Nutrition basics in Cancer (for nursing).pptx

This presentation gives an introduction to the importance of nutrition in cancer treatment. This presentation will provide nurses with a basic understanding of the work of medical nutrition therapy. This presentation will allow nurses to use the basics of nutrition in cancer for better treating a cancer patient.

1. Nutrition Cancer Sakul Rai Clinical Dietitian BSc. Nutrition & Dietetics

2. Nutrition Cancer Sakul Rai Clinical Dietitian BSc. Nutrition & Dietetics

3. “ One quarter to one third of all of the cancers that occur are due to poor nutrition, physical inactivity, and excess weight - World Cancer Research Fund

4. “ poor nutrition ” Excessive intake of Alcohol, Tobacco, Saturated-Trans fat, high-glycemic diet, smoked, grilled, preserved/processed, red-meats

5. “ poor nutrition ” Excessive intake of Alcohol, Tobacco, Saturated-Trans fat, high-glycemic diet, smoked, grilled, preserved/processed, red-meats

6. Malnutrition Oncology patients are at high risk of malnutrition due to treatment side effects, and metabolic and physiological side effects of cancer. As many as 20% of patients with cancer die from the effects of malnutrition rather than malignancy.

7. Malnutrition Oncology patients are at high risk of malnutrition due to treatment side effects, and metabolic and physiological side effects of cancer. As many as 20% of patients with cancer die from the effects of malnutrition rather than malignancy.

8. Poor Nutrition Cancer Poor treatment outcome Malnutrition

9. Cancer Poor Nutrition Poor treatment outcome Malnutrition

10. Poor treatment outcome Cancer Poor Nutrition Malnutrition

11. Importance of nutrition in cancer care

12. Appropriate nutrition (Medical Nutrition Therapy) Importance of nutrition in cancer care improves treatment tolerance decreases unintentional weight & lean body mass reduces the need for breaks in treatment & unplanned hospitalizations by >50%, reduce length of hospital stays and can improve quality of life, overall survival for patients undergoing cancer treatment

13. Nutritional needs in cancer patients Tumor growth increases energy demand. Protein and fat breakdowns at high rates to maintain the high energy demand. So high protein and calories are needed during treatment to prevent and slow down malnutrition or cachexia.

14. Nutritional needs in cancer patients Tumor growth increases energy demand. Protein and fat breakdowns at high rates to maintain the high energy demand. So high protein and calories are needed during treatment to prevent and slow down malnutrition or cachexia.

15. Nutritional needs in cancer patients Tumor growth increases energy demand. Protein and fat breakdowns at high rates to maintain the high energy demand. So high protein and calories are needed during treatment to prevent and slow down malnutrition or cachexia.

16. The role of dietitian

17. “ The role of a dietitian in an oncology setting is to provide personalized nutrition care that helps manage treatment side effects, prevent or address malnutrition, and improve patients' overall quality of life and treatment outcomes The role of dietitian

18. Delivering “ Medical nutrition therapy ” by using the “ Nutrition Care Process ” The role of dietitian

19. Assessment Diagnosis Intervention Monitoring & Evaluation NCP Nutrition Care Process

20. Assessment Height Weight MUAC

21. BMI Score >20 (> 30 Obese) 18.5-20 1 <18.5 2 Unplanned weight loss in past 3-6 months % Score <5 5-10 1 >10 2 If the patient is acutely ill and there has been or is likely to be no nutritional intake for > 5 days Score 2 Add scores together Overall Score Risk Low risk 1 Medium risk ≥2 High risk MUST (Malnutrition Universal Screening Tool) Assessment Routine clinical care Observe Refer to dietitian Management guideline

22. BMI Score >20 (> 30 Obese) 18.5-20 1 <18.5 2 Unplanned weight loss in past 3-6 months % Score <5 5-10 1 >10 2 If the patient is acutely ill and there has been or is likely to be no nutritional intake for > 5 days Score 2 Add scores together Overall Score Risk Low risk 1 Medium risk ≥2 High risk MUST (Malnutrition Universal Screening Tool) Assessment Routine clinical care Observe Refer to dietitian Management guideline

