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Nutritional Aspects of Cancer Management
Chapter 12
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Epidemiology
• Age is major risk factor in cancer incidence• Multiple causes, including personal choices
and behaviors• Lifetime risk– 1:10 men– 1:3 women
• Survival– Increased longevity
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Prevention
• Fruit and Vegetable Consumption– Limited fruit and vegetable consumption is a
cancer risk– Healthy People 2010 suggests > 5 daily servings– Access to nutrient-dense foods can be
problematic for low-income populations– Isoflavones inversely associated with some types
of cancer
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Prevention
• Weight– Increased weight is a risk factor for a number of
cancers common in older adults
• Low-Fat Diet– Decreased risk of invasive ovarian cancer
• Trans-fatty Acids– Intake may be risk factor for cancer of the small
intestine
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Prevention
• Cholesterol-Lowering Drugs– Associated with a reduction for the risk of
advanced prostate cancer and other cancers• Folate and Cobalamin– Studies show inconsistent results
• Fiber– Recommended for prevention of colon cancer
• Omega-3 Fatty Acids– May decrease risk of cancer
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Prevention• Carotenes– An antioxidant• Linked to lower mortality in older adults
– Beta-carotene• May act as both an oxidant and an antioxidant
when consumed in high doses
• Vitamin D– High-dose activated vitamin D combined with
chemotherapy may increase survival in men with prostate cancer
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Prevention
• Aspirin and Vitamin E– Some research shows aspirin and other anti-
inflammatory drugs may protect against colon cancer
• Multivitamin Use– Has little or no influence on risk for common
cancers or total mortality in postmenopausal women
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Prevention
• Coffee– Inverse relationship between caffeine intake and
ovarian cancer risk
• Meat Mutagens– Heterocyclic amines (HCAs)• Formed from cooking meat at high
temperatures• Carcinogens found in beef, pork, fowl, and fish
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Ethnicity, Culture, and Cancers
• American and Alaskan Natives– Cancer rates among this population has been
increasing in the past 20 years• African Americans– Cancer is second leading cause of death in this
population– Cancer survival is lower compared to whites in the
U.S.• Asian Americans– Cancer is the number one cause of death for this
population
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Ethnicity, Culture, and Cancers
• Native Hawaiians and Pacific Islanders– Native Hawaiians have the second highest
incidence of cancers and of cancer-related mortality
– Pacific Islanders have significant health-related high-risk behaviors
• Seventh-day Adventists– Have a very low incidence of cancer
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Common Cancers and Dietary Recommendations
• Prostate Cancer– Diet: limit intake of red meat and full-fat dairy
products and eat at least five servings of fruits and vegetables daily
• Breast Cancer– Older women who smoke or have smoked appear
to be at very high risk for breast cancer– Recommendations• Exercise at least four hours each week• High folate intake• Limit alcohol to no more than one drink/day
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Common Cancers and Dietary Recommendations
• Lung and Bronchus Cancers– Diets high in phytochemicals have been shown to
decrease lung and bronchus cancer risk
• Colon and Rectum– Recommendations• Increase physical activity• Avoid obesity• Limit meat consumption• Increase fruit and vegetable intake
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Cancer Treatments
• Many therapies are aggressive• Patient may require aggressive nutrition
management• Dietary counseling is part of the treatment
plan• Therapy kills both cancer cells and healthy
cells• Therapy has side effects that affect eating and
nutrition
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Cancer Treatments
• Surgery– If malnourished, patient should correct prior to
surgery, if time permits– After surgery body needs extra calories and
protein– Maintain adequate fluid intake– Side effects may affect eating and food intake
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Cancer Treatments
• Chemotherapy– A systemic therapy • Affects the entire body
– Use of high-calorie and high-protein liquid supplements between meals
– Avoid fried foods– Small, frequent meals are encouraged– Drink adequate fluids
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Cancer Treatments
• Radiation Therapy– Affects both healthy and diseased tissues– Side effects are usually acute and begin the 2nd or
3rd week of therapy– GI tract most susceptible to nutrition-related
radiation side effects
• Immunotherapy– Monoclonal antibodies (MAb)• Made in the laboratory
