Presentation is loading. Please wait.

Presentation is loading. Please wait.

Provided Courtesy of Nutrition411.com

Similar presentations


Presentation on theme: "Provided Courtesy of Nutrition411.com"— Presentation transcript:

1 Provided Courtesy of Nutrition411.com
Cancer: Nutritional Strategies for Managing Side Effects During Treatment Today we will discuss nutritional strategies for managing side effects during cancer treatment. Review Date 10/13 G-1505 1

2 Objectives Importance of nutrition Prevalence of side effects
Nutritional strategies This presentation will cover: The importance of nutrition during cancer treatment The common side effects during cancer treatment and their prevalence Nutritional strategies for managing these side effects 2

3 Good Nutrition Is Important
Good nutrition can help people with cancer: Feel better Fight fatigue Maintain body weight Consume enough vitamins and minerals Improve strength and energy Reduce risk of infection Manage treatment-related side effects Improve quality of life Good nutrition is important, especially for people with cancer. Good nutrition can help people with cancer: Feel better Fight fatigue Maintain body weight and nutrient stores Improve strength and energy levels Reduce the risk of infection Manage treatment-related side effects Improve quality of life Eating well means eating a variety of foods that provide the nutrients needed to maintain good health during cancer treatment. The right nutrients include protein, carbohydrate, fat, water, vitamins, and minerals. The side effects of cancer and cancer treatments can make it difficult to eat well. Appetite, taste, and the ability to eat enough food and absorb nutrients sometimes are affected. Malnutrition can result, making the individual too weak and tired to tolerate treatment. Malnutrition also plays a role in cancer mortality. Of people who die from cancer, up to half are malnourished, and as many as 20% die from the effects of malnutrition, rather than the cancer itself. Reference Ottery FD. Cancer cachexia: prevention, early diagnosis, and management. Cancer Pract. 1994;2(2): 3

4 People With Cancer Need Extra Nutrition
Healthy Individual Individual With Cancer Calories 25-30 Cal/kg Maintenance: Cal/kg Gain: Cal/kg Protein 0.8 g/kg Maintenance: g/kg with severe stress Healthy Individual Individual With Cancer Calories needed per day for a 150-lb person Maintenance: Gain: It is important to note that people with cancer often need extra nutrition, especially additional calories and protein. Not consuming enough calories and protein is a common nutritional problem for people with cancer. An increase in resting energy expenditure (REE) often is seen in people with cancer, especially those who have lost weight. Therefore, increasing calorie and protein intake is important for improving nutritional status. This chart shows that individuals with cancer, even those who just need to maintain their weight and lean body mass, have higher calorie and protein needs than healthy individuals. The needs of those patients who need to gain weight and/or lean body mass are even higher. Their calorie needs increase to between Cal/kg body weight. Few studies have examined the calorie and nutrient intake of people with cancer, but studies that have show that the majority of people with cancer have a calorie intake much lower than the general population and current calorie recommendations. Note to presenter (not shown on slide): One study found that cancer patients consumed only Cal/day, which was significantly lower than the 2262 Cal/day consumed by the control patients without cancer. Reference Levine JA, Morgan MY. Preservation of macronutrient preferences in cancer anorexia. Br J Cancer. 1998;78(5): Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012: Cal=Calorie, kg=kilogram, lb-pound 4

