Nutrition in cancer

Question 1

Considerations in managing a cancer patient

Answer 1

• Type/ Site of cancer
• Stage of cancer
• Multi-modality treatment i.e. chemotherapy, radiotherapy, surgery &
  biological therapies
• Side effects of treatment & disease
• Co-morbidities
• Age of patient
• Social circumstances i.e. alcohol / drug & nicotine dependency
• Cachexia syndrome

Question 2

Weight loss and cancer survival connection

Answer 2

Diminished survival rate when cancer patients lose weight
due to decreased response to treatment but all treatments have weight loss as a side effect

Question 3

Factors that contribute to the
development malnutrition in the cancer
patient

Answer 3

1. Alterations in physiology
   - malabsorption/maldigestion due to tumour or to therapy
   - constipation/gastrointestinal dysmotility
2. Insufficient dietary intake
    Suppression of appetite
    Cytokines
    Depression
    Loss of taste

3.Physical impairment of swallowing
 effects on chewing or swallowing mechanisms
 reduction in saliva production –xerostomia
 radiation- or chemotherapy-induced mucositis
 surgical interruption of swallowing mechanism

Question 4

What is Cancer Cachexia

Answer 4

• Extreme on the continuum of weight loss and anorexia
• Seen in cancer, cardiac disease & chronic infection
• Due to a systemic inflammatory response
• Mediated through cytokines

Question 5

Mechanisms and clinical outcomes of cancer cachexia

Draw the flowchart

Answer 5

Lecture Slide

Question 6

Starvation vs Cachexia

Table
- Acute phase reaction
-adipose tissue
-Appetite
- Glucose intolerance
- Insulin levels
-Liver size
-Resting energy expenditure
- Skeletal muscle

Answer 6

Starvation
- Acute phase reaction: No
-adipose tissue: Decreased
-Appetite Increased
- Glucose intolerance No
- Insulin levels Decreased
-Liver size Decreased
-Resting energy expenditure Decreased
- Skeletal muscle: maintained initially

Cachexia
- Acute phase reaction Yes
-adipose tissue Decreased
-Appetite Decreased
- Glucose intolerance Yes
- Insulin levels Increased
-Liver size Increased
-Resting energy expenditure: Increased
- Skeletal muscle: Decreased

Question 7

Negative nitrogen balance diagram

Answer 7

Lecture Slide

Question 8

Criteria for classifying stage of cachexia
1. Precachexia
2. Cachexia
3. Refactory Cachexia

Criteria and Goal

Answer 8

Pre-cachexia:
Weight loss ≤ 5% over six-months & anorexia,
inflammation and/or metabolic changes, e.g.
impaired glucose tolerance

Goal: Preserve muscle mass

Cachexia
Weight loss > 5%, or ≥ 2% in patients already showing
depletion in skeletal muscle mass or BMI ≤ 20 kg/m2

Goal: Reduce rate of muscle mass loss

Refractory cachexia (usually
anorexia- cachexia syndrome)
Variable degree of cachexia where there is no
response to cancer treatment, life expectancy less
than three months and a low Performance Status
score

Goal: Maintain quality of life, symptom
palliation and control

Question 9

Cancer - Aims of Nutritional Support

Answer 9

Improve the
subjective quality
of life (QoL)

Enhance anti-
tumour treatment
effects

Reduce the
adverse effects of
anti-tumour
therapies

Prevent & treat
under nutrition

Question 10

Nutrition Therapy:
What does it involve

Answer 10

• Supplemental feeding
• Support/Advice
• Pharmacological agents to combat anorexia, wasting
  and nausea
• Nutraceutical agents to enhance immunity & and
  anabolism