Nutrition is very important yet neglected in field of oncology. Majority of healthcare providers know and practice very little on this burning issue! It is proven that nutrition impacts on overall survival, treatment outcome & recovery in oncology. This presentation will give you brief information regarding importance and need of nutrition in Oncology.

1. N U T R I T I O N I N
O N C O L O G Y
D R . M A L H A R P A T E L

2. N U T R I T I O N I S I M P O R T A N T
C A N C E R P A T I E N T S A R E A T R I S K O F
M A L N U T R I T I O N
P h y s i c a l & M e t a b o l i c E f f e c t o f C a n c e r
E f f e c t o f A n t i - C a n c e r T h e r a p i e s

3. 40% are Malnourished at Diagnosis.
"Head and neck cancer, pre-treatment
weight loss is an independent predictor of
survival in advanced stage disease."
Weight Loss - Greater Morbidity and Poor
Tolerance to Treatment
20% Die Due to Effects of Malnutrition
FACTS

4. I T ' S D I F F E R E N T F R O M
S I M P L E M A L N U T R I T I O N
N E G A T I V E E N E R G Y B A L A N C E
S K E L E T A L M U S C L E M A S S L O S S
E L E V A T E D R E S T I N G M E T A B O L I C R A T E
I N S U L I N R E S I S T A N C E
L I P O L Y S I S
P R O T E O L Y S I S
S Y S T E M I C I N F L A M M A T I O N
C A T A B O L I C F A C T O R S

5. ENERGY INTAKE
<60% FOR 1-2 WEEKS
80% SUFFERS
WEIGHT LOSS
PRIMARY
SECONDARY
MID ARM CIRCUMFERENCE
MEN: 32
FEMALE:18
MORTALITY
DOSE LIMITING TOXICITY
FATIGUE
IMPAIRED PHYSICAL ACTIVITY
IMPAIR REPAIR
INADