1. Nutritional Support in Cancer and AIDS
Chapter 23

2. Nutritional Support in Cancer and AIDS
Although AIDS and cancer share a direct relation to the body’s immune system and basic nutritional needs, their courses and fatal outcomes are distinct
This chapter looks at nutritional support in relation to both cancer and AIDS
Both conditions have important nutritional connections in prevention and therapy.

3. Objectives: Describe process of cancer development
Describe nutritional support for cancer treatment
Identify conclusions of cancer therapy and prevention
Describe the process of AIDS development

4. Nutritional Support in Cancer and AIDS
Key Concepts:
Environmental agents, genetic factors, and any weaknesses in the body’s immune system can contribute to the development of cancer.
The strength of the body’s immune system relates to its overall nutritional status

5. Nutritional Support in Cancer and AIDS
Key Concepts cont.
Nutritional problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS
The progressive effect of the human immunodeficiency virus (HIV) through its three stages of white T-cell destruction requires aggressive nutrition therapy

6. Cancer – It’s Nature
Malignant tumor (neoplasm) can express itself in multiple forms
The relationship of nutrition and cancer care focus on the following 2 fundamental areas:
Prevention
Therapy

7. Cancer – It’s Nature
Normal cell: the process of individual cell growth and reproduction occurs continually
Cell division is guided by the genetic code contained in the cell nucleus, DNA
This orderly cell operation can be lost by:
Mutation (change in the regulatory genes)

8. Cancer – It’s Nature
Cell growth may form malignant tumors when normal gene control is lost
Tumors are identified by primary site of origin and stage of growth
The misguided cell and its tumor tissue represent normal cell growth that has gone wrong

9. Causes of Cancer Cell Development
Underlying cause is the fundamental loss of cell control over normal cell reproduction due to:
Mutations – changes in the genes, esp. the regulatory genes

10. Causes of Cancer Cell Development
Chemical carcinogens – Agents that cause cancer are call carcinogens. Chemical substances which interfere with the structure or function of regulatory genes may result in gene mutation, damage to gene regulation, or activation of a dormant virus

11. Causes of Cancer Cell Development
Radiation damage – may come from xrays, radioactive materials, sunlight, or atomic wastes Includes skin cancers such as Basal cell carcinoma, squamous cell carcinoma, and melanoma

12. Causes of Cancer Cell Development
Viruses – Oncogenic (tumor inducing viruses) viruses interfere with the function of regulatory genes, taking over the cell machinery to reproduce themselves

13. Causes of Cancer Cell Development
Epidemiologic factors - race, region, age, heredity, occupation and diet

14. Causes of Cancer Cell Development
Stress and dietary factors – Stress can lead to reduced immune response to disease; poor food behaviors, nutritional status, and overall of oxidative stress make a person more vulnerable to cancer-producing factors.

15. The Body’s Defense System
Two populations of lymphocytes in immune system:
T cells
Derived from thymus cells
Activate phagocytes that attack antigens
B cells
Derived from bursal intestinal cells
Produce antibodies that attack antigens
These are part of a “search and destroy” defense for detecting and killing alien, non-self substances that carry potential for disease.

16. Nutrition and Immunity
Inadequate nutrition weakens the immune system
Antibodies are the core of the immune system; protein in structure

17. Nutrition and Immunity
Severely malnourished persons show changes in the structure and function of their immune system
Changes result from atrophy of losses in the basic tissues involved (liver, bowel wall, bone marrow, spleen, and lymphoid tissue).
Nutrition is fundamental in maintaining normal immunity and combating sustained attacks of diseases such as cancer.

