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Nutritional Ax and Mgt of Oncology (Goals (Enhance tolerance and response…
Nutritional Ax and Mgt of Oncology
Goals
Enhance tolerance and response to anti-cancer therapy
Enhance quality of life
Maintain or improve food intake
Optimise body's own defense mechanisms
Maintain skeletal mass and physical performance
Reduce risk of interruptions to anti-cancer treatment
Prevent Malnutrition
Nutritional Ax
The tools
Ideally, mal. risk screening prior to Ax
SGA
PG-SGA
Anthro
Wt Hx
BMI
Wt & Ht
Fluid status
Dry wt
Chemo protocols
Oedema/ascites
Biochem
Blood count
Check WCC & neutrophils
Immunosuppression/neutropenia
Food safety
Low lymphocyte assoc w mal.
Liver funct tests
Electrolytes/renal func
Inflammatory markers
Serum albumin
BGLs
Steroid induced diabetes
NFPF
Dysphagia
Dysgeusia
Mucositis
Odynophagia
N&V
Bowels
Diet
Diet patterns prior to illnes
Current intake
Compare to usual
Focus on E&P intake
Check for fads/restrictions
Check for supps
Social Hx
Cultural factors
Finance
Currently working
Previously work
Living situation
Temporary residence
Who there with?
In usual residence
Nutrition beliefs/knowledge
Access to food
Cooking facilities
Ability to cook
Transport
Support & Coping abilities
Medical Hx
Present state/staging
Treatment
Past treatments
Intent
Pallative
Curative
Proposed treatment plans
Prognosis
Co-morbidities
Diagnosis/type of cancer
Date of diagnosis
Location
Medications
Diagnosis
Common problems
Inadequate enteral nutrition infusion
Inadequate oral intake
Protein-energy malnutrition (incorporate PG-SGA)
Predicted suboptimal oral intake
Intervention
Alternate feeding regime
AI even with ONS may be difficult
Consider EN/PN
Consider prognosis & guidelines
Energy and Protein requirements
Requirements during oncology
Energy
125-145kJ/day
Protein
XRT
1.2g/kg/d
Mild-mod catabolism
1.2-1.5g/kg/d
ESPEN
1g & up to 1.5g/kg/day
Pratical strategies for symptom mgt
Vitamin/mineral supps
As per RDI - no greater