Nutrition and Rehabilitation in Oncology
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This document discusses cancer malnutrition and nutrition rehabilitation strategies. It notes that 40% of cancer patients are malnourished at diagnosis and weight loss is a predictor of poor outcomes. Cancer and its treatments can negatively impact energy balance, muscle mass, metabolism and inflammation. Early nutritional intervention is important to maintain weight and nutrition status. A multidisciplinary approach includes screening, counseling, oral nutrition supplements, and potentially enteral feeding via nasogastric tube or PEG tube depending on the patient's status and needs. Overall survival depends on initial BMI and prevention of weight loss through comprehensive nutrition management from diagnosis onward.
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Nutrition and Rehabilitation in Oncology
- 1. N U T R I T I O N & R E H A B I L I T A T I O N D R . M A L H A R P A T E L
- 2. Don't Think of Your Past Patient Don't Think of Your Future Patient Just Think of Your Present Patient The Patient Who is Yours Today; Was Someone Others' Yesterday And Tomorrow, He/She Will be Someone Others' What You Think Yours is Not Yours
- 3. N U T R I T I O N I S I M P O R T A N T C A N C E R P A T I E N T S A R E A T R I S K O F M A L N U T R I T I O N P h y s i c a l & M e t a b o l i c E f f e c t o f C a n c e r E f f e c t o f A n t i - C a n c e r T h e r a p i e s
- 4. 40% are Malnourished at Diagnosis. "Head and neck cancer, pre-treatment weight loss is an independent predictor of survival in advanced stage disease." Weight Loss - Greater Morbidity and Poor Tolerance to Treatment 20% Die Due to Effects of Malnutrition FACTS
- 5. I T ' S D I F F E R E N T F R O M S I M P L E M A L N U T R I T I O N N E G A T I V E E N E R G Y B A L A N C E S K E L E T A L M U S C L E M A S S L O S S E L E V A T E D R E S T I N G M E T A B O L I C R A T E I N S U L I N R E S I S T A N C E L I P O L Y S I S P R O T E O L Y S I S S Y S T E M I C I N F L A M M A T I O N C A T A B O L I C F A C T O R S
- 6. ENERGY INTAKE <60% FOR 1-2 WEEKS 80% SUFFERS WEIGHT LOSS PRIMARY SECONDARY MID ARM CIRCUMFERENCE MEN: 32 FEMALE:18 MORTALITY DOSE LIMITING TOXICITY FATIGUE IMPAIRED PHYSICAL ACTIVITY IMPAIR REPAIR INADEQUATE INTAKE MUSCLE PROTEIN DEPLETION SYSTEMIC INFLAMMATION What Happens in Cancer Malnutrition
- 8. Energy 25-30 Kcal/Kg/Day Loss of 800 Kcal on average Resting Energy Consumtion Increases to 10-25% Glucose and Fat
- 9. INSULIN RESISTANCE Weight Loss - Increase Fat Diet Fat: 0.7 - 1.9 Gm/Kg/Day Glucose - Sodium Imbalance
- 10. Protein 1.5 - 2.0 Gm/Kg/Day Inactivity, Old Age, Systemic Inflammation Decrease Protein Synthesis
- 11. Salt Old Age Tube Feeding Taste Alteration
- 12. Vitamins Same as Well Nourished Person
- 13. HOW TO GO ABOUT IT?
- 14. Different Patients Already Malnourished Surgical Morbidity Tumour Site Duration Dose Radical Adjuvant Palliative
- 15. Start @ Diagnosis Avg Weight Loss 5 kg Nutritional Assessment The Malnutrition Screening Tool The Interdisciplinary Nutrition Care Plan The Patient- Generated Subjective Global Assessment (F. D. Ottery, personal communication, 2000) #1
- 16. COUNSELLING #2
- 18. Treat Secondary Causes Radiation Technique #4
- 19. Still Losing Weight??? Naso-Gastric Tube 1 2 PEG Tube 3 Parenteral Nutrition #5
- 21. ASSESSMENT FOR ENTERAL NUTRITION PERFORMANCE STATUS WHO 2-3 SMOKING 20/DAY PRE-RX WEIGHT LOSS >10% ADVANCED AGE >70 YEARS ADVANCE STAGE AJCC 3-4 SERUM ALBUMIN <40G/L
- 22. Prophylactic Tube Oropharynx Weight Loss >10% BMI < 20 kg/m2 Age > 70 years
- 23. OVERALL SURVIVAL DEPENDS ON BMI AND WEIGHT LOSS 0: Best 4: Worst
- 24. Naso-Gastric Tube PEG Tube Economic Easy to insert Easy to Remove Less Care Few Weeks to Months Cosmetic Months to Years Less Aspiration Large Bore Invasive Surgical Care Infection Rate 15% Peritonitis Expensive Cosmetic Discomfort Small Bore Chance of Aspiration
- 25. NUTRITION ORAL NUTRITION SUPPLEMENT COUNSELLING ENTERAL NUTRITION NG OR PEG PROPHYLACTIC OR ELECTIVE START AT DIAGNOSIS
- 26. REHABILITATION
- 28. Thank You