Cancer- Nutritional assessment and intervention

Question 1

nutritional assessment

Answer 1

weight loss , MM and strength, abnormal biochemical tests, subjective assessemt

Question 2

nutritional intervention

Answer 2

counselling, nutritional needs, promising therapy

Question 3

what aspects affect nutritional status

Answer 3

tumour, host response, anti-cancer treatment

Question 4

why assess?

Answer 4

early identification of patients at risk, improves patients well being, survival and immune function, improves response to treatment

Question 5

what is assessment

Answer 5

assessing body compartments and analysis the function of organs and metabolic effects : done through medical and dietary history, physical examination, anthropometric measurements, biochem tests, clinical symptoms

Question 6

%weight loss

Answer 6

U-Current/ usual

Question 7

what is most powerful independent variable that predicts mortality in CA - and clinical manifestation of Cancer cachexia

Answer 7

% weight loss

> 5% moderate
10% severe
15% very severe

Question 8

what do need to be careful to watch out for with % weight change

Answer 8

edema, ascites, pleural effusion - weight could actually be a lot less but if patient has these they will appear heavier bc of excess fluid load

Question 9

how to assess loss of muscle mass?

Answer 9

• MAMA
• creatinine/height index
• methH excretion
• DXA
• BIA
• CT scan
• muscle grip
• functional tests

Question 10

MAMA ! when?

Answer 10

<15th percentile for age and sex

Question 11

3-MH/creatinine ration

Answer 11

marker of myofibrillar protein degradation

Question 12

best functional tests

Answer 12

6 min walking test, gait speed

Question 13

what do you look at for biochem tests in cancer patients?

Answer 13

1. albumin
2. B12
3. Calcium
4. folate
5. glucose
6. hemoglobin
7. potassium
8. lymphocyte count

Question 14

albumin high

Answer 14

dehydration

Question 15

albumin low

Answer 15

inflammation, protein def, sepsis, hyper hydration (too much fluids)

Question 16

B12 high

Answer 16

leukaemia (blood cancer)

Question 17

B12 high

Answer 17

gastrectomy

Question 18

hg low

Answer 18

radio or chemo, blood losses, leukaemia, lymphoma, Hodgkin

Question 19

potassium values

Answer 19

low means Tx with cisplatin

Question 20

if results look whack what should you look at the interpret if dehydration screwed the results

Answer 20

• if blood values have high concentrations of electrolytes, BUN, creatine, CBC: hematocrit indicates dehydration
• or look at clinical signs- low BP, rapid HR, dry skin, dry mouth and lips, confusion, thirst

Question 21

how to measure inflammation

Answer 21

CRP and albumin and utilize glasgo prognosis score

Question 22

what does Glasgow prognostic score tell you

Answer 22

about cachexia - it is a measure of CRP and albumin –> pre cachexia would be high CRP and normal albumin, or refractory cachexia would be Hugh CRP and low albumin

Question 23

possible nutritional diagnoses after nutrition assessment has taken place

Answer 23

1. involuntary weight loss
2. malnutrition
3. dehydration

Question 24

nutrition intervention

Answer 24

1. preventative
2. adjuvant
3. palliative

Question 25

nutritional needs: ESPEN guidelines

Answer 25

1. energy - 25-30 kcal/kg/d 2. protein - 1.0-1.5 (moderate exercise) or 1.2-2.0 (bed ridden) 3. micronutrients 4 consider efficiency of feeding 5. assess/ communicate about potentially harmful diets (keto, fasting)

Question 26

parenteral is not recommended for??

Answer 26

advanced cancer patients receiving chemo

Question 27

what are some common complications with hematopoietic stem cell transplantation

Answer 27

infection- immunosuppression, symptoms of toxicity, graft-vs-host defence - skin rash, liver disfunction, GI problems

Question 28

nutrition approach for hematopoietic cell transplant

Answer 28

avoid foods that have increased risk of infection ( and safe handling procedure) - may have to use parental feeding for patients that develop GVHD or cannot ingest and absorb food for a long time

Question 29

nutrition approach for hematopoietic cell transplant

Answer 29

avoid foods that have increased risk of infection ( and safe handling procedure) - may have to use parental feeding for patients that develop GVHD or cannot ingest and absorb food for a long time

