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Nutrition and the cancer patient - Coggle Diagram
Nutrition and the cancer patient
Anti-cancer treatment
surgery
depending on extent of impairment to absorption, may require PN/EN
surgery to pancreas
new da Vinci technology improves precision
chemotherapy
weighing patient on same day as chemotherapy as additional fluid can cause weight gain (need to know if had chemo before or not )
neo adjuvant =chemo before treatment
concurrent chemo-rad= occurs at same time
adjuvant = after treatment
has side-effects affecting ability to eat and drink:
Head and neck patient- take pain killer which can cause constipation. Ondansetron anti-emetic can be constipating
Radiotherapy
nutritional problems may arise depending on location of treatment, size of radiation field, dose, length of treatment
burning sensation to throat, dry mouth, appetite loss, taste changes, sore mouth, loss of teeth. often insert NG tube
Additional types
immunotherapy, hormonal, multimodality etc
Cancer cachexia
caused by complex mix of variables, including tumour-produced factors and metabolic abnormailities
tumour-induced metabolic effects - cancer cells producing chronic inflammatory response with direct catabolic effect o host tissues
= results in carb metabolism abnormalities (hyperglycaemia, body breaks down stores), increased lipolysis and whole body protein turn-over, increased REE, reduced appetite, early satiety
treatment
most will not see reversal of wasting syndrome (advanced protein-energy malnutrition)
exercise/muscle strengthening
prehailitation= optimise nutrition and fitness before treatment
Nutritional screening
MUST not specific enough for cancer patients: insensitive to body comp (e.g. moon face/bloated face, fat around abdomen but skinny arms/legs as muscle loss due to cortisol from steroids), fluid changes,
holistic needs assessment : can be used to monitor, patient scores themselves on physical, practical, emotional and family, spiritual and support concerns . Issues can all impact ability to eat and drink
PG-SGA (Patient generated subjective global assessment tool)= proven nutritional assessment tool for individuals with cancer . considers metabolic demand, muscle strength, muscle loss= overall score to fit into category in relation to risk of malnutrition
more detailed and complex to use than MUST, ? more a form of assessment than screening
Assessment
A:
weight hx, % weight loss, MUAC, Handgrip
B:
Biochemistry, electrolytes (loss from diarrhoea)
C:
cancer diagnosis, staging
active treatment? (type, when) or post-treatment, best supportive care
PMHx e.g. relevant surgical intervention like esophagectomy
Current medication
D:
symptoms affecting nutritional intake and medication used to counteract this
E:
Goals for cancer patients
enhance anti-cancer treatment effects and prevent/treat undernutriton , reduce adverse effects and improve QOL
Since 2013, > emphasis on cancer survivorship (QOL beyond diagnosis)
Addressing symptoms
neutropenic diet
PERT