23. PES statement Nutrition diagnosis identifies the specific nutrition problems that can be resolved or improved through nutrition intervention Diagnosis

24. Problem Etiology Sign and Symptom Inadequate oral intake related to chemotherapy-induced nausea, as evidenced by unintentional weight loss of 3% in 1 month. Diagnosis

25. Problem Sign and Symptom Inadequate oral intake related to chemotherapy-induced nausea, as evidenced by unintentional weight loss of 3% in 1 month. Etiology Diagnosis

26. Problem Sign and Symptom Etiology Inadequate oral intake related to chemotherapy-induced nausea, as evidenced by unintentional weight loss of 3% in 1 month. Diagnosis

27. Problem Sign and Symptom Etiology Inadequate oral intake related to chemotherapy-induced nausea , as evidenced by unintentional weight loss of 3% in 1 month. Diagnosis

28. Problem Sign and Symptom Etiology Inadequate oral intake related to chemotherapy-induced nausea , as evidenced by unintentional weight loss of 3% in 1 month . Diagnosis

29. Individualized nutrient requirement calculation Nutrient delivery through in-house catering services Personalized counseling by giving diet-chart Intervention

30. Changes in anthropometric measurements Input/Output charting Biochemical data, medical tests, and procedures Clinical symptoms Medications Nutrition-focused physical findings Patient/family/client medical/health history and social history Monitoring and Evaluation

31. Referral/Admission Clinical Dietitian Screening/Assessment Nutritional Diagnosis Nutrient Calculation Medical Nutrition Therapy Diet order slip Management dietitian Feeding preparation by kitchen staff Review diet order slip Management dietitian Feed sent to patients Feeding quality review WO R K F LOW

32. So what is preventing adequate nutrition ? Nutrition impact symptoms (NIS) They are unique symptoms and side effects of cancer and cancer treatment that directly affect the nutrition status resulting in a depletion of nutrient stores and deterioration in nutrition status

33. So what is preventing adequate nutrition ? Nutrition impact symptoms (NIS) They are unique symptoms and side effects of cancer and cancer treatment that directly affect the nutrition status resulting in a depletion of nutrient stores and deterioration in nutrition status

34. Nausea & Vomiting Inadequate Nutrition Early satiety Mucositis Diarrhea Constipation Dysphagia Xerostomia Anorexia Steatorrhea Altered taste or smell Neutropenia Dysgeusia

35. Practical Dietary Strategies for Managing NIS NIS Nutritional management Dysphagia Change textures of foods based on level of dysphagia; Thickening agents may be indicated for fluids Mucositis Consume soft, nonfibrous, nonacidic foods; Avoid hot foods and beverages Xerostomia Chew sugar-free gum or suck on tart candies; Use sauces and gravies to moisten foods Dysgeusia Metallic taste : Use plastic utensils; eat nuts, cheese, and poultry for protein as red meats are often not tolerated; Sweet sensitivity : Drink flavorless supplements or diluted juices Impaired taste : Use spiced or very flavorful foods Esophagitis/ gastritis Eat bland, pureed, or soft foods; Avoid alcohol, coffee, or spicy and acidic foods Radiation enteritis Follow a lactose-free and low-fat diet; Drink electrolyte-fortified beverages for hydration Nausea & Vomiting Early satiety Mucositis Diarrhea Constipation Dysphagia Xerostomia Anorexia Steatorrhea Altered taste or smell Neutropenia Dysgeusia

36. Practical Dietary Strategies for Managing NIS NIS Nutritional management Dysphagia Change textures of foods based on level of dysphagia; Thickening agents may be indicated for fluids Mucositis Consume soft, nonfibrous, nonacidic foods; Avoid hot foods and beverages Xerostomia Chew sugar-free gum or suck on tart candies; Use sauces and gravies to moisten foods Dysgeusia Metallic taste : Use plastic utensils; eat nuts, cheese, and poultry for protein as red meats are often not tolerated; Sweet sensitivity : Drink flavorless supplements or diluted juices Impaired taste : Use spiced or very flavorful foods Esophagitis/ gastritis Eat bland, pureed, or soft foods; Avoid alcohol, coffee, or spicy and acidic foods Radiation enteritis Follow a lactose-free and low-fat diet; Drink electrolyte-fortified beverages for hydration

