Yudu - Nutrition Care of the Older Adult, 3e

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Part II Nutrition Assessment, Consequences, and Implications

BOX 14.5 Assessment of Risk Factors for Older Adults with Cancer

Does the patient have risk factors for adverse outcomes from cancer treatment?

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Comorbidities: cardiovascular disease, renal insufficiency, neuropathy, anemia, osteoporo- sis, GI problems, diabetes, lung disease, hearing or vision loss, prior cancer diagnosis and treatment, chronic infections, decubitus or pressure ulcers

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Geriatric syndromes: functional dependency, mobility problems, falls, dementia, delirium, depression, nutritional deficiency, polypharmacy

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Socioeconomic issues: poor living conditions, no caregiver or limited social support, low income, transportation barriers/access problems, underinsurance and/or high out-of-pocket costs for medications

Source: Bickley LS, Szilagyi PG. The older adult. In: Bates’ Guide to Physical Examination and History Taking. 11th ed. Philadelphia, PA: Wolters Kluwer Health, Lippincott Williams & Wilkins; 2013.

Integrative Therapy in Cancer Treatment

Examination of evidence regarding dietary supplements cautions against any use during therapy and supplemen- tation of greater than 100% of Recommended Dietary Allowance (RDA) or Dietary Reference Intake (DRI) levels. Amounts of dietary supplements over the RDA and DRI should be considered only in instances of nutrient deficiency caused by such conditions as anemia, osteoporosis, or documented GI maldigestion/ malabsorption. Emphasis should be on obtaining vita- mins and minerals through food sources rather than dietary supplements (4,16).

Nutrition Support in Cancer Treatment: Oral, Enteral, and Parenteral

BOX 14.6 Approach to Decision-Making for Older Adults with Cancer

Is the patient at moderate or high risk of dying or suffering from cancer, considering his or her over- all life expectancy? Yes or no?

Does the patient have decision-making capacity? Yes or no?

Does the patient have advance directives, a living will, health care power of attorney, a patient’s proxy, or clinician’s documentation?

Does the patient: ●

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understand the relevant information about proposed diagnostic tests or treatment?

appreciate his or her situation? ● use reason to make a decision? communicate his or her choice?

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The goals of nutrition support are to provide adequate nutrients to minimize weight loss, to reduce or prevent any nutrition-related symptoms associated with the cancer treatments, and to prevent or correct any under- lying nutritional deficiencies. Symptom control is the first step in preventing weight loss and malnutrition in those with cancer. When necessary, oral feedings should be augmented with more nutrient-dense foods and fluids to provide adequate nutrients to meet the higher energy needs of those with cancer. Modifications in diet consistency may be necessary for those experiencing symptoms of dysphagia or mucositis. Modifications in specific components or nutrients may be used to relieve symptoms of diar- rhea, constipation, or malabsorption. It is advised to encourage intake of high-energy, high-protein foods or medical nutritional supplements if oral intake is not adequate.

If oral intake is inadequate to maintain weight, which is often seen in treatment for head and neck or esophageal cancers, enteral nutrition support should be recommended (6). The provision of adequate calories and nutrients via an enteral nutrition feeding tube may help the individual to complete the prescribed cancer treatment. Parenteral nutrition is reserved for individu- als unable to utilize oral or enteral nutrition due to GI obstruction or documented dysfunction of the GI tract. Each form of nutrition support should be evaluated for efficacy, cost, and possible side effects, and should con- sider the individual’s preferences and quality of life (6). Nutrition and supportive care interventions strategies for cancer-related side effects or symptoms are found in Box 14.7 (see pages 195–197).