiato 2nd leading cause of of cancertheyare promoters mortality IFrenf.EE themselves ntsbEhfIffseffiem  they can also suppress immunitydueto chemo thereforetheywill be infectedalot Cancer malnutrition Abnormal cell division and reproduction that can spread throughout the body called metastasis Three stages Initiation Promotion Tumor progression, including metastasis cured extend life cancome ba Response to treatment is complete, partial, stable, or progressive there butwont spreading spread 4  encapsulated wontspreadtheyhave boundriel not capsulated can spread  Introduction In United States 10,400 children under 15 diagnosed with cancer in 2007. Overall cure rate for childhood cancer now exceeds 70%. Major attention being placed on reducing the side effects of therapy. (American Cancer Society 2007) Introduction Studies suggest up to 46% of children with cancer experience malnutrition Malnutrition: characterized by deficiency or excess of energy with measurable adverse effects on clinical outcome Energy key component of malnutrition, but vitamin & mineral deficiencies also greatly contribute advised togiveenergy restriction ketogenic diet Children particularly vulnerable  Age: The risk of cancer increases with age. nactivity BMI Many types of cancer are more common in So BC esp older adults. postmenoposal Family History: If close family members (such as Also GITcareer parents or siblings) have had cancer, you may be at higher risk. Risk Genetics: Inherited gene mutations can increase the risk of certain types of cancer, like breast, Factors ovarian, or colon cancer. Tobacco Use: Smoking and using other forms of tobacco is a leading cause of cancer, including lung, mouth, and throat cancers. Diet and Nutrition: Poor diet and obesity are associated with an increased risk of various types of cancer.  Physical Inactivity: Lack of physical activity and a sedentary lifestyle can contribute to cancer risk. Exposure to Carcinogens: Occupational exposure to certain chemicals and substances, as well as environmental pollutants, can increase the risk of cancer. Risk Sun Exposure: Overexposure to ultraviolet (UV) Factors radiation from the sun or tanning beds can lead to skin cancer. Chronic Infections: Infections like HPV (human papillomavirus), hepatitis B and C, and HIV can increase the risk of certain cancers. Alcohol Consumption: Heavy alcohol use is linked to an increased risk of several types of cancer.  Carcinogenesis Carcinogens Etiology: Role of Chemicals, physical agents, radiation, Genetics and infectious microorganisms Genetics Nutrition carcinogens Damage to gene d/t exposure to chemicals, physical agents, viral agents and bacterial agents Etiology: Role of Genetics and Nutrition Nutritional Factors Antioxidants notused tothe Soy ifthehtgends.is pltiodeaitgeincgsEau Ilmenite I Protein plant animal Dietary fat more oxidation means freeradicals mono ore means say Calories Antioxidants Alcohol Kleintin Fat Phytochemicals Giffienast  redmeat Etiology: Role of Genetics and Fasterits Yettamethod Nutrition obesity Epidemiological research suggested links Red meats iftheyhavepesticides Fruits and vegetables Whole grains, fiber, vitamin D coz it usuallyregulate cell growth Saturated fat, trans fat Physical activity increase GI Obesity motility Food preparation methods frying 0 acrylamide carcinogenic grilling Boiling at temp time cuz it will breakdown very nutrients  Pathophysiology Brief Overview of Normal Cell Growth Cells that reproduce copy DNA and then split into 2 new cells, constantly regenerating Cycling cells (Blood Cells)changeeveryperiod Non-dividing cells (myocytes, adipocytes, adipocytes, skin cells and neurons, are in the non-dividing state, i.e. terminally- differentiated). Resting cells (cells in resting stage is part of the natural life-cycle of the organism). grow stop thengrow again  Cancer Cell Growth Cancer cells reproduce at an uncontrolled rate, theydont n tonormalsignals respond becomes autonomous from normal signals, and may secrete their own growth factor. An enzyme is secreted leading to loss of cell’s internal clock.not stop at specifictimes theycontinuegrowing Physical characteristics of cell are altered.  