5 Prevalence of Side Effects
Treatment Weight Loss Fatigue Nausea/ Vomiting Oral Mucositis Taste Alterations Constipation Overall % 50%-90% 70%-100% 30%- 90% 40%-100% 35%- 70% 40%- 50% Chemotherapy Radiation Surgery Immunotherapy Treatment-related side effects are extremely common in people with cancer. These side effects can significantly impact both nutritional intake and weight status, and may result from the cancer and/or its treatment. This chart shows the prevalence of common side effects and what treatments they are typically related to. Common side effects include: Weight loss: Affects 50%-90% of people with cancer Fatigue: The most common side effect, affecting 70%-100% of people with cancer Nausea and vomiting: Prevalent mostly in people on chemotherapy and radiation, affecting 30%-90% of such patients Oral mucositis: Common for people on treatments such as chemotherapy, head and neck radiation, and bone marrow transplant, affecting 40%-100% of people with cancer Taste alterations: Affects approximately 35%-70% of people overall Constipation: A common side effect, especially for people taking opioid analgesics, with a 40%-50% occurrence in individuals with advanced cancer Nutrition can play a key role in the management of many side effects, including those shown here. Now we will discuss these side effects in more detail and list a few nutritional strategies that may help. References Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer. J Palliat Care. 1991;7(2):25-29; Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients: Eastern Cooperative Oncology Group. Am J Med. 1980;69(4): ; Leonard M, Navari RM. Special Report: 5-HT3 Receptor Antagonists and ECG Effects. Philadelphia, PA: McMahon; 2003; Lin EM. In: Yasko JM, ed. Nursing Management of Symptoms Associated With Chemotherapy. 5th ed. West Conshohocken, PA: Meniscus LTD; 2001; National Cancer Institute. Oral complications of chemotherapy and head/neck radiation (PDQ®), Health Professional Version. Cancer.org Web site. Accessed October 17, 2013; National Comprehensive Cancer Network. Cancer-related fatigue: clinical practical guidelines in oncology. J Natl Comp Can Netw. 2003;1(3): ; Prommer E. Taste alterations in cancer. Proc Am Soc Clin Oncol. 2003;769 (abstract 3093). = treatment in which side effect is common 5

6 Weight Loss Is Significant
50%–90% of people with cancer experience weight loss A weight loss of as little as 5% of body weight can cause reduced response to treatment Weight loss is associated with poor quality of life and reduced survival Cancer and cancer treatments cause many side effects—weight loss is a significant one. At the time of cancer diagnosis, many patients already have experienced substantial weight loss. As many as 50% to 90% of people with cancer develop weight loss at some point in the progression of cancer. In many instances, weight loss is the result of reduced dietary intake. This sometimes is because of mechanical obstruction of the upper or lower gastrointestinal tract caused by tumor growth or the side effects of cancer treatment, such as chemotherapy, radiation, or surgery. These cancer treatments can cause symptoms such as nausea, vomiting, diarrhea, altered taste and smell, mucositis, strictures, and malabsorption. Weight loss during cancer treatment is significant, because a loss of as little as 5% of body weight can cause a reduced response to treatment. Patients with weight loss may experience more toxicities from cancer treatments than patients without weight loss, leading to decreased ability to tolerate treatment and interruption in treatment. Weight loss also is associated with poor quality of life and reduced survival. References Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4): ; Davidson W, Ash S, Capra S, Bauer J; Cancer Cachexia Study Group. Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr. 2004;23(2): ; Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients: Eastern Cooperative Oncology Group. Am J Med. 1980;69(4): 6

7 Cycle of Malnutrition CYCLE OF MALNUTRITION Infections and Medications
Decreased Appetite Mouth Sores Diarrhea Eat Less Lose Weight Lose Strength CYCLE OF MALNUTRITION Tire Out Quickly Too Tired to Cook to Eat This diagram shows the cycle of malnutrition. Many factors come together that decrease oral intake and create a cycle that often is difficult to manage. It is far better to anticipate risk factors and put interventions in place to minimize or avoid cancer-related weight loss as early in this cycle as possible. 7

8 Nutritional Strategies for Weight Loss
Eat small, frequent meals Serve favorite foods Plan physical activity to stimulate appetite Use medical nutritional shakes and drinks to provide extra calories and protein Many nutritional strategies can help combat weight loss: Eat small, frequent meals throughout the day to help increase intake Serve favorite foods to help increase calorie and protein intake Plan some physical activity to stimulate appetite Have medical nutritional shakes or drinks to provide a convenient source of extra calories and protein 8

9 Fatigue Is Common Fatigue is most common side effect
Associated with treatment, pain, stress, and/or weight loss Effect on nutritional status: Weight gain/loss Changes in calorie intake Fluid and electrolyte imbalances Fatigue associated with cancer is defined as a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning. Fatigue is the most common side effect reported by people with cancer, affecting 70% to 100% of patients. Causes of fatigue include the cancer itself, treatments, pain, stress, sleep pattern changes, loss of lean body mass, and/or weight loss. Fatigue can lead to weight gain or loss, caloric intake changes, and fluid and electrolyte imbalances. Nutrition intervention can help make fatigue more manageable and may help decrease fatigue related to treatment. 9

