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Part 2
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Cytokines are protein mediators produced by
inflammatory cells
Cytokines produce metabolic wasting in the tumor-
bearing host
Cytokines involved:
TNF-E and TNF-F (Cachectin),
Interleukin-1, 6, and
Gamma-interferon
Treatment
x Anticytokine antibodies or inhibitors
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` Chemotherapy Definition
Use
Target of impact
Nutrition-related side effects: Myelosuppression, anemia,
fatigue, nausea, vomiting, loss of appetite, mucositis, changesin taste and smell, xerostomia, dysphagia, diarrhea, andconstipation, adynamic ileus, anorexia, vomiting
Other side effects: neutropenia
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` Why Immunotherapy?
Immune stimulation sensitizes the patients own
immune system, helping it to be more likely to
notice, and therefore destroy deposits of cancer cells
` Side-effects:
Fatigue, chills, fever, flu-like symptoms, decreased
food intake
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` Alkylating agents ( cysplatin, cyclophosphamide,bisulfan)
` Nitrosoureas
` Antitumor antibiotics (doxorubicin, mitomycin,neomycin)
` Hormones or H antagonist (glucocorticoids,antiandrogens, antiestrogens tamoxifen,
progestins)
` Antimetabolites (Fluorouracil, methotrexate)
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` Vinca Alkaloids (vincristine, paclitaxel, docetaxel)
` Taxanes
` Immunologics ( Interferon Alfa, interleukin)
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` Radiation Therapy (Use of ionizing radiation tocure, control or palliate cancer) Acute complications manifest after 2-3 weeks of the
treatment and resolve 2 4 weeks following treatment
exception late effects of radiation
Fatigue, loss of appetite, skin changes, and hair loss inarea treated
Site-specific effects
x Head and neck x Acute effects
x Late effects
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` Hemopoietic stem cell transplantation(Bone Marrow Transplantation)
involves taking cells that are normally found in the bone
marrow (stem cells) from the donor or from cord blood and
giving them back, by intravenous infusion, to the recipient,
either the same person or to another person.
The sources of these stem cells can be:
from the patient (autologous)
from a relative (allogeneic)
from a matched unrelated donor (MUD)
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` Immunosuppression can lead to Nausea, vomiting, anorexia, dysgeusia, stomatitis, oral and esophageal
mucositis (in 75% of transplants) , fatigue, and diarrhea
Patients have no oral intake during 1st few weeks and require enteral orparenteral support usually G-Tubes or TPN
When oral foods introduced, bland liquids or soft solids work best
Dietary precautions with neutropenia:Foods to avoid:x Fresh fruits or vegetables
x Raw or rare cooked meats, fish, or eggs
x Dried fruits or nuts
x Unpasteurized dairy products (such as raw milk, and naturally aged cheeses, and all yogurts).x Fresh herbs and seasonings (unless added during cooking)
x Shellfish
x Unpasteurized beverages
x Raw Honey
x Foods from street vendors, delis, coffee carts and salad bars
Do: Choose foods in portion control packets
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Graft versus host disease (GVHD)
x Possible side effectsx Gastroenteritis, severe diarrhea, pain, nausea, vomiting
x
1st
phase treatment: total bowel restx 2nd phase treatment: liquids that are isotonic, low residue andx lactose-freex 3rd phase treatment: solids low-fiber, lactose-free, low acid
x 4th phase treatment: restrictions are reducedx 5th phase treatment: back to normal diet
Sinusoidal obstructive syndrome (S0S) orVenocclusive Diseasex Causes damage to hepatic venulesx Requires aggressive parenteral support
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` Surgery
Fatigue, pain, loss of appetite
Require additional energy and protein for
wound healing
If certain parts of the digestive system are
removed
Nutritional problems: related to specific site:head & neck, gastric resections
Treat the affected area
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` Determining routes of nutritional therapy
` Oral nutritional management techniques
` Management of chemotherapy-induced vomiting
` Pharmaceutical management of anorexia
syndrome
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` Enteral nutrition
` Parenteral nutrition
` Rehabilitation and physical therapy
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` Palliative Care forAdvanced Cancer
Focus on pain management, weakness, loss
of appetite,dry mouth, etc
Focus on maintaining strength and quality of
life
Nutrition as desired, as tolerated
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` Families and caregivers often have extremepreoccupation with eating and weight
` Creativity in feeding
` Enteral nutrition support
` Individualize requirements
` Requirements for growth and development
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` Whole medical systems` Traditional Chinese Medicine, ayurvedic medicine, homeopathy,
naturopathy
` Mind-body intervention
Mindfulness, meditation` Biologically based therapies
Botanicals, dietary supplements, vitamins, minerals
` Manipulative and body-based methods Massage, yoga, reflexolgy
` Energy therapies Veritable and measurable sound, light, energy
Putative such as biofields
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` Nutrition plays important role throughout the
continuum of cancer care Reducing cancer risk
Caring for patients undergoing CA treatment
Promoting healthy lifestyles forCA survivors
` Nutrition mgt. can help improve patients
tolerence of treatment minimize impact of systems
and maximize quality of life