ONCOLOGYONCOLOGYNUTRITIONNUTRITION

Goals of PresentationGoals of Presentation What is Cancer?What is Cancer? Cancer statisticsCancer statistics Diet Cancer RisksDiet Cancer Risks Importance of Nutrition before Tx Importance of Nutrition before Tx Reasons for Nutritional Effects During TxReasons for Nutritional Effects During Tx Nutrition after TxNutrition after Tx Nutrition Screening and Assessment in Nutrition Screening and Assessment in OncologyOncology Management of Symptoms NutritionallyManagement of Symptoms Nutritionally Recommendations to help Prevent Recommendations to help Prevent

CancerCancer

What is Cancer?What is Cancer?

Cancer is abnormal cell division and Cancer is abnormal cell division and reproduction that can spread reproduction that can spread throughout the bodythroughout the body

Three Stages: Initiation, Promotion, Three Stages: Initiation, Promotion, Tumor progression, includes Tumor progression, includes metastasismetastasis

Cancer StatisticsCancer Statistics Out of 562,875 people 23.2% will get Out of 562,875 people 23.2% will get

cancercancer

What May Cause Cancer?What May Cause Cancer?

Dietary Fat Intake-lung, colon, endometrial Dietary Fat Intake-lung, colon, endometrial and ovarian Caand ovarian Ca

Alcohol Intake and Tobacco use-Head and Alcohol Intake and Tobacco use-Head and Neck CaNeck Ca

Increased Body weight and Lack of Increased Body weight and Lack of physical activity-Esophageal cancer, colon physical activity-Esophageal cancer, colon and rectum cancer, breast cancer, and rectum cancer, breast cancer, endometrial cancer, liver cancer, endometrial cancer, liver cancer, gallbladder cancer, pancreatic and kidney gallbladder cancer, pancreatic and kidney cancer, non-hodgkin’s lymphoma, cancer, non-hodgkin’s lymphoma, leukemia, and multiple myelomaleukemia, and multiple myeloma

Reasons for Nutritional effects Reasons for Nutritional effects before Treatmentbefore Treatment

Tumors – A malignant tumor may Tumors – A malignant tumor may alter body composition and food alter body composition and food intake.intake.

Head and Neck CancersHead and Neck Cancers Obstructing mass in the GI Obstructing mass in the GI PainPain Emotions: Fear, anxiety, depressionEmotions: Fear, anxiety, depression

Reasons for Nutritional Reasons for Nutritional effects during treatmenteffects during treatment

Nutritional Implications of Nutritional Implications of ChemotherapyChemotherapy

Nutritional Implications of Nutritional Implications of RadiationRadiation

Nutritional Implications of Nutritional Implications of ChemotherapyChemotherapy

Chemotherapeutic Agents are toxic and have Chemotherapeutic Agents are toxic and have adverse effects:adverse effects:

Common Nutrition-Related Side Effects are:Common Nutrition-Related Side Effects are: NauseaNausea VomitingVomiting AnorexiaAnorexia MucositisMucositis EsophagitisEsophagitis FatigueFatigue ConstipationConstipation DiarrheaDiarrhea Early fullness and decrease in appetiteEarly fullness and decrease in appetite Altered sense of taste and smellAltered sense of taste and smell

Nutritional Implications of Nutritional Implications of RadiationRadiation

Depends on location of radiation Depends on location of radiation TxTx

Individuals receiving radiation Individuals receiving radiation therapy to any part of the GI therapy to any part of the GI tract are especially susceptible tract are especially susceptible to nutrition-related side effectsto nutrition-related side effects

Central Nervous System (brain Central Nervous System (brain and spinal cord)and spinal cord)

NauseaNauseaVomitingVomitingFatiqueFatiqueLoss of appetiteLoss of appetite

HEAD AND NECKHEAD AND NECK

XerostomiaXerostomia Sore mouth and throatSore mouth and throat DysphagiaDysphagia MucositisMucositis Alterations in taste and smellAlterations in taste and smell FatigueFatigue Loss of appetiteLoss of appetite

