Yudu - Nutrition Care of the Older Adult, 3e

Chapter 14 Consequences of Cancer

TABLE 14.1 Estimated Energy Require- ments for Adults with Cancer

Specific Condition or Situation

Cancer, nutritional repletion, weight gain

Cancer, hypermetabolic Cancer, inactive, no stress

Hematopoietic cell transplantation

Sepsis Overweight, obesity

Estimated Energy Needs (kcal/kg)

30–35a 35

25–30 30–35

25–30 21–25

aSome individuals may require more calories for weight maintenance and/or weight gain.

Source: Hamilton HK. Nutritional needs of the adult oncology patient. In: Leser M, Ledesma N, Bergerson S, Trujillo E, eds. Oncology Nutrition for Clinical Practice. Chicago, IL: Academy of Nutrition and Dietetics Oncology Nutrition Dietetic Practice Group; 2013:33-39.

from cancer treatments; delay treatment, which can interfere with the tumor response to treatment; and possibly increase acute care medical expenses. Therefore, during active cancer treatment and recovery from treatment, the overall goals of nutritional care should:

● ● prevent or reverse nutrient deficiencies;

preserve lean body mass and maintenance of body weight;

●

minimize nutrition-related side effects of cancer and its treatment;

●

successfully complete prescribed cancer treat- ment; and

● maximize quality of life.

Surgery, systemic therapy, and radiation therapy can each affect nutritional status, and nutrition care should focus on providing relief from treatment- related symptoms (18). Knowledge about possible side effects of cancer treatment that impact nutritional status and how to manage them needs to be communicated to all members of the health care team. The following sec- tions provide an overview of commonly experienced nutrition-impact symptoms of each treatment modality.

Dietary Reference Intake (DRI)

Normal maintenance (healthy adult)

Cancer Hematopoietic cell

transplantation ●

●

Increase: immediately post-transplant

Decrease: with renal or hepatic dysfunction

Cancer cachexia 1.5–2.5

Cancer-Related Surgery Surgical interventions to the gastrointestinal (GI) tract have specific nutritional implications, which can range from difficulty ingesting or digesting foods to difficulty absorbing specific nutrients such as fat. Fatigue, temporary appetite loss, and changes in GI and bowel function are also common problems asso- ciated with surgery (18). Nutritional implications of cancer-related surgeries can be found in Box 14.3 (see page 194).

Systemic Therapy

Antineoplastic regimens (eg, chemotherapy, biotherapy, hormone therapy) are used to systemically treat cancer (16). Routes of administration include oral, intravenous (IV), subcutaneous (SQ), intramus- cular (IM), intrathecal (IT), intra-arterial (IA), or top- ically and can be given on a continuous, daily, weekly, or less frequent basis. Classifications of sys- temic antineoplastic agents include the following: ●

Chemotherapy: alkylating agents, antimetabolites, antitumor antibiotics, anthracyclines, epipodo- phyllotoxins, taxanes, and vinca alkaloids; and

●

Biotherapy: monoclonal antibodies, protein- targeted therapies, angiogenesis inhibitors,

TABLE 14.2 Estimated Protein Requirements for Adults

Specific Condition

Protein Requirements (g/kg/d)

0.8 0.8–1

1.0–1.5 1.5

189