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14 Onco > Nutritional Management of CA Patients > Flashcards

Nutritional Management of CA Patients Flashcards

1
Q

patients with increased risk for malnutrition

A
  • smoking hx
  • low socioeconomic status
  • poor performance status
  • older age
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2
Q

t/f 20% of ca patients die because of malnutrition

A

true

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3
Q

top 5 nutrition impact symptoms across all cancers

A 
anorexia
dry mouth
nausea
smell intolerance
taste changes
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4
Q

severity of weight loss depends on ___

A

cancer type, cancer stage, type of surgeries and treatment being done to the patients

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5
Q

release of cytokines lead to __

A

hypermetabolism, anorexia, lean body mass loss, decreased adipose tissue

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6
Q

tumor related factors drive up proteolysis and lipid mobilization causing ___

A

losses in lean body mass and losses in adiposity

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7
Q

a complex metabolic syndrome associated with underlying illness characterized by muscle loss with or without fat loss

A

cachexia

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8
Q

prominent features of cachexia

A

adults: weight loss
children: growth failure

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9
Q

symptoms of cachexia

A

unintentional weight loss, anorexia, skeletal muscle wasting, lowered quality of life

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10
Q

t/f cancer cachexia always has fat mass loss

A

false, can be with or without this

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11
Q

t/f cancer cachexia cannot be fully reversed by conventional nutritional support

A

true

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12
Q

t/f cancer cachexia leads to progressive functional impairment

A

true

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13
Q

pathophysiology of cancer cachexia

A

negative protein energy balance driven by reduced food intake and abnormal metabolism

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14
Q

central pathophysiological problem in cancer cachexia

A
  • inflammation

- interaction of cytokines and hypothalamic systems interacting with hypothalamus (center for appetite)

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15
Q

in cancer cachexia, neurotransmitters ad proinflammatory cytokines interact with the brain resulting to ___

A
  • decrease in orexigenic signals (lower appetite stimulation)
  • increase in anorexigenic signals (lack of appetite goes up)
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16
Q

t/f anorexia is just reduced intake

A

false, the brain is not functioning well to tell the patient that they have to eat!!

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17
Q

treatable causes of weight loss

A

MEALS ON WHEELS

medications
emotional problems
anorexia
late-life paranoid
swallowing disorders

oral factors
no money

wandering (dementia)
hyperthyroidism
hyperparathyroidism
hypoadrenalism
enteric problems
eating problems (inability to feed self)
low salt, low cholesterol
stones, social problems
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18
Q

t/f involuntary weight loss combined with low muscle mass was more closely associated with poor quality of life than involuntary weight loss along in community dwelling oler adults

A

true

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19
Q

what is sarcopenia

A

muscle wasting

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20
Q

methods for assessing sarcopenia

A
  • muscle mass: calf circumference
  • muscle strength: handgrip strength, handshake test, handgrip dynamometer
  • performance: sppb, get up and go, 6 min walk
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21
Q

patient profile in precachexia

A
  • normal
  • weight loss is less/= 5%
  • some anorexia
  • some metabolic changes
22
Q

treatment for precachexia

A
  • monitor and prevention

- be aggressive and manage nutritional status

23
Q

patient profile in cachexia

A
  • weight loss >5% OR
  • bmi < 20 AND weight loss >2% OR
  • presence of sarcopenia and weight loss (>2%)
  • often with reduced food intake/ systemic inflammation
24
Q

treatment for cachexia

A

multimodal approach to reversible factors

25
Q

patient profile in refractory cachexia

A
  • variable degree of cachexia
  • cancer disease both pro-catabolic and no longer responsive to anticancer treatment
  • low performance score
  • <3 mos expected survival
26
Q

treatment for refractory cachexia

A
  • palliation and ethics

- patient is prepared for eventual death

27
Q

adverse effects of radiation therapy depends on

A
  • individual or host response
  • severity/dose of radiation
  • site of radiation administration
28
Q

most vulnerable sites to adverse effects of radiation and chemo therapy

A
  • skin
  • internal mucosa
  • immune system
29
Q

common effects of radiation therapy in h&n cancer

A
  • salivary glands dry up
  • oral mucositis
  • swallowing defects
  • esophagitis
30
Q

adverse effects of chemotherapy depend on ___

A
  • agent used
  • dose and route of administration
  • length of therapy
31
Q

common side effects of chemo

A
  • constipation, diarrhea, vomiting

- fatigue, pain

32
Q

surgical effects on gi function

A
  • tumor site
  • extent of resection
  • adjunctive therapies used
33
Q

espen guidelines on malnutrition in ca pts

A
  • screen them first and assess if there’s malnutrition
  • how aggressive is the malnutrition
  • where is the malnutrition coming from
34
Q

part one of the pg-sga (patient-generated subjective global assessment)

A

patient info

  • weight history
  • food intake
  • symptoms impairing food intake
  • activities and function
35
Q

part 2 of the pg-sga

A

healthcare professional scoring

  • quantifies, qualifies, and scores:
  • weight loss
  • disease and relation to nutritional demang
  • metabolic demand
  • nutrition focused PE
36
Q

t/f you can give the same amount of proteins to a ca patient and a normal pt

A

false, you must give at least more than 1 g/kg. give more than the rda

37
Q

t/f majority of ca patients can eat regular diets

A

true

38
Q

symptoms and factors affecting diminished nutrient intake

A

table 2

39
Q

one way to maximize oral feeding is with ___

A

oral nutritional supplements or foods for special medical purposes

40
Q

content of ons

A
  • carbohydrates (lactose free)
  • fats (essential fa or omega 3 fats)
  • proteins
  • fiber
  • water
41
Q

how to select ons

A

acceptable, available, affordable

42
Q

t/f we must exhaust all tehcniques and methods of oral feeding before considering tube feeding

A

true

43
Q

purpose of neutropenic diets

A

to avoid food more likely to contain infection causing bacteria

44
Q

indications of neutropenic diets

A
  • allogeneic transplants
  • autologous transplant (until 3 mos after)
  • chemo/radio

(chemo pts and bone marrow transplant pts who are extremely immunocompromised)

45
Q

t/f there is sufficient evidence to keep allogeneic transplant patients on the neutropenic diet for 30 days

A

false

46
Q

a more practical guide to the neutropenic diet

A
  • keep food clean
  • proper hand hygiene
  • avoid cross contamination
  • cook the food to proper temp
  • refrigerate properly
47
Q

usual diet vs ketogenic diet

A

usual: 50-55% carbs, 15-20% protein, 25-30% fat
ketogenic: 70-90% fat, 8-10% protein, 2-5% carbs

48
Q

potential risks of ketogenic diet

A
  • inducing weight loss = NO NO!

- acute and chronic effects

49
Q

how to stratify patients in palliative care

A

life expectancy

50
Q

considerations for patients with life expectancy of >3 mos to years

A

improve nutritional status!!

  • treat reversible cause of anorexia
  • note goals of care:
  • weight stabilization or gain
  • improve symptoms that interfere with intake
  • improved energy
  • resolution of metabolic and endo abnormalities
51
Q

considerations for patients with life expectancy of < 3 mos to weeks

A
  • quality of life and wishes of family
  • goals of care: read
  • nutrition support may not change outcomes, but lessen distress

14 Onco (27 decks)

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