ch 24 cancer & HIV/AIDS

Cancer and HIV/AIDS - Nutrition therapy

• Cannot cure either disease

• Has the potential to maximize the effectiveness of drug therapy

• Can alleviate the side effects of the disease and its treatments

• Can improve overall quality of life

with cancer, eat a ______ based diet

plant

Cancer - Tumor-induced changes in metabolism

• Alterations in metabolism (usually increases) can directly impair nutritional status

• Weight loss in pts with solid tumors of the lung, pancreas, and upper GI tract

sarcopenia

• Loss of lean body mass, with or without fat loss

• Muscle protein depletion

• Independent risk factor for poorer outcomes

• Predicts risk of physical impairment, postop complications, chemotherapy toxicity, mortality

Systemic inflammation syndrome (SIS)

• Associated with the development of fatigue, impaired physical activity, anorexia/weight loss

• Impacts all relevant metabolic pathways, although the degree of impact varies

• Loss in fat/muscle mass (malnutrition)

• Insulin resistance

Cancer cachexia

• Muscle wasting that cannot be fully reversed by conventional nutrition support

• Progressive impairment

• Alters metabolism of carbs, protein, and fat

• poor intake and/or an increase in metabolism → weight loss

• Can increase toxicity related to treatment, aggravate symptoms, worsen quality of life, and shorten survival

Cancer cachexia - Precachexia

loss of appetite and altered glucose intolerance, substantial weight loss

Cancer cachexia - Cachexia

• significant weight loss or sarcopenia in the absence of simple starvation

• Weight loss >5% in the past 6 months OR BMI <20 and degree of weight loss >2% OR sarcopenia and any degree of weight loss >2%

Cancer cachexia - Refractory cachexia

associated with advanced stage cancer or rapid progression of disease that is unresponsive to treatment

impact of cancer treatments - surgery

• Often the primary treatment for cancer

• Malnourished pts prior to surgery are at higher risk of morbidity and mortality

• Postsurgical nutritional requirements

• Increased need for protein, calories, vitamin C, B vitamins, and iron to replenish losses and promote healing

impact of cancer treatments - chemotherapy

• ________ drugs damage the reproductive ability of both malignant and normal cells

  • rapidly reproducing cells are in the GI, skin, respiratory, hair, bone marrow cells

• Cyclic administration of multiple drugs is given in maximum tolerated doses.

• Side effects vary with the type of drug or combination of drugs used, dose, rate of excretion, duration of treatment, and individual tolerance.

• Side effects are systemic.

Chemotherapy side effects

• Anorexia

• N/V/D

• Taste alterations

• Sore mouth or throat

• Early satiety

• Constipation

impact of cancer treatments - radiation

• injures ALL rapidly dividing cells

• Normal tissue appears to recover more quickly from radiation damage than does cancerous tissue.

• Side effects may last for a few weeks after tx, or may never go away (ex: damage to salivary glands)

• Side effects depend on type of radiation used, the site, the volume of tissue irradiated, the dose of radiation, the duration of therapy, and individual tolerance.

  • most at risk for side effects: head and neck, lungs, esophagus, cervix, uterus, colon, rectum, and pancreas

impact of cancer treatments - biotherapy

• Seeks to enhance the body’s immune system to help control cancer.

• common side effects: fever, N/V/D, and fatigue → weight loss and malnutrition

impact of cancer treatments - hemopoietic and peripheral blood stem cell transplantation

• Preceded by high-dose chemotherapy

• Possibly total-body irradiation to suppress immune function and destroy cancer cells

• Nutrition-related side effects: mucositis and significant diarrhea

• Acute or chronic graft-versus-host disease may also occur

• PN or EN may be necessary for malnourished pts not expected to eat adequate calories for 7-14 days.

• Neutropenia leaves the pt susceptible to infection.

  • no raw foods and veggies (canned is okay), soft cheeses or deli meat, yogurt

Nutrition therapy during cancer treatment

• maintain or improve intake ; adequate calories ; weight maintenance

• Maintain skeletal muscle mass and physical performance

• Reduce the risk of reductions or interruptions of scheduled anticancer treatments

• Early & regular nutrition screening helps identify nutritional problems early on

  • with this illness, once weight is lost, its very hard to gain it back on this diet

• protein = 1.5+ g/kg/day if possible

• Oral nutrition supplements (ONS) can be used to supplement or replace oral meals and snacks

  • 230-360 calories, 10-20 g protein per 8 oz serving

• appetite stimulants may be used

• Oral intake preferred but if inadequate or contraindicated, EN or PN can provide supplemental or complete nutrition.

HIV

• A chronic infectious disease that attacks the immune system, specifically CD4 cells.

• Diagnosed with an enzyme-linked immunosorbent assay test (ELISA) and confirmed with a Western blot test.

• AIDS = CD4 cell count <200 cell/mL

• if compliant with meds, these pts are more likely to die of chronic disease

HIV and AIDS - Nutrition therapy

• Optimal nutritional status

• Prevent foodborne illnesses

• Improve quality of life

• Manage or reduce the risk of comorbidities

• Nutrition intervention should begin soon after diagnosis

• No one-size-fits-all diet for HIV/AIDS

• Recommended caloric intake should increase by 10% in asymptomatic clients

  • balanced caloric intake = 45-65% from carbs, 10-35% from protein, 20-35% from fat

  • if symptomatic, increase calorie needs by 20-30% above normal

• Loss in bone density common with ART so supplementing vit D & calcium may be beneficial

HIV and AIDS - Food safety

Steps should be taken to reduce the risk of foodborne illness

• Discard leftovers after 24 hours.

• Keep hot foods >140°F and cold foods <40°F.

• Thaw food in the refrigerator, not at room temp; if using a microwave, cook meat immediately after defrosting.

• avoid raw or undercooked foods (especially meats), unpasteurized drinks and foods, hot dogs, deli meats, luncheon meats that have not been reheated, salad bars and buffets when eating out