Tumor Suppressor Proteins and Oncogenes Healthy normal can fightcan Tonormallythey protect faster requires 2 o mutations 0  Medical Diagnosis Biochemical – detect biomarkers Tumor imaging techniques- MRI, CT, ultrasound, PET, mammogram, bone scans etc Invasive techniques- biopsy, cytologic aspiration, laparoscopy. Tumor classified according to “stage”. Tumor classification Y Nutritional Manifestations Cancer Cachexia Generalized weakness, fever, wasting, anorexia, pallor. Metabolic alterations attributable to increased levels of CRP, fibrinogen, WBC, pro-inflammatory cytokines. Tumor specific “cachectic factors”(include various proteins, cytokines, and other molecules that are secreted or overexpressed by cancer cells. These factors can have several effects on the body, leading to the wasting of muscle and fat tissue, as well as other metabolic disruptions). 3 phases  worsethanothers egGCisworsethanBC disgeusia akenotes Iamation Da mouth paralysis tumornarrowinglumene.gGitlung etc useespglucose in amounts problemwith sphifery.gg production metabolism  or o o o anemiaprofile at least monthly 0 not useful  How To Assess Nutritional Status No consensus on how to define malnutrition Most common practices plotting weight-height ratios Z-scores: more than 2 standard deviations below mean Other practices include: Voluntary food intake less than 70% of estimated requirements Adipose energy reserves (triceps skinfold thickness) less < 5th percentile (Andrassy & Chwals, 1998)  How To Assess Nutritional Status http://www.medscape.org  How To Assess Nutritional Status considered as naked http://www.ltcconline.net/greenl/courses/201/probdist/zScore.htm  assessment formto quickly patientgenerated identifychildrenatrisk ofmalnutrition apply properinterventionearly notvalidatedyet Nutritional Manifestations Cancer Abnormalities in Carbohydrate, Protein, and Lipid Metabolism Insulin resistance, increased glucose synthesis, gluconeogenesis, increased Cori cycle activity,GenerateGlufro decreased glucose tolerance and turnover Depletion of lean body mass d/t protein catabolism and decreased protein synthesis Increased lipid metabolism, decreased lipogenesis, decreased LPL hypermetabolism Treatment: Focus on Nutritional Concerns Chemotherapy Radiation Surgery leavepttoche.in peace Dependent on location & size of tumor and health of individual Treatment: Focus on Nutritional Concerns Chemotherapy Common side effects due to toxicity of rapidly dividing cells: low Neutropenia neutrophils min Thrombocytopenia thrombus for blood clotting Anemia, and Diarrhea Mucositis, and Alopecia hair loss Kills rapidly dividing cells, including epithelial cells in digestive tract Unable to absorb nutrients ototoxicity, neurotoxicity, nephrotoxicity. Cachexia: wasting syndrome Loss of weight and atrophy of muscle, resulting in intense fatigue, weakness Treatment: Focus on Nutritional Concerns Radiation Delayed wound healing swallowdifficulty mucusinflamation fastaltered drymouth Fatigue, mucositis, dysguesia, xerostomia, dysphagia, swallowing pain odynophagia, severe esophgitis, dehydration (head and neck) mainlyhead mouth on LSI enterocyteinflamation 8f.SI openings duefoarraklhm smystances Radiation enteritis, fistulas, strictures, chronic malabsorption, severe diarrhea (abdominal, pelvic) TPN may be warranted to prevent weight loss and correct electrolytes Treatment: Focus on Nutritional Concerns Other Therapies Biological Response Modifiers Immunotherapy or biological response modifiers – use body’s own immune system to eradicate cancer cells Synthesized interferons, interleukins, cytokines Side effects: bone pain, fatigue, fever, anorexia, rashes, flu-like symptoms Gene therapy in clinical trials make pt unabletoswallow Nutrition Therapy Nutrition Assessment Determining Nutrient Requirements Energy needs equations Calculate protein needs based on body weight Consider dehydration Vitamins and minerals Healthy foods: low in fat and sugar Nutrition Diagnosis  Nutritional Needs of Children Children receiving cancer treatment Increased calorie needs due to raised metabolic rate Increased protein needs to prevent wasting knowifenough by 2g/ per kg of body weight per day not more coz we will have over ingNbalance feeding burden on all Adequate