18. Nutrition and Healing
Body tissue strength depends on ability to build and rebuild, which requires optimal nutrition intake
Protein and key vitamins and minerals, as well as nonprotein energy sources, must be constantly supplied by the diet

19. Nutritional Support for Cancer Treatment
3 major forms of therapy are used today as medical tx. of cancer
Surgery
Radiation
Chemotherapy
Each one requires nutritional support

20. Surgery
All surgery requires nutritional support for the healing process
General condition of cancer patients is often weakened by the disease process and its drain
on body resources

21. Radiation Therapy
Involves high-energy x-rays targeted on the cancer site
Often kills surrounding healthy cells as well as cancerous cells
Nutritional problems driven by site and intensity of radiation treatment

22. Radiation Therapy
Radiation to the head, neck, and esophagus affects the oral mucosa and salivary secretions  affects taste, sensitivity to food texture and temperature  anorexia and nausea
Radiation to the abdominal area affects the intestinal mucosa, causing loss of villi and absorption area  malnutrition

23. Radiation Therapy
Ulcers, inflammation, obstruction, or fistulas may develop from tissue breakdown.
Fistula – an abnormal opening or passageway within the body or to the outside.

24. Chemotherapy
Drugs kill rapidly growing cancer cells but also affect healthy cells
Drug side effects on rapidly growing healthy tissue include: GI
Bone marrow
Hair follicles

25. Chemotherapy
GI tract: numerous problems that interfere with food tolerance:
n/v/d; loss of normal taste sensations; lack of appetite, ulcers, malabsorption, stomatitis
Bone Marrow: interference with the production of specific blood factors reduced RBCs  anemia; reduced WBCs  lowered resistance to infection; reduced platelets  bleeding

26. Chemotherapy
Hair Follicles: interference with normal hair growth  hair loss

27. Systemic Effects of Cancer
Cancer causes several systemic effects which in turn cause continuing weight loss:
Anorexia, loss of appetite  poor food intake
Increased metabolism  resulting in increased energy and nutrient need
Negative nitrogen balance  more breakdown (catabolism) of body tissue

28. Cachexia
Extreme weight loss and weakness caused by inability to ingest or use nutrients
Body feeds off its own tissue protein
Experienced by half of all cancer patients
Aggressive nutrition therapy is necessary

29. Cachexia

30. Objectives of Nutrition Therapy
Prevention of catabolism
Meet increased metabolic demands
Relief of symptoms

31. Principles of Nutritional Care
Basic principles of nutritional care underlie all sound patient care:
Identify needs
Planning care based on these needs

32. Principles of Nutritional Care
Nutrition assessment
Determine and monitor nutritional status
Body measurements, calculations of body composition, laboratory tests, physical examination, clinical observation, dietary analysis
Personal care plan
Daily plan for nutrition therapy incorporated into nursing care plan

33. Nutritional Needs
Nutritional Therapy must meet specific nutrient needs and goals related to the accelerated metabolism
Energy
Protein
Vitamins and minerals
Adequate fluid intake

34. Nutritional Needs
Energy – the hypermetabolic nature of the disease and its healing requirements place great energy demands on a cancer patient
Need sufficient fuel from CHO, and some fat to spare protein to do vital tissue rebuilding
Increase kcals

35. Nutritional Needs
Protein – To offset tissue breakdown by the disease requires essential amino acids and nitrogen
Increase intake of high quality protein

36. Nutritional Needs
Vitamins and Minerals – Key vitamins and minerals control protein and energy metabolism through their coenzyme roles
Play a role in building and maintaining strong tissue
Often use of vitamin and mineral supplements

37. Nutritional Needs Fluid
To replace GI losses from fever, infection, vomiting or diarrhea
To help the kidneys dispose of metabolic breakdown products from destroyed cancer cells and chemo toxins

38. Nutrition Management Enteral: Oral Diet
Oral diet with supplementation is optimal when tolerated
Food plan must include adjustments in food texture and temperature, food choices, and tolerances

39. Nutrition Management Loss of appetite Mouth problems
Anorexia is a vicious cycle
A vigorous program of eating that does not depend on appetite for stimulus must be planned with pt./family
Mouth problems
Taste loss; changes in taste sensations
Decreased saliva
Consider artificial saliva, adding sauces and gravies to food, good oral care habits