37. Practical Dietary Strategies for Managing NIS NIS Nutritional management Dumping syndrome Avoid drinking beverages with meals; Consume soluble fiber Follow a lactose-free diet Nausea Avoid noxious odors by using microwaves or opening windows when cooking Vomiting Avoid greasy foods the day of treatment; Drink electrolyte-fortified beverages after vomiting Constipation Ensure adequate fiber and fluid intake Diarrhea Avoid highly concentrated sweets, sip electrolyte; fortified beverages, eat soluble fiber Steatorrhea Take pancreatic replacement enzymes, follow a low-fat diet, supplement with medium-chain triglyceride oil Anorexia Maximize intake when appetite is present; Limit fluid with meals to avoid feeling of fullness; Eat small, frequent meals

38. Supporting oral intake Trying new variety of recipes using cook books

39. Supporting oral intake Trying new variety of recipes using cook books Additional nutritional support Enteral and Parenteral Nutrition & Oral Nutritional Supplements when the oral feeding route is unavailable or not tolerated or not sufficient

40. Additional nutritional support Enteral and Parenteral Nutrition & Oral Nutritional Supplements when the oral feeding route is unavailable or not tolerated or not sufficient

41. Additional nutritional support Enteral and Parenteral Nutrition & Oral Nutritional Supplements when the oral feeding route is unavailable or not tolerated or not sufficient

42. Additional nutritional support

43. Possible food-drug interactions

44. Prescribed drugs has the potential to affect alter nutrient metabolism and nutritional status. Possible food-drug interactions

45. Individuals with certain types of lung cancer who are being treated with Pemetrexed require V-B12 (often by injection) and folic acid supplementation throughout the duration of their therapy to avoid significant anemia associated with this chemotherapy agent. Possible food-drug interactions

46. A severe hypertensive event is possible when tyramine-rich foods and beverages are consumed while taking Procarbazine , a chemotherapy agent commonly used to treat brain cancer. Possible food-drug interactions

47. Individuals with colon cancer receiving Oxaliplatin should not drink, eat, or handle cold drinks or foods for up to 5 days because of treatment-related neuropathy or transient paresthesia of the hands, feet, and throat. Possible food-drug interactions

48. Individuals with certain types of cancer or rheumatoid arthritis who are being treated with Methotrexate may benefit from supplemental folate which can reduce the toxicity of treatment similar or better than a common medication given for the same effect, leucovorin. Possible food-drug interactions

49. Cyclophosphamide causes bladder irritation, acute hemorrhagic cystitis. Maintain high fluid intake (2–3 L daily) to induce frequent voiding. Possible food-drug interactions

50. Avoid grapefruit /related citrus (limes, pomelo, Seville oranges) with Erlotinib ( Tarceva ). Hold tube feeds 2 h before and 1 h after drug. It can cause a rash and profound diarrhea unless taken on an empty stomach Possible food-drug interactions

51. To prevent unnecessary gastric upset, individuals taking the medication capecitabine (Xeloda) must take the medication within 30 minutes of eating food or a meal. Possible food-drug interactions

52. When using Warfarin (Coumadin) consistent intake of vitamin K–containing foods and supplements is required, not complete avoidance to achieve desired state of anticoagulation. Possible food-drug interactions

53. Practical takeaways

54. Practical takeaways Early referral to a dietitian using nutritional screening tools Promote Small, Frequent Meals, Protein Intake Monitor and encourage hydration Educate Patients on Food Safety when immunocompromised Offer quick advice for common Nutrition Impact Symptoms Identify common food-drug interactions Help identify appropriate supplements and timing for patients Monitor Weight and Muscle Mass

55. Practical takeaways Early referral to a dietitian using nutritional screening tools Promote Small, Frequent Meals, Protein Intake Monitor and encourage hydration Educate Patients on Food Safety when immunocompromised Offer quick advice for common Nutrition Impact Symptoms Identify common food-drug interactions Help identify need for appropriate nutritional support Monitor Weight and Muscle Mass