Question

Steve Palmer has been undergoing chemotherapy for liver cancer. In the past 3 months, Mr. Palmer has lost 25 pounds from his pre-cancer weight of 190 lbs. He is 6 ft 2 inches tall. He reports decreased appetite, nausea, vomiting, and dry mouth. He reports feeling full quickly and extreme fatigue. His oncologist refers him to you for suggestions on increasing his food intake. • Use your textbook to respond to the following questions (provide your responses in the Assignment Worksheet section on page 3) • Submit the Week 8 Assignment via Blackboard by clicking on the “Week 8 Assignment” link. • Include the proper file naming convention: SCI115_wk8_assn_jsmith_mmddyyyy. Grading: Gradable items in assignment Points Identify the main objectives for nutrition intervention in cancer patients 15 Calculate nutrient needs for protein, calories, and fluid 10 Discuss dietary suggestions for decreased appetite and nausea 5 Discuss dietary suggestions for xerostomia 5 Adhere to Writing Guidelines (see below). 5 Total Points 40

Answer 1

*Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. All types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving according to the characteristics of individual cancers. All of these treatments may be mainly leads to frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. However, the frequent presence of malnutrition in cancer patients can limit their response to even the best therapies if nutritional issues are not appropriately managed.

Healthy eating habits are important during and after cancer treatment. Nutrition therapy is used to help cancer patients keep a healthy body weight, maintain strength, keep body tissue healthy, and decrease side effects both during and after treatment. Oncology nurses know that nutrition interventions can help their patients, both during and after active treatment.

When designing the right nutrition intervention for the right patient. Nutrition interventions should prevent nutrient deficiencies, maintain lean body mass, and minimize the impact of treatment-related side effects. However, the active treatment phase for most people is a time of coping, anxiety, and just getting through the treatments; and we need to be plan respective of that.

In addition, we evaluate the patient’s and caregiver’s readiness and motivation toward dietary change.

*Nutrition and Physical Activity Guidelines for Cancer Survivors:

According to the American Cancer Society:

• Balance caloric intake with physical activity
• Engage in at least 30minutes of moderate-to-vigorous exercise,5 or more days per week(45-60 minutes Preferred)
• Eat 5 or more servings of vegetables and fruits per day
• Choose whole grains over processed grains
• Limit consumption of processed and red meats
• Limit alcoholic beverages to no more than 2 per day

American Institute for Cancer Research:

Engage in physical activity for at least 30 minutes per day

Avoid sugary drinks, limit processed, high sugar, and high-fat foods.

Eat more vegetables, fruits, whole grains, and legumes

Limit consumption of red meats

Limit alcoholic beverages to no more than 2 per day

Limit consumption of salty foods

Do not use supplements to protect against cancer

*Protein and Amino acid requirement

Muscle protein synthesis is evidently not shut off completely in patients with cancer because several studies suggest that this process is not impaired and remains responsive to the dietary supply of amino acids. According to a recent literature review, the dose of amino acids capable of supporting a positive protein balance in cancer patients might be close to 2 g/kg/day (Electronic supplementary material).

In subjects with normal kidney function, intake of protein in doses up to and above 2 g/kg/d are safe, in patients with acute or chronic renal failure protein supply should not exceed 1.0 or 1.2 g/kg/d, respectively. Recently, Deutz et al. reported the findings of a randomized clinical trial, showing that the administration of 40 g of amino acids (0.48 g/kg) when given as an oral nutritional supplement enriched in leucine and N-3 fatty acids to non-malnourished patients with advanced cancer, led to a significant increase in the fractional synthetic rate of muscle protein when compared to feeding a conventional supplement containing 24 g of protein.

Gamble first demonstrated that glucose reduces renal sodium excretion and, for the same reasons, the loss of extracellular fluid and Bloom suggested that this effect was mediated by insulin, a potent anti-natriuretic, and antidiuretic hormone through increased sympathetic activity. The effects of glucose-based PN on water and sodium retention have been demonstrated by Rudman et al.and were subsequently described in cancer patients by Fan et al., Bozzetti et al., and Gray and Meguid. In cancer patients, there may be excessive production of antidiuretic hormone (ADH) due to the tumor, to the presence of nausea, or to the administration of morphine.

Furthermore, severe malnutrition is associated with loss of intracellular water and solutes which, via hypothalamic ADH release, result in serum osmolality and sodium at subnormal levels. As a consequence, the clearance of free water is decreased, whereas the synthesis of endogenous water is maintained by the oxidation of carbohydrates and fat and insensible water loss drops due to reduced physical activity.

*The nutritional needs of cancer patients should be adequately met, independent of pharmaconutrient or pharmacologic treatment. Specific pharmacological agents may be required or helpful in gastrointestinal disorders with relevance to food intake or absorption as well as in states typically associated with decreased appetite, like microbial infections, chronic pain, or psycho-social distress.

This may include the following categories of agents, which are not a topic of this guideline, including suggested recommendations for their use.

• antiemetics to relieve nausea.
• antimicrobials to eliminate fungal, bacterial, or viral causes of gastrointestinal or other infections.
• analgesics to relieve chronic pain or pain associated with chewing, swallowing, or intestinal activity
• agents to induce saliva production in xerostomia
• anti-secretory agents to diminish excessive saliva production or vomiting in cases of impaired intestinal transport
• Inhibitors of gastric acid secretion and other substances to treat or protect against symptomatic mucosal lesions or oesophageal reflux.
• agents to maintain or normalize intestinal motility and to treat or avoid constipation or diarrhea.
• antidepressants, agents that relieve anxiety, mood modulators

• Assess hydration status. If oral intake is inadequate, encourage (noncaffeinated) cold fluids to help relieve mouth dryness.

• Increased liquid consumption may provide symptomatic relief but liquids have no lubricating properties, therefore sauces, gravies, salad dressings, and other high fat liquids should be encouraged for their lubricating effects and high calorie content.

• Recommend sips of fluid with each mouthful of food to aid in chewing and swallowing.

• In general, dietary texture and consistency changes (soft, moist, bland, not too salty) help minimize the discomfort associated with xerostomia.

• Foods not well tolerated include: plain, roasted or baked meats, poultry etc.; bread; crackers; bananas; dry cake; alcohol; extremely hot (temperature) foods.

• If xerostomia is only a temporary condition, mint or tart sugar-free gum/candy may help stimulate saliva. Citric acid containing beverages (preferably sugar-free) such as lemonade, orange flavored soft drinks, frozen juice bars, and sherbets may also help increase secretions.

• Foods or drinks containing sugar should be taken with meals and teeth should be cleaned afterwards

. • Discourage the intake of sweet, sticky, cariogenic foods such as dried fruits, candies, chocolates, honey, jams, jelly and sugar coated nuts.

• Xylitol (artificial sweetener), dairy products (especially cheddar cheese) and peanuts have been shown to have a protective effect on tooth decay. If the patient is unable to clean teeth after eating a potentially cariogenic food consumption of one of the above products afterward may provide some protection.

• Encourage patient to use fluoride gel applications daily and to clean teeth and mouth after every meal and snack. (BC Cancer Agency Care and Research, An agency of the Provincial Health Services Society)