In patients with advanced tumor protein-calorie malnutrition is a recurring problem due to factors such as a form of anorexia that is established, to maldigestion, malabsorption, and difficulty in chewing and swallowing. You should provide foods that are consumed in sufficient quantities to cover the caloric and protein requirements, aimed at correcting the nutritional deficiencies and minimize the reductions in weight. Maintaining an adequate nutritional status may also reduce complications to cancer therapy contributing to the welfare of the patient. This is why nutritional therapy is an essential part of the treatment of cancer patients.
nutritional effects of cancer
Malnutrition interferes with the immune humoral and cellular, but not only with the functions and the reparative tissue. The impairment of liver function may also change the metabolism of drugs. For this reason, malnutrition may interfere with cancer treatment and increase the severity of side effects.
malnourished patients are unable to tolerate surgery, chemotherapy or radiation therapy instead of those in better nutritional status. For all these reasons, cachexia may threaten the patient's life more local effects of the tumor. The cancer cachexia presents clinically with anorexia, altered taste perception, and therefore loss of weight, muscle mass and appearance of malnutrition that cause a general reduction in physical function, immune and mental. The causes of this syndrome, anorectic-cachectic are not yet fully known. Although the reduction in the contribution
nutritional seems the main cause of decay, it can not fully explain the gradual weight loss that often occurs with an apparently adequate nutritional intake. In general, however, the tumor is usually considered too small to have an effect of absorption so remarkable as to have the metabolic decay of the host, although the presence of a tumor can induce alterations in the metabolism of carbohydrates, fats and proteins that can cause an increase in energy demands.
nutritional effects of cancer therapy
Goals of dietary treatment
Diet for cancer patients must be studied and adapted to each application taken keeping in mind the prognosis of the disease itself, so as to adjust the intensity of the intervention diet (support, aid or palliative). All patients with nutritional problems should be closely followed and helped to understand the role of nutrition in the treatment of their disease. The dietary changes depend on the degree of anorexia, alteration of the sense of taste, nausea, a sense of early satiety, weight loss and the consequences of therapy.
Dietary Recommendations
1. Should be identified a detailed food history to determine changes in weight in the past, preferences and eating habits, the use of nutritional supplements, today's protein-calorie intake, food intolerance, abnormal sense of taste, the distribution of meals during the day, an indication of who is responsible for preparing the meal and whether the patient is able to eat alone or not. Care should be taken as a nutritional side effects related to past or current treatment.
2. The information obtained by history food should be carefully followed in the formulation of the diet. The proposed interactive module highlights the potential nutritional problems of cancer therapy, suggesting that some dietary approaches to autare the patient to cover the nutritional requirements.
3. The effect of tumor metabolism is only partially known and can not locate the minimum calorie and protein sufficient to cover the needs of the patient with cancer. Also, it currently can not be defined yet energy sources (carbohydrates and lipids) and the quantity and quality of protein needed to maintain nitrogen balance. For this reason, protein-calorie dietary recommendations on the assumption should be checked daily and changed over time according to individual response.
4. If the patient has weight loss, the first nutritional objective is to prevent further weight loss. Numerous studies have shown that megestrol acetate may cause stimulation of the sense of appetite in patients with advanced malignancies. This therapy should be considered for patients with anorexia and cachexia.
5. If the patient complains of nausea as a result of cancer, radiation therapy or chemotherapy may be useful to the use of an antiemetic such as prochlorperazine The drug should be administered 30 to 60 minutes before a meal. Also, if you have pain that interferes with the power-I, the use of an analgesic before meals may increase the urge to eat.
6. Should be clearly explained to the patient the need to change the characteristics of meals and snacks daily. For example, a patient used to, before the diagnosis of cancer, not to take snacks and / or dessert to avoid weight gain, you should explain that this habit is no longer adequate. They will also be liberalized previous dietary restrictions (check cholesterol, fat, total caloric intake).
7. The dietary recommendations should take into account the possibilities and capabilities the patient to prepare food. If he is only the tip of the day will be to use foods that are easy to prepare.
8. The patient must be given in writing of the dietary guidelines and must be encouraged to use the foods suggested in the recommended amounts. However, the patient should not be unduly pressured by family and friends about the issues concerning his lack of power because this could increase the anxiety and become counterproductive.
9. When their prescription diet should include all natural foods. In some cases it may be useful for integration with high-calorie products and high-protein, in liquid form. Predigested products for nutrition (primary) should be used only if specifically indicated, as in the presence of malabsorption (fat malabsorption).
10. The multivitamin and mineral supplements should be given to patients who are unable to introduce a well-balanced diet or who have specific deficiencies.
The progress of the patient should be followed at regular intervals to assess the improvement of nutritional status. The monitoring of the patient over time offers the possibility to change the prescription diet in relation to response to treatment.
If efforts to oral feeding fail or are impossible to undertake, it may be necessary to use alternative methods of nutrition, such as feeding tube, enteral or parenteral nutrition, into the bloodstream.
The use of aggressive nutritional support is effective for many patients undergoing treatment, and which have a high probability of getting a positive response from antineoplastic therapy. However, the use of nutritional support for terminal cancer patients is of doubtful value. In the latter case, the suggestions are more appropriate for oral feeding, depending on the tolerance and support from a psychological point of view. For patients terminal state should be emphasized the pleasurable aspects of food, paying less attention to the quantity and calorie content.
Weight gain and obesity are common events in patients with breast cancer. Bone metastases can cause serious problems in overweight, such as pathological fractures. Some evidence suggests that the risk of the cancer worsened or increased in overweight patients. That is why obesity should be treated.
Bibliography:
1. P Binetti, M. Marcelli, R. Bals. (2007) Handbook of Clinical Nutrition and Dietary Applied Sciences. " Company Editrice Universo. Rome.
2. Sylvia Escott-Stump. (2005). "Nutrition, Diagnosis and Treatment." Mc Graw Hill. 5 Edition. Mexico.
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