Question 30

promising nutritional therapies for cachexia

Answer 30

omega-3 --> anti-inflammation, reduce chemotoxicity in animal models, improve appetite, body weight and body comp in weight losing cachexia patients -amino acids- anabolic response- leucine stimulates protein synth adninsulin secretion, glut and arginine increases immune competence, help wound heali

Question 31

how to ease symptoms of N/V

Answer 31

antiemetics- 30-45 mins before eating, cook in microwave, marihuana, avoid frying food, tell fam members to avoid perfumes, - eat small, low fat meals - avoid greasy, fried and favourite foods, - could do clear liquid for first 24 h - non-acidic fruit drinks - electrolyte drinks - prokinetics may be prescribed

Question 32

how to ease early satiety

Answer 32

- eat small, frequent meals that are nutrient dense - beverages that contain nutrients should be consumed between meals and not at meals so as not to add to the feeling of fullness - no high fiber or raw veg - prokinestics - meds that increase gastric emptying can be used--> Side effect = diarrhea

Question 33

how to ease mucositis (stomatitis- irritation and inflam of epithelial cells of the muscular membrane and lining of the gastrointestinal tract- any point from mouth to anus)

Answer 33

this is the main source of cancer treatment pain - 40-70% patients suffer from this - related to direct and indirect cytotoxicity - chemo induced occurs 5-7 days after chemo - to ease: zinc supplements to ease pain, narcotic analgesics, topical therapies - eat soft and non-fibrous foods, non-acidic foods, no hot foods, encourage liquids, high protein nd high energy dense milk shakes

Question 34

symptoms of mucositis

Answer 34

pain and burning when swallowing - if severe- patient won't eat of drink -

Question 35

what's important for patients with mucositis

Answer 35

good oral hygiene- to prevent infection

Question 36

what foods to give to patient with mucositis

Answer 36

high-pro, high energy dense milk shakes, soft, non-acidic, lots of water/liquids, non-fibrous foods, pureed foods

Question 37

how to ease diarrhea symptoms in Ca patients

Answer 37

drink small amounts of fluid frequently, limit excess fructose ( limit fruit juices), rehydration drinks, anti-diarrhea agents, high fiber intake (soluble)

Question 38

how to ease Dysgeusia- alteration in taste- (meats have a bitter taste, morning coffee tastes weird)

Answer 38

profound impact on ability to eat adequate food - could be metallic taste, no taste, heightening of certain tastes, aversions to foods - metallic taste- don't use metal utensils - stop eating meat- need to watch protein intake - usually can't tolerate sweets

Question 39

how to ease Xerostomia (reduced saliva production)

Answer 39

- common in head and neck radiation or chemo - or from CVHD, dehydration or medications - treatment: artificial saliva, mouth moisturizers, - sugar free gum and sour flavoured candies may help produce saliva -

Question 40

how to ease the symptoms of Anorexia

Answer 40

50% prevelance - omega-3 - exercise - eat smaller more frequent meals - max your intake when appetite is most normal - limit fluid intake with meals - glass of wine before meal may help stimulate appetite - ventilate eating area - pharmacologic interventions (corticosteroids and megestrol acetate

Question 41

hematopoietic stem cell transplantation

Answer 41

bone marrow transplant | -

Question 42

what is conditioning phase?

Answer 42

remove stem cells from bone marrow - high does chemo or total body radiation to 1) immunosupress the body so as not to react to transplant and 2) kill malignant cells

Question 43

side effects of HSCT

Answer 43

high rate of infection and GVHD

Question 44

long term complications of GVHD (more common in allogeneic HSCT)

Answer 44

growth retardation, infertility, endocrine failure, osteopenia, delayed gastric emptying

Question 45

when is parental nutrition recommended for head and neck patients:

Answer 45

- 5% weight loss over last month or10% in 6 months - ongoing dehydration, dysphagia, anorexia or pain - severe aspiration

Question 46

nutritional support for HSCT

Answer 46

-enerteral for patients with functioning GI -parental only in severe cases -parental glutamine may be beneficial -deitary counselling for food that have low infection risk -