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Side Effects of Therapy: Nutrition and Symptom Management
• Eat when hungry, rather at “meal times”• Eat favorite foods• Dine with family and friends• Have others prepare foods• Eat small, frequent meals and snack
throughout the day• Maintain hydration
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Side Effects of Therapy: Nutrition and Symptom Management
• Protein-Calorie Malnutrition– Most common nutrition diagnosis associated with
cancer– May be unable to digest certain foods– Metabolic abnormalities may occur
• The Immunocompromised Patient– Avoid infection-causing organism type foods– Practice safe food-handling techniques
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Side Effects of Therapy: Nutrition and Symptom Management
• Anorexia– Loss of appetite or desire to eat– Multiple recommendations to combat anorexia
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Side Effects of Therapy: Nutrition and Symptom Management
• Cachexia– A wasting syndrome– Cause is probably multifactorial, but not well
understood– Treatment includes medications
• Fatigue– Numerous suggestions to manage fatigue
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Side Effects of Therapy: Nutrition and Symptom Management
• Weakness and Falls– A common side effect of cancer therapy and
cancer– Vitamin D may reduce risk of falls• Vitamin D production is diminished in older
adults• Consistent use of sunscreens will decrease
synthesis of Vitamin D
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Side Effects of Therapy: Nutrition and Symptom Management
• Altered Taste– Prevent developing an aversion to meat with
preparation suggestions– If experiencing a bitter or metallic taste:• Use plastic utensils• Suck lemon drops or mints• Rule out dental problems• Check if medications could cause odd taste
– Alter food flavor as needed
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Side Effects of Therapy: Nutrition and Symptom Management
• Mucositis and Stomatitis– Eat soft foods– Avoid irritating foods and beverages– Use a straw to drink liquids– Eat foods cold or at room temperature– Practice good oral hygiene– Increase fluid intake by adding sauces, gravy, or
broths to foods– Numb the mouth with ice chips or ice pops
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Side Effects of Therapy: Nutrition and Symptom Management
• Dysphagia– Puree or thicken food or liquids to a consistency
that is easy to swallow– Meet with speech therapist– Call physician or nurse if choking while eating– Drink 6 – 8 cups of fluid per day– Use liquid supplements– Use pureed vegetables in soup
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Side Effects of Therapy: Nutrition and Symptom Management
• Nausea and Vomiting– Sip clear liquids frequently– Eat dry foods– Sit up or keep head raised after eating– Eat bland, soft foods– Eat away from odors– Eat in a cool room– Rinse mouth before and after eating– Suck on hard candies– Eat easy-to-digest foods– Ask about anti-nausea medications
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Side Effects of Therapy: Nutrition and Symptom Management
• Diarrhea– Drink room temperature fluids– Drink 1 cup of liquid after each bowel movement– Limit milk to 2 cups per day– Avoid foods that cause gas– Avoid sugar-free gum and candies– Avoid high-fiber foods– Eat small frequent meals and snacks– Eat high-sodium foods– Drink high-potassium liquids and foods– Eat foods high in soluble fiber
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Side Effects of Therapy: Nutrition and Symptom Management
• Constipation– Eat high-fiber foods– Drink 8-10 cups of fluid daily– Try to eat at the same time each day– Limit gas-causing drinks and foods– Limit chewing gum, talking while eating, chewing
with mouth open, and using straws– Exercise
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Side Effects of Therapy: Nutrition and Symptom Management
• Advanced Cancers– Patients often have no appetite and lose weight
rapidly– Appetite stimulants may be effective– Look up American Cancer Society suggestions– Food should not be a source of stress
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Methods of Nutrient Delivery
• Nasogastric Tubes– Used for a short period of time– Cost-effective management of nutrition
• Percutaneous Endoscopic Gastrostomy Tubes– Used for longer period of time– Bolus vs. continuous feeds
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Methods of Nutrition Delivery
• Parenteral Nutrition– Used in patients with nonfunctioning gut or
profound nausea– Delivered via central venous catheter or a
peripheral venous catheter
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Palliative Care
• Maintain comfort and quality of life• Nutrition and hydration are considered
medical interventions that can be stopped• Advisable not to force eating and drinking
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Conclusion
• Goal of nutrition therapy for the older adult with cancer is to provide optimal nutritional status and to maximize quality of life