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NUTR 424 Cancer > Nutritional Assessment (Week 2 Lecture 2) > Flashcards

Nutritional Assessment (Week 2 Lecture 2) Flashcards

1
Q

prevalence of weight loss patterns in different cancers

A

lecture said GI cancers and lung?

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2
Q

Causes of POOR nutritional STATUS in patients WITH CANCER

A

Half of patients have some nutritional issues prior to diagnosis
* Decreased dietary intake
* Increased nutrient requirements
* Increased losses of nutrients
* Impaired nutrient digestion/ absorption (especially GI tract)

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3
Q

Poor nutritional status and weight loss prevalence

A

common in the oncology patients
* Oncology patients are among the most malnourished of all patient groups → In a classic paper by Dewys (1980) malnutrition ranged from 31% to 87% (40 years later no change)
* 40% of hospitalized oncology patients are malnourished
* Depending on tumour type, 32-88% of patients are at risk of malnutrition4,5,6,7
* 35-75% of lung cancer patients report unintentional weight loss prior to diagnosis

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4
Q

Experience of weight loss with diagnosis, anti-cancer treatment and cachexia

A
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5
Q

Why might patients experience weight loss prior to diagnosis?

A
  • They probably have other comorbidities such as diabetes or heart disease
  • More overweight or obese than general population and may be malnourished
  • Sudden stress or anxiety
  • Late stage of cancer, untreated
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6
Q

What does weight loss in cancer primarly consist of?

A

Skeletal muscle mass - will have reduced function and cannot respond as well to treatment and may not get treatment they need, will have more toxicities
* cachexia

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7
Q

cachexia in cancer

A

defined as a “multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support, and leads to progressive functional impairment

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8
Q

What should assessment tools consider in nutritional assessments?

A
  • Easy to use clinically - inexpensive, yes/no
  • Rapid classification
  • Captures all patients who require further nutritional support
  • Validated in the population of interest
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9
Q

What are the similarities and differences between MNA and PG-SGA?

A
  • similar: has subjective questions about food intake, weight change, physical activities
  • Different: SGA assess weight loss more strictly
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10
Q

Screening for nutritional status

A
  • Energy Intake
  • Biochemistries/biological measures
  • Symptom assessment (i.e. ESAS) - Edmonton Systems Assessment Survey
  • Functional status (i.e. FAACT) - Functional Assessment of Anorexia Chacexia Therapy
  • Measures of immunity and/or inflammation
  • Anthropometry
  • EORTC - QoL questionairre
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11
Q

What are some ways that
body composition can be measured?

A
  • DEXA - small dose of radiation considered trivial (less than what you get in airplane)
  • MRI
  • Anthro - skin folds, MAMC, weight and height
  • CT imaging (can see all the different tissues)
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12
Q

What is considered the best method for assessing body composition in cancer patients?

A

CT analysis → Usually do an image just at site of tumour area to prevent full body radiation
* Usually upper body at 3rd lumbar (upper body) because this is proportional to entire body
* fat free tissue: bone tissue, liver, kidneys, spleen tumour, intestines, specific skeletal muscle groups.
* fat tissue: visceral, intramuscular, subcutaneous

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13
Q

What is intrabdominal fat considered

A

pathological in nature
* except for those around kidney whic are for shock absorption fat pad

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14
Q

Why is muscle mass loss important?

A

Weight and muscle Loss affects prognosis. Many patients report some degree of weight loss in the 2-6 months prior to receiving treatment leading to:
* Poorer response to treatment
* Poor prognosis and even worse during chemotherapy
* Lung cancer patients treated with chemoradiation who had >5% weight loss within the first three weeks of treatment had decreased overall survival (13 vs. 23 months, p=0.017)
* Weight loss >2.4% is significantly related to decreased survival especially unintended (often related to malginancy)

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15
Q

Causes of Muscle mass loss in patient with cancer

A
  • chronic or acute illness
  • poor oral intake and weight loss
  • advanced age
  • inactivity
  • inflammation
  • T2D
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16
Q

What does age-related loss of muscle mass look like in normal subjects

A

4% per decade in men and 3% per decade in women
* Even if active would still lose muscle but less severely

17
Q

Outcomes of muscle mass loss in cancer patients

A
  • ANOREXIA
  • FATIGUE
  • MUSCLE DECONDITIONING
  • EXCESS PROTEOLYSIS
  • EXCESS LIPOLYSIS
  • FUTILE CYCLING
18
Q

Loss of muscle mass contributes to

A
  • Greater decline in physical function
  • Decreased Health Related Quality of Life (dependant care)
  • Greater toxicities of chemotherapy (get knocked out)
  • Negative impact on treatment completion
  • Decreased performance status
  • Increased fatigue (cognitive, failure to produce ATP)
  • Reduced muscle strength
  • Impaired wound healing (higher infection risk)
19
Q

Nutritional status and muscle loss affecting quality of life

A

Nutritional status (and intake) are independent determinants of QoL as much as stage of disease, location of the cancer and treatment regimen in some types of cancer.
Patients rated 50% of their QoL to nutrition related outcomes
* Dietary intake
* Weight loss

20
Q

What is low muscle mass a predictor/ indicator of?

A

Low muscle mass may be even more important to outcomes
* Low muscle mass is common and independent predictor of immobility and mortality
* Low muscle mass is an independent adverse prognostic indicator in obese patients

21
Q

Aim of guidelines for nutrition intervention and optimizing muscle mass in oncology patients

A

Translate current evidence and expert opinion into recommendations for the multi-disciplinary team responsible for prevention, identification and treatment of reversible elements of malnutrition in cancer patients and contribute to decreasing the risk of cancer recurrence.

22
Q

What is GRADE?

A

Grading of Recommendations, Assessment, Development and Evaluations

23
Q

What are the certainty’s for GRADE and there meanings?

A
24
Q

What is included for guidelines on nutrition for patients with cancer?

A
  • Screening
  • assessment
  • energy requirements
  • protein intake
  • exercise in combination with nutrition & type of exercise recommended
25
Q

screening guidelines

A
26
Q

assessment guidelines

A
27
Q

energy requirement guidelines

A
28
Q

Protein Intake Guidelines

A
29
Q

Exercise guidelines

A
30
Q

Nutrition recommendations

A
  • energy
  • protein
  • other nutrients
31
Q

What do oss of weight and mean muscle mass affect?

A
  • strength
  • QoL
  • tolerance to treatment
  • survival

NUTR 424 Cancer (19 decks)

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