10 Nutritional Strategies for Fatigue
Have small, frequent meals Prepare meals in quantity when feeling well Make easy-to-prepare foods Use ready-to-serve medical nutritional products for convenience and extra nutrition Many nutritional strategies can help fight fatigue: Have small, frequent meals that do not take much energy to make and consume Prepare meals in large amounts on days when feeling well, and freeze individual-sized portions for use on days when not feeling as well Make foods that require little or no preparation, such as sandwiches, frozen entrées, convenience foods, takeout foods, and nutrition/energy bars and shakes Use nutritional ready-to-serve medical nutritional products to provide a convenient source of extra nutrition 10

11 Nausea/Vomiting Common with chemotherapy and radiation
Effect on nutritional status: Dehydration/electrolyte imbalance Loss of appetite Poor intake of food and fluid Food aversions Weight loss Nausea and vomiting are common, especially as a result of chemotherapy and radiation to the whole body, head and neck, or abdomen. Nausea and vomiting affect nutritional status and can cause: Dehydration and electrolyte imbalance Loss of appetite Inability to consume adequate food and fluid Food aversions, which can lead to decreased calorie intake Weight loss Antinausea and antiemetic medications play an important role in managing nausea and vomiting, but it also is important to encourage nutritional interventions along with these medications. 11

12 Nutritional Strategies for Nausea/Vomiting
Eat small, frequent meals and snacks Try cold foods, ice chips, dry foods, and room-temperature foods Drink liquids between meals to avoid feelings of fullness The following nutritional strategies help with nausea and vomiting: Eat small, frequent meals and snacks throughout the day Try eating the following: – Cold foods, such as juice, yogurt, sherbet, and canned fruit – Ice chips – Dry foods – Room-temperature foods Drink liquids between meals to avoid feelings of fullness 12

13 Nutritional Strategies for Nausea/Vomiting (cont’d)
Avoid: Greasy, fatty, or spicy foods Strong food odors Very sweet foods Hot foods Drinking liquids with meals Favorite foods around treatment time Avoid the following: Greasy, fatty, or spicy foods Foods with strong odors Very sweet foods Hot foods Drinking liquids with meals—drink liquids between meals to avoid feelings of fullness Favorite foods around treatment times to avoid developing food aversions 13

14 Oral Mucositis Inflammation of the mucous membranes; red, burnlike sores and ulcers Effect on nutritional status: Decreased dietary intake Dehydration Malnutrition and weight loss Oral mucositis, a common complication of cancer treatments, especially head and neck radiation and high-dose chemotherapy, is inflammation of the mucous membranes of the mouth and presents as red, burnlike sores or ulcers. Oral mucositis can result in pain, infection, bleeding, and difficulty eating. This condition sometimes is so severe that it delays treatments, thus limiting the effectiveness of the cancer treatment program. Damaged oral mucosa and reduced immune status from chemotherapy and radiation also increase the risk of infection in the mouth. Oral mucositis can affect nutritional status and can result in: Decreased dietary intake because of pain, taste changes, and/or dry mouth Dehydration Malnutrition and weight loss 14

15 Nutritional Strategies for Oral Mucositis
Select soft foods Use a straw to make swallowing easier Avoid acidic, spicy, and dry foods Use high-calorie drinks and/or medical nutritional supplements Use the following nutritional strategies for managing oral mucositis: Select soft foods that are easy to chew and swallow, such as soups, stews, cottage cheese, milk shakes, etc Use a straw to make swallowing easier Avoid acidic, spicy, and dry foods that can irritate the mouth Use high-calorie drinks and/or medical nutritional supplements 15

