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Part II Nutrition Assessment, Consequences, and Implications

EBNPG Workgroup found the following four nutri- tion screening tools to be valid and reliable for deter- mining malnutrition risk in adults with cancer: Inpatient and Outpatient Settings:

●

Patient-Generated Subjective Global Assessment (PG-SGA)

● Malnutrition Screening Tool (MST)

Inpatient Setting Only: ●

●

Malnutrition Screening Tool for Cancer Patients (MSTC)

Malnutrition Universal Screening Tool (MUST) (6)

Nutrition Assessment of Energy

and Nutrient Requirements Adequate intake of macronutrients and micronutrients is necessary for an individual to maintain his or her weight and nutritional stores while undergoing and recovering from cancer treatment. The following factors should be considered when assessing nutritional status and determining energy and nutrient require- ments in the cancer care setting (10,11):

● ● stage and extent of cancer diagnosis

goal or intent of cancer treatment—cure, control of disease, or palliation

●

treatment modalities—surgery, radiation therapy, or systemic therapy (eg, chemotherapy, biother- apy, hormone therapy, vaccine therapy)

● ● ●

presence and extent of malnutrition presence and extent of comorbidities

stress factors—presence of fever, infection, edema

● advance directives

The Academy’s ON EBNPG for Critical Illness states that the most precise method for estimating resting metabolic rate and determining the energy needs of the critically ill is to perform indirect calorimetry (12). However, outside of acute care, this type of method is often unrealistic or not possible because it requires medical equipment and specialized training. Therefore, in the cancer care setting, predictive equa- tions for estimating energy requirements are com- monly utilized. Examples of these equations include the Mifflin-St Jeor equation and the Harris Benedict equation (13,14,15). Quick methods for estimating energy needs for individuals with cancer do not have evidence-based validation but are often used by clini- cians. The calculations shown in Tables 14.1 and 14.2 are based on body weight and the individual’s specific

● ● ● ● ● ● ● ● ● ●

BOX 14.2 Nutrition Suggestions for Individuals Undergoing Cancer Treatment

The following foods may contain bacteria and can possibly lead to food-borne illness and should be avoided: ●

undercooked foods containing raw eggs, such as eggnog, Caesar dressing, smoothies;

● nonpasteurized milk or dairy products; ●

soft cheeses such as Brie, Camembert, feta, Mexican-style cheese (queso blanco fresco), or blue cheese (Roquefort, Gorgonzola, Stilton);

raw or undercooked meat or poultry, espe- cially ground meats;

raw or lightly cooked fish, shellfish, lox, sushi, or sashimi;

raw or undercooked tofu;

raw or unprocessed peanut butter or other nut butters;

raw honey;

fresh salad dressings and salsas found in the refrigerator case at the grocery store;

unwashed raw vegetables and fruits, espe- cially those with visible mold;

nonpasteurized vegetable or fruit juices, unless prepared with washed produce;

vegetable sprouts (all types, including bean, alfalfa, radish, broccoli);

sun tea (tea that is left to steep in sunlight); ● uncooked brewer’s yeast; and ● untested well water.

Source: Seattle Cancer Care Alliance. Food safety guidelines. http://www.seattlecca.org/food-safety-guidelines.cfm. Accessed January 25, 2016.

condition and/or situations. See Chapter 6 for addi- tional information when determining the energy, mac- ronutrient, micronutrient, and fluid needs of older adults.

EFFECTS OF CANCER TREATMENT

ON NUTRITIONAL STATUS Conventional modalities of cancer treatment include surgery, radiation therapy, and systemic antineoplastic therapy (eg, chemotherapy, biotherapy, hormone therapy, or vaccine therapy), used alone or in combina- tion (16,17). The goals of treatment are to prevent, cure, control, or palliate cancer. Unintended weight loss and poor nutritional status can prolong recovery