THORAX (esophagus, lung; also THORAX (esophagus, lung; also breasts if tx field involves breasts if tx field involves

esophagus)esophagus)

Dysphagia Dysphagia HeartburnHeartburnFatigueFatigueLoss of appetiteLoss of appetite

Abdomen and Pelvis Abdomen and Pelvis (gastrointestinal system, (gastrointestinal system,

reproductive organs, prostate, reproductive organs, prostate, colon, rectum, testicles)colon, rectum, testicles)

Nausea, vomitingNausea, vomiting Diarrhea, cramping, bloating, gasDiarrhea, cramping, bloating, gas Changes in urinary function (increased Changes in urinary function (increased

frequency, burning sensation with urination)frequency, burning sensation with urination) Acute colitis or enteritisAcute colitis or enteritis Lactose intoleranceLactose intolerance FatigueFatigue Loss of appetiteLoss of appetite

Nutrition after TreatmentNutrition after Treatment

Maintain a healthy weightMaintain a healthy weight Adopt a healthy lifestyleAdopt a healthy lifestyle Eat a healthy dietEat a healthy diet Limit alcoholLimit alcohol

SCREENING & ASSESSMENTSCREENING & ASSESSMENT

Weight loss as low as <5% body Weight loss as low as <5% body weight can adversely affect prognosisweight can adversely affect prognosis

Symptoms influencing weight loss Symptoms influencing weight loss include: abdominal fullness, taste include: abdominal fullness, taste changes, nausea/vomiting, mouth changes, nausea/vomiting, mouth drynessdryness

Quality of life may be a more Quality of life may be a more appropriate outcome to measure when appropriate outcome to measure when evaluating nutrition intervention during evaluating nutrition intervention during cancer treatments.cancer treatments.

Nutrition AssessmentNutrition Assessment

Female with Breast Ca has been Female with Breast Ca has been receiving CT for 6 weeks.receiving CT for 6 weeks.

Ht 5’6”Ht 5’6” 10/13/10-Wt 140#-; 10/20/10-Wt 136# -10/13/10-Wt 140#-; 10/20/10-Wt 136# - BMI – 22BMI – 22 Labs Labs Physical Activity-mostly sedentary for Physical Activity-mostly sedentary for

the past weekthe past week

Nutrition Assessment Nutrition Assessment cont’d…cont’d…

Pt was screened on the first day Tx (Sept.8). Pt has Pt was screened on the first day Tx (Sept.8). Pt has maintained her current weight of 140 pounds for the last 6 maintained her current weight of 140 pounds for the last 6 months. Nutrition care plan management suggestions was months. Nutrition care plan management suggestions was given to this patient.given to this patient.

Pt has had weekly follow-ups. NCP notes indicate that pt Pt has had weekly follow-ups. NCP notes indicate that pt has good appetite, with no complaint, Drinking high protein has good appetite, with no complaint, Drinking high protein shakes daily (42g pro/shake), plenty of fluids, and shakes daily (42g pro/shake), plenty of fluids, and maintaining weight of 140 pounds.maintaining weight of 140 pounds.

On Oct 20On Oct 20thth it is noted that pt decreased in weight by 4 it is noted that pt decreased in weight by 4 pounds. 3% wt loss in one week indicating significant wt. pounds. 3% wt loss in one week indicating significant wt. loss.loss.

Pt c/o nausea and vomiting which occurred for 3 days in the Pt c/o nausea and vomiting which occurred for 3 days in the past week since her last Tx. Pt was vomiting at least past week since her last Tx. Pt was vomiting at least 3x/day. On the fourth day she stopped vomiting but had 3x/day. On the fourth day she stopped vomiting but had loss of appetite.loss of appetite.