Calcium and Vitamin D intake essential organs More than 1,000 mg calcium More then 10 mg vitamin D Promote proper bone growth (Shawn and Lawson 2007)  What Causes Malnutrition During Childhood Cancer One overall common reason – an inability to consume or digest food and nutrients Side effects of chemotherapy and other aggressive treatments Increased metabolic demands of the cancer The Type & Stage of Cancer The type of cancer also affects nutritional status of child when based on type, stage, and metastatic status of disease rest if localized startwithradio the give some radio incase to kill chemo if metastasis (Bauer et al 2011) Side Effects of Malnutrition During Cancer Increased treatment time Decreased quality of life after survival Children Greater chance of becoming underweight or overweight adults bcuz of taking cortisol  Side Effects of Malnutrition During Cancer Increased Treatment Time Malnutrition reduces effectiveness of chemotherapy o Increases length of time children must spend in hospital Malnutrition also increases likelihood of developing infection (Bauer et al 2011)  Side Effects of Malnutrition During Cancer Decreased Quality of Life After Survival Lower chances of patients’ survival post-treatment “Undernourishment has significant role in survival rate especially in children with solid tumors and metastatic frombirthday diseases…” Leukemiachildrenhave bettersurvivalthanadults (Bauer et al 2011)  Side Effects of Malnutrition During Cancer Becoming Underweight or Overweight Specific cancer types more likely to cause a child to become underweight or overweight later in life if experience malnutrition during treatment. (Bauer et al 2011) Side Effects of Malnutrition During Cancer Becoming Underweight or Overweight p Underweight: Soft tissue sarcoma, neruoblastoma, non-Hodgkin’s lymphoma, brain tumors, male leukemia patients, non-amputated females with bone cancer, Wilms tumors, survivors of Hodgkin’s disease. Overweight: Acute lymphoblastic leukemia and those receiving cranial radiation therapy for brain tumors. Possible Reasons total body radiation, abdominal radiation, very young age, use of anthracyclines or actinomycincauseunderwt (Bauer et al 2011)  Side Effects of Malnutrition During Cancer through all consequences not all ptswill go Short-Term Consequences Long-Term Consequences Wasting of muscle and fat mass Growth impairment, reduced final height Decreased tolerance of chemotherapy/ Decreased long-term survival Increased treatment time Treatment delays Retardation of skeletal muscles Fatigue Risk for secondary cancers Drug dose alteration Abnormal bone mineral density Greater levels of psychological distress Decreased quality of life Higher susceptibility to infections (Bauer et al 2011) Nutritional Intervention – During Therapy Supplemental (oral feeding) Best when patient has reduced oral intake but no change in nutritional status Be flexible! Studies show flexible menu choice and meal times increase children’s food, protein, and energy intake (Houlston et al., 2009) Enteral (tube feed) Best when child’s gut still functioning Parenteral (intravenously) waitfor5digit c PNhasmany complications its expensive Used if child has gut dysfunction >5 days (Houlston et al., 2009)  Chemopts shoulddrink watercuz cancause chemotoaffect offhydration nausea withnotfood coldfood nosmell nonausea if mouthnotused candidafungi willgrow causeulcers  water NatK Glusometimes Breadvia make sweets osmolarityinstomach absorb morediarrhea if diarrhea putyogurtinstead of milk caseinpartially hydrated Tamountsofneutrophillsh meansimmune systemis compromised so we give nutropenia diet cuzthey wont be able to tolerate lukemia acute m anypathogenseventhe beneficial ones mainlyapples bananas energyfor enterocytes involved in cellproliferation immunity Take Home Points Malnutrition results from chemotherapy and other aggressive treatments & increased metabolic rates due to type of cancer Main side-effects of malnutrition include: increased treatment time decreased quality of life after survival greater chance of becoming underweight or overweight Parenteral nutrition best used when child malnourished After therapy, folate, calcium, and iron most problematic nutrients