Chapter 14 Consequences of Cancer ●

BOX 14.1 The American Institute for Cancer Research/World Cancer

Research Fund Recommenda- tions for Cancer Prevention

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Be as lean as possible without becoming underweight.

Be physically active for at least 30 minutes every day.

Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, low in fiber, or high in fat).

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Eat more of a variety of vegetables, fruits, whole grains, and legumes such as beans.

Limit consumption of red meats (eg, beef, pork, and lamb) and avoid processed meats.

If consumed at all, limit alcoholic drinks to two for men and one for women a day.

Limit consumption of salty foods and foods processed with salt (sodium).

Don’t use supplements to protect against cancer.

Special Population Recommendations ●

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It is best for mothers to breastfeed exclusively for up to six months and then add other liquids and foods.

After treatment, cancer survivors should follow the recommendations for cancer prevention.

Source: Adapted with permission from American Institute for Cancer Research. Recommendations for cancer prevention. www.aicr.org/site/PageServer? pagename=dc_home_guides. Accessed March 29, 2015.

location of the tumor and the extent of disease. Other factors impacting nutrition well-being include the effect of supportive care medications (eg, pain medica- tions, antiemetics, antibiotics) and preexisting comor- bidities. The timely identification and management of nutrition-impact symptoms affecting the client’s nutri- tional status can help to improve the person’s outcomes (6). Nutrition-impact symptoms of cancer and cancer treatment can include:

● ● ● anorexia cancer cachexia

changes in bowel habits—diarrhea, constipation, bloating

● changes in smell and taste—dysosmia, dysgeusia

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changes in swallowing—dysphagia, esophagitis, odynophagia

● ● ● ● fatigue

malabsorption, maldigestion mucositis, stomatitis

myelosuppression—neutropenia, thrombocytopenia, anemia

● ● ● nausea, vomiting

unintended weight loss xerostomia

According to the ON EBNPG for Oncology, cancer cachexia is defined as a multifactorial wasting syn- drome characterized by the ongoing loss of skeletal muscle mass with or without loss of fat mass and cannot be fully reversed by conventional nutrition support (6,9). Its associated symptoms may include progressive weight loss, generalized weakness, pain, metabolic alterations, oral and gastrointestinal con- cerns (eg, taste changes, xerostomia, nausea, consti- pation, and diarrhea), and anorexia. Cachexia can occur regardless of tumor size, type, or extent of disease. It is a common secondary diagnosis seen with advanced cancer and is associated with decreased survival and poorer prognosis. Myelosuppression (a decrease in the number of blood cells in the bone marrow) can occur as a result of chemotherapy, biotherapy, or radiation therapy. Conditions that characterize treatment-related bone marrow suppression include the following:

Neutropenia: a decreased number of circulating neu- trophils, which can increase the risk of infection, lead to prolonged hospital stays, and delay treatment

Thrombocytopenia: a decreased number of circulat- ing platelets, increasing the risk of bleeding and bruising

Anemia: decreased number of red blood cells or a reduction in the normal concentration of hemoglobin, which can result in fatigue and weakness While adherence to a neutropenic diet is no longer supported by evidence, attention to food safety is important for individuals at risk for treatment-related neutropenia and possible food-borne illness (6). Box 14.2 (see page 188) gives nutrition suggestions for cancer patients.

NUTRITION SCREENING AND ASSESSMENT

There is evidence that proactive nutrition screening and assessment improves and protects nutrition status and quality of life, which can lead to improvements in clinical outcomes (6,9). The Academy’s ON