Nutrition for Cancer. Nutrition for Cancer. Patients. Geoffrey Axiak. Clinical Nutrition Nurse Mater Dei Hospital

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1 Nutrition for Cancer Nutrition for Cancer Patients Geoffrey Axiak Clinical Nutrition Nurse Mater Dei Hospital

2 Change in Energy Expenditure in Change in Energy Expenditure in Disease (Northwestern University Medical School, 2000) Cancer Acute Renal without dialysis Acute Renal with dialysis Liver Failure Lung (COPD) GI (Crohn's) % Above Normal Energy Requirements

3 Cancer-Related Defects in Carbohydrate Metabolism (The Cancer Nutrition Network for Texas, 2000) Glucose intolerance Insulin resistance Abnormal insulin secretion Delayed glucose clearance Increased glucose production Increased glucose turnover Variably increased Cori cycle activity

4 Cancer-Related Defects in Fat Metabolism (The Cancer Nutrition Network for Texas, 2000) Excess body fat depletion relative to protein loss Decreased lipolysis,, free fatty acids, and glycerol turnover Hyperlipidaemia Failure of glucose to suppress oxidation of free fatty acids Decreased serum lipoprotein lipase activity despite normal insulin

5 Cancer-Related Defects in Protein Metabolism (The Cancer Nutrition Network for Texas, 2000) Increased whole-body protein turnover Increased protein fractional synthetic rates in liver Reduced fractional synthetic rates in muscle Increased hepatic protein synthesis Persistent muscle protein breakdown Decreased plasma branched-chain chain amino acids

6 Side-Effects of Chemotherapy Anorexia Nausea Diarrhoea Vomiting Inflammation and sores of the mouth Changes in the taste of food Infections

7 Chemotherapy & Nutritional Status Chemotherapy & Nutritional Status Several studies demonstrated that the inability to maintain nutritional status is a particularly common problem for persons with cancer (BC Cancer Agency, 2007; The Cancer Nutrition Center 2006; Morss Center,, 2007; Arends et al., 2006; Bozzetti, Morss Dy,, 2006; Brogden,, 2004; National Cancer Institute, 2002).

8 Chemotherapy & Nutritional Status Chemotherapy & Nutritional Status Up to 80% of people with cancer may be mildly malnourished and that up to 40% have been reported as showing signs of severe malnutrition (The South West Wales Cancer Institute, 2007). 40% of cancer patients experience anorexia due to cancer at diagnosis and up to 70% in the more advanced stages of the disease (Molassiotis & Foubert,, 2006).

9 Reasons for Anorexia in Cancer Reasons for Anorexia in Cancer patients Decreased taste and smell of food Increased sweet and decreased bitter thresholds Loss of appetite due to stress or depression Nausea Vomitting Bowel obstruction Dysphagia

10 The Effects of Malnutrition The Effects of Malnutrition Decreased taste and smell of food Increased sweet and decreased bitter thresholds Loss of appetite due to stress or depression Nausea Vomitting Bowel obstruction Dysphagia

11 Malnutrition and Prognosis Malnutrition and Prognosis The rationale for using artificial nutrition (enteral or parenteral nutrition) in cancer patients is primarily based on the assumption that although the final outcome of cancer patient mainly reflects the prognosis of the primary tumour, concomitant malnutrition can affect survival by increasing the complications of the oncological therapy, reducing tolerance to these treatments and, in some cases, decreasing both the length and the quality of survival. Bozzetti (2001, p. 654)

12 Malnutrition and Prognosis Malnutrition and Prognosis The malnourished patient responds poorly to treatment such as chemotherapy, radiotherapy and surgery, and has an increased rate of mortality and morbidity compared with well- nourished patients (Rivadeneira et al., 1998). Due to malnutrition, the responses to chemotherapy are decreased, chemotherapy- induced toxicity and complications are more frequent and severe, and survival times are shortened shortened (Argil Argilés,, 2005, Davies, 2005 & Van Cutsem & Arends,, 2005).

