Nutrition & Radiation Therapy

Why is Nutrition important?

A patients nutritional status is critical in fighting disease, cell building and tolerance of therapy

Terminology

• Pharyngitis – inflammation of the pharynx, causing symptoms of a sore throat

• Mucositis – inflammation of a mucus membrane such as the lining of the mouth and throat

• Stomatitis – inflammatory condition of the mouth

• Anorexia – loss of appetite resulting in weight loss

• Cachexia – state of general ill health with early satiety, electrolyte and water imbalances, and progressive loss of body weight, fat and muscle – a general ‘wasting away’.  Affects ½-2/3 of patients with cancer.

• Marasmus – calorie malnutrition.  Common in slender of slightly underweight patients.  Weight loss of 7%-10% and fat and muscle depletion

• Kwashiorkor – protein malnutrition.  It is seen in patients with adequate intake of carbs and fats, but not protein.  It is often overlooked because patients appear well-nourished.  Characterized by muscle wasting, depigmentation of hair and skin, edema

• Xerostomia – dry mouth

• Dysphagia – pain or difficulty swallowing

• Early Satiety – early feeling of fullness after eating

• Nausea and Vomiting

• Constipation

The science of nutrition

The study of nutrients in foods and how these nutrients are processed by the body

2 types of Nutrients

• Macronutrients

  • Carbohydrates

  • Fats

  • Protein

  • Water

• Micronutrients

  • Vitamins
    Minerals

Carbohydrates

• Primary energy source for body

• Basic unit: glucose

• 4 calories/gram

• Sugar, Starch, Fiber

Glucose, fructose, lactose, and sucrose; polysaccharides

Protein

• Growth, repair tissue

• Enzymes, hormones

• Basic unit: amino acids

• 4 calories/gram

• Meat, Dairy, Nuts

Fat

• Protects, insulates organs, cell membranes

• Alternate energy source

• 9 kcal/gram

• Saturated (Butter)

• Unsaturated Fats (Oils)

Water

• Largest component of the body

  • Adult body is 75% - 80% water

• Maintains temperature

• Solvent for pro, cho, fat, vit, minerals

• Medium for chemical reactions

• Lubricant, shock absorber

Vitamins and Minerals

Fat Soluble Water Soluble

A, D, E, K B’s, C

Macrominerals Microminerals (Trace)

Ca, Mg, P, K, Na, Cl Fe, Zn, Cu, Se

• Essential for physiological processes

• Deficiency leads to disease state

Nutrition Basics (MyPlate)

Balancing Calories

• Enjoy your food, but eat less.

• Avoid oversized portions.

Foods to Increase

• Make half your plate fruits and vegetables.

• Make at least half your grains whole grains.

• Switch to fat-free or low-fat (1%) milk.

Foods to Reduce

• Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers.

• Drink water instead of sugary drinks.

Healthy diet vs “scientific diet”

• Healthy Diet

  • Provides adequate nutrients

  • Fruits, vegetables, whole grains, lean meats

  • Portion control

  • Limited processed foods, sugar, saturated, trans fat

  • Limit alcohol

• “Scientific Healthy Diet”

• 50-60% carb, 25-35% fat, 10-15% protein; RDA’s

• 25-30 kcal/kg body weight

Causes of cancer

• External

  • Tobacco, Chemicals, Radiation

• Internal (Unhealthy diet may allow expression of internal factors

  • Inherited mutations

  • Hormones

  • Immune conditions

What is the main goal of why ideal nutrition is needed for cancer patients?

To prevent or correct nutritional deficiencies and to minimize weight loss.

Nutrition in Cancer Prevention

1. Healthy Weight (BMI < 25)

2. Moderate fat intake

3. Fruits and vegetables, plant foods

   1. antioxidants

4. Limit red meat

5. Limit consumption of alcohol

6. Physically active lifestyle

What are Cancer’s effect on nutritional status?

In other words, Why is nutritional status altered when a patient has cancer?

• Altered metabolism of carb, protein, and fat

• Increased metabolic rate

• Altered GI function and nutrient absorption

• Psychological changes

• Early Satiety, food aversions, not enjoying food leads to social isolation

Anorexia

Loss of appetite resulting in weight loss

• The causes of anorexia in a patient can occur because of

  • Fatigue

  • Dry mouth, Esophagitis, nausea, vomiting

  • Pain

  • Presence of an infection

  • Presence of stress, anxiety, depression

  • Change in usual life style patterns

Cachexia

• Loss of lipid (fat) and protein stores induces: weight loss, muscle wasting, lethargy, chronic nausea, weakness, immunosuppression.

• STRONG relationship between nutrition status, weight loss, and cancer survival. This condition needs lots of care, increased food intake alone cannot reverse Cachexia

Cancer

• Altered Taste, Smell

• N/V

• Swallowing Problems

• Early Satiety

• Altered Metabolism

• Increased energy expenditure

• Depression/Anxiety

↓

Anorexia

↑↓

Cachexia

Screening/assessment

Assess the current nutrition status. Id factors that could complicate optimal nutrition in the future (ex: impending esophageal surgery)

• Nutrition Screening

  • Identify patients at risk

  • by nursing staff (inpatient)

  • by dietitian (outpatient)

• Nutrition Assessment

  • In depth assessment of nutritional status

Nutrition assessment

• Ht, Wt, BMI

• Subjective Global Assessment

  • Weight, Food Intake, Symptoms, Fncl Status, Cancer, Metabolic Stress, Physical Exam

• Diet History

• Supplement use, Medications

• Medical History

• Labs

• Treatment of Symptoms

Goals of nutrition therapy

• Interventions include counseling patient, providing supplements, or providing enteral or parenteral nutrition

• Intervention Goals

  • Correct nutritional deficiencies

  • Minimize weight loss

  • Maintain protein status

    • support immune system

• Maintain fluid status

• Maintain QOL (strength, energy, ↓pain)

• Reduce nutrition related side effects treatment & “symptoms” of cancer

Radiation Treatment & Nutritional Status

• Effects of Radiation on Nutritional Status

• Altered transit, digestion, absorption

• Side effects that cause fatigue, pain, and ↓appetite – all of which affect oral intake

Double Whammy

Increased complications and decreased survival

Effects of Radiation Therapy

• Side effects depend on

  • Area irradiated

  • Total dose

  • Duration of treatment

What can we do for: ??

• Anorexia (lack of appetite resulting in wt loss)

• Altered Taste

• Xerostomia (dry mouth)

• Weight Loss

• Anorexia (lack of appetite)

  • Sere food attractively and in a pleasant environment

  • Small, frequent high pro/cal meals

  • Avoid liquids with meals

  • Add extra calories to meals (butter, powdered protein)

  • Liquid supplements

  • Eat favorite foods

  • Increase fluid intake

• Altered Taste

• No Taste: Spices

  • Tart foods

  • Strong tasting foods (choc vs vanilla)

• Bad Taste:

  • Use plastic utensils

  • Cold temperature foods

  • Chew gum, use lemon drops

  • Rinse mouth with tea, ginger ale, salt water

• Xerostomia (dry mouth)

  • Salt or soda mouthwash before eating

  • Use sauces and gravies; eat moist foods

  • Sour foods to increase salivation

  • Sip water often

  • No smoking, alcohol

• Weight Loss

  • Small frequent meals

  • High calorie/high protein low volume foods

  • Liquid supplements

What can we do for: ??

• Dysphagia (difficulty swallowing)

• Sore Mouth/Throat (‘itis’)

• Nausea

• Diarrhea