16 Taste Alterations Are Significant
Mouth blindness—bitter/metallic taste Meat aversions Reduced ability to taste salt and sugar Cancer and its treatments may cause changes in a person’s sense of taste. Chemotherapy and head and neck radiation may cause foods to have no taste or to taste differently. These changes may result from damage to the taste buds, dry mouth, infection, and/or dental problems. A condition called mouth blindness, or taste blindness, may cause foods to taste bitter or metallic, especially meat and other protein foods. Individuals also may develop an aversion to meat, as well as a reduced ability to taste salt and sugar. 16

17 Taste Alterations Are Significant (cont’d)
Effect on nutritional status: Food aversions Loss of appetite Decreased dietary intake, especially of protein Weight loss Taste alterations can impact nutritional status by causing food aversions, loss of appetite, and decreased dietary intake, especially of protein foods, which also can lead to weight loss. 17

18 Nutritional Strategies for Taste Alterations
Use tart or sour foods to reduce metallic taste Season foods with herbs Serve foods cold or at room temperature The following are nutritional strategies for managing taste alterations: Use tart or sour foods, such as citrus fruits, cranberry juice, and pickles, to help reduce the metallic taste Season foods with herbs, such as onion, garlic, chili powder, and oregano Serve foods cold or at room temperature to help decrease the taste and smell of foods, making them easier to tolerate 18

19 Constipation Constipation is common, especially among people taking opioid analgesics Effect on nutritional status: Loss of appetite Decreased dietary intake Weight loss Constipation sometimes is a symptom of cancer, a result of a growing tumor, or a side effect of cancer treatment. It is a common side effect of opioid analgesics, inadequate fluid intake, inactivity, and immobility. Constipation can affect nutritional status. People with constipation may have a lack of appetite because of symptoms such as bloating and a feeling of fullness. This may lead to decreased dietary intake and can result in weight loss. 19

20 Nutritional Strategies for Constipation
Choose high-fiber foods Drink plenty of fluids Keep physically active if you are able Avoid or limit gas-forming foods and beverages These nutritional strategies may help manage constipation: Follow a high-fiber diet, which includes foods such as beans, fruits, vegetables, and whole grains Drink plenty of fluids each day Understand the importance of adequate exercise Avoid or limit gas-forming foods and beverages from the diet, such as dairy products, if they cause bloating and gas problems 20

21 Summary Nutritional status is critical during cancer and its treatment
Treatment-related side effects are common Nutritional strategies can help manage many side effects We have discussed many aspects of nutrition and cancer, especially the connection between nutrition and the side effects of cancer treatment. In summary: Nutritional status is critical during cancer and its treatment—an adequate nutritional status can have many significant benefits, including helping to improve strength, immune function, and treatment tolerance Treatment-related side effects are common, especially fatigue and weight loss Many nutritional strategies, including the use of medical nutritional shakes and drinks, can help patients with cancer manage their side effects 21

22 References Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4): Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer. J Palliat Care. 1991;7(2):25-29. Davidson W, Ash S, Capra S, Bauer J; Cancer Cachexia Study Group. Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr. 2004;23(2): Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients: Eastern Cooperative Oncology Group. Am J Med. 1980;69(4): Leonard M, Navari RM. Special Report: 5-HT3 Receptor Antagonists and ECG Effects. Philadelphia, PA: McMahon; 2003. Levine JA, Morgan MY. Preservation of macronutrient preferences in cancer anorexia. Br J Cancer. 1998;78(5): 22

23 References (cont’d) Lin EM. In: Yasko JM, ed. Nursing Management of Symptoms Associated With Chemotherapy. 5th ed. West Conshohocken, PA: Meniscus LTD; 2001. Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012: National Cancer Institute. Oral complications of chemotherapy and head/neck radiation (PDQ®), Health Professional Version. Cancer.org Web site. Accessed October 17, 2013. National Comprehensive Cancer Network. Cancer-related fatigue: clinical practical guidelines in oncology. J Natl Comp Can Netw. 2003;1(3): Ottery FD. Cancer cachexia: prevention, early diagnosis, and management. Cancer Pract. 1994;2(2): Prommer E. Taste alterations in cancer. Proc Am Soc Clin Oncol. 2003;769(abstract 3093).   23


Download ppt "Provided Courtesy of Nutrition411.com"

Similar presentations


Ads by Google