13 Malnutrition and Prognosis Malnutrition and Prognosis From the randomised controlled trials that were carried out in adults (13 in all (Bozzetti Bozzetti,, 2001)): ): 1 study showed an increased number of complete remissions in patients receiving parenteral nutrition 3 studies showed decreased survival or shorter remissions in the same conditions the other studies either did not test or did not demonstrate benefits with respect to remission or survival.

14 Malnutrition and Prognosis Malnutrition and Prognosis There was a tendency towards improved skin test responses in patients receiving enteral nutrition but no differences in weight, total lymphocyte count or survival lymphocyte count or survival (Douglass et al., 1978). On the contrary, TPN groups showed improved performance (Douglass et al.,, 1978). Children with higher levels of antioxidants respond better to chemotherapy treatment for acute lymphoblastic leukaemia, suggesting that they should have a diet rich in organic fruit and vegetables (Ross, 2005).

15 Healthy Nutrition Healthy Nutrition

16 Major Side-Effects of Chemotherapy Lack of appetite Nausea and/or vomitting Constipation Diarrhoea Dry mouth Mouth sores

17 Treating Side-Effects Side-Effect Things to try Things to avoid Lack of appetite Small, high calorie meals Drink liquids high in nutrients Eat high calorie foods Use complete nutritional supplements Exercise lightly and regularly Foods you dislike Foods that are difficult or time- consuming to prepare Foods that are difficult to eat

18 Treating Side-Effects Side-Effect Things to try Things to avoid Nausea and/or vomiting Anti-nausea nausea medications Small, more frequent meals Cold foods to lessen strong food odors. Dry crackers or toast, pretzels, plain cake or vanilla wafers Eat low fat foods

19 Treating Side-Effects Side-Effect Things to try Things to avoid Nausea and/or vomiting Drink clear, cold beverages and sip slowly through a straw. Drink small amounts of liquids frequently throughout the day Fatty or greasy foods Fried foods Spicy foods Foods that have strong odors Drinking hot liquids, or large amounts of liquids with meals

20 Treating Side-Effects Side-Effect Things to try Things to avoid Nausea and/or vomiting Drink clear, cold beverages and sip slowly through a straw. Drink small amounts of liquids frequently throughout the day Lying down after meals. DO NOT eat or drink anything until vomiting is controlled; then begin with small amounts of water or liquids.

21 Treating Side-Effects Side-Effect Things to try Things to avoid Constipation Drink as much water and other liquids as possible Drink warm beverages Eat foods with a high fiber content Exercise lightly and regularly Decreasing your amount of fluid intake while increasing fiber intake

22 Treating Side-Effects Side-Effect Things to try Things to avoid Diarrhoea Drink plenty of fluids Eat smaller amounts of food at each meal Eat foods that have high potassium, low fiber content Drink liquids that have high potassium, low fiber content Foods that are high in fiber Foods that cause gas Gravies and sauces Foods that are greasy Caffeinated beverages

23 Treating Side-Effects Side-Effect Things to try Things to avoid Diarrhoea Drink plenty of fluids Eat smaller amounts of food at each meal Eat foods that have high potassium, low fiber content Drink liquids that have high potassium, low fiber content Carbonated beverages Chocolate

24 Treating Side-Effects Side-Effect Things to try Things to avoid Dry mouth Products that moistened the mouth Practice good oral hygiene Drink liquids with meals

25 Treating Side-Effects Side-Effect Things to try Things to avoid Dry mouth Take sips of water or suck ice chips; eat popsicles or sugarless hard candies; chew sugarless gum Drink liquids that are high in citric acid and stimulate saliva Alcoholic beverages Bread, crackers or dry cake Plain meats (add broth, gravy or sauce) Extremely hot food or beverages

26 Treating Side-Effects Side-Effect Things to try Things to avoid Mouth sores Practice good oral hygiene Cook foods until soft or puree foods in a blender Eat cold or frozen foods Eat soft foods Use nutritional supplements Drink fruit nectars through a straw. Alcoholic beverages Acidic foods or beverages Coarse or dry foods Salty foods Spicy foods Extremely hot food or beverages

27 Thank you Thank you