Please refer to h/o for Nutrition assessment form.Please refer to h/o for Nutrition assessment form.

Cancer PreventionCancer Prevention Meeting nutrient needs and ExerciseMeeting nutrient needs and ExerciseAmerican Cancer Society recommends:American Cancer Society recommends:

Eat a variety of healthful foods, with an emphasis on plant Eat a variety of healthful foods, with an emphasis on plant sources.sources.Eat 5 or more servings of a variety of vegetables and fruits Eat 5 or more servings of a variety of vegetables and fruits each day.each day.Choose whole grains in preference to processed (refined) Choose whole grains in preference to processed (refined) grains and sugars.grains and sugars.Limit consumption of red meats, especially those high in fat Limit consumption of red meats, especially those high in fat and processed.and processed.If you drink alcoholic beverages, limit consumption.If you drink alcoholic beverages, limit consumption.

ExerciseExerciseAdopt a physically active lifestyle.Adopt a physically active lifestyle.Maintain a healthful weight throughout lifeMaintain a healthful weight throughout lifeChoose foods that help you maintain a healthful weight.Choose foods that help you maintain a healthful weight.

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the prevention of cancer. the prevention of cancer. Public Health NutrPublic Health Nutr. 2004;7:187-200.. 2004;7:187-200. Lacey k, Pritchett E. Nutrition Care process and model; ADA adopts road map to Lacey k, Pritchett E. Nutrition Care process and model; ADA adopts road map to

quality care and outcomes. quality care and outcomes. J Am Diet AssocJ Am Diet Assoc. 2003;103:1061-1072. 2003;103:1061-1072 Rubin H. Cancer cachexia: its correlations and causes. Rubin H. Cancer cachexia: its correlations and causes. Proc Natl Acad SciProc Natl Acad Sci USA. USA.

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(Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2(Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2ndnd edition (pp.28- edition (pp.28-30).USA:American Dietetic Association.30).USA:American Dietetic Association.

Elliott L, Molseed L, (2006).Changes in Carbohydrate, Lipid, and Protein Metabolism in Elliott L, Molseed L, (2006).Changes in Carbohydrate, Lipid, and Protein Metabolism in Cancer. In McCallum PD, (Eds), Grant B, (Eds.). The Clinical Guide to Oncology Cancer. In McCallum PD, (Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2Nutrition 2ndnd edition (pp.19-24). USA:American Dietetic Association. edition (pp.19-24). USA:American Dietetic Association.

Elliott L, Molseed L, (2006).Tips for Managing Nutrition Impact Symptoms. In Elliott L, Molseed L, (2006).Tips for Managing Nutrition Impact Symptoms. In McCallum PD, (Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2McCallum PD, (Eds), Grant B, (Eds.). The Clinical Guide to Oncology Nutrition 2ndnd edition (pp.241-245). USA:American Dietetic Association.edition (pp.241-245). USA:American Dietetic Association.

(2010).Cancer statistics. .Retrieved Oct. 19, 2010 from the World Wide Web: (2010).Cancer statistics. .Retrieved Oct. 19, 2010 from the World Wide Web: http://www.cancer.org/Search/index?QueryText=cancer+statistics+2010&x=52&y=19htt

(2010).What is Cancer?. Retrieved Oct. 23, 2010 from the World Wide Web: (2010).What is Cancer?. Retrieved Oct. 23, 2010 from the World Wide Web: http://www.aicr.org/site/PageServer?pagename=tellmeabout_what_is_cancer?? Oncology Nutrition, A Dietetic Practice Group of the American Dietetic Association.Oncology Nutrition, A Dietetic Practice Group of the American Dietetic Association.

(2010).Oncology Nutrition Links. Retrieved Oct. 23, 2010 from the World Wide Web: (2010).Oncology Nutrition Links. Retrieved Oct. 23, 2010 from the World Wide Web: USA:American Dietetic AssociationUSA:American Dietetic Association