40. Nutrition Management GI problems Pain and discomfort
Nausea and vomiting
Small frequent feedings of soft-> liquid cold foods may help; antiemetics
Pain and discomfort
More able to eat if pain is controlled

41. Nutrition Management Enteral: Tube feeding Parenteral nutrition PPN
TPN

42. Tips for Controlling Nausea and Vomiting
Try smaller, more frequent meals.
Eat more when feeling better.
Eat drier foods with fluids in between.
Try cold foods, saltier foods.
Avoid fatty or overly sweet foods.
Do not recline immediately after eating.
Replace fluids and electrolytes.
Use foods with pleasant aromas.

43. Tips for Increasing Energy and Protein Intake
Add high-calorie condiments, sauces, dressings
Add extra ingredients during food preparation
Drink commercial food supplements
Avoid low-calorie foods and beverages
Have a meal or snack every 1-2 hours

44. Prevention: Reduce the Risk
American Cancer Society
Eat a variety of healthful foods
Adopt a physically active lifestyle
Maintain a healthful weight
Limit alcohol consumption
U.S. Food and Drug Administration
Low-fat diets rich in grain products, fruits, and vegetables may reduce the risk of some cancers

45. Acquired immunodeficiency syndrome

46. Human Immunodeficiency Virus
Virus causes immune system suppression
Created a widespread epidemic and pandemic proportions

47. Process of AIDS Development
Parasitic nature of the Human Immunodeficiency Virus
No virus can have a life of its own.
Can only live through a host
When invade and infect a host, they “hijack” the host’s cell machinery to run off a multitude of copies of themselves
The “ultimate” parasite
The current deadly strength of HIV results from its aggressive growth within an increasing number of hosts.

48. Stages of Disease Progression
Stage 1: Primary HIV infection
Transmitted from an infected person to another person through sexual contact, sharing needles, or blood transfusion
Flu-like symptoms 2-4 weeks after initial exposure; lasts about 1 wk.
Reflects the initial development of antibodies to the virus
Subsequent HIV testing is +
This “well period” = viral incubation and multiplication

49. Stages of Disease Progression
Stage 2: AIDS-related complex
Infectious illnesses invade the body
“Opportunistic” infections: at this point, the HIV infection has killed enough host-protective WBCs to damage the immune system severely and lower the body’s normal disease resistance

50. Stages of Disease Progression
Stage 3: Final stages of AIDS
Rapidly-declining T-helper lymphocyte counts  < 200/mcL
Severe immunodeficiency  several diseases occur (Kaposi's sarcoma, protozoan parasites, CMV, lymphomas, TB, etc.)

51. Goals of Medical Management
Delay progression of the infection and improve the immune system
Toxic effects of HIV drugs
Prevent opportunistic illnesses
Recognize the infection early and provide rapid tx. for complications including infections and cancer

52. Severe Malnutrition, Weight Loss
Decreased appetite, insufficient energy intake in addition to elevated resting energy expenditure
Major weight loss, eventual cachexia
Malnutrition suppresses cellular immune function  perpetuating the onset of opportunistic infections

53. Causes of Body Wasting Inadequate food intake
Malabsorption of nutrients
Disordered metabolism

54. Lipodystrophy
Megace (megestrol) used in treating the cachexia and wasting syndrome in AIDs and cancer patients
A synthetic hormone which improves appetite and food intake  weight gain
Majority of wt. gain is fat mass, not lean tissue
Disproportionate gaining of fat mass = Lipodystrophy, however, there is continued wasting of lean tissue
This drug was determined to be not the best choice.

55. Nutrition Assessment Anthropometry Biochemical tests
Clinical observations
Diet observations
Environmental, behavioral and psychological assessment
Financial assessment

56. Principles of Nutrition Counseling
Motivation for dietary changes
Rationale for nutrition support
Provider-patient agreement on plan
Development of manageable steps for change
Development of personal food management skills
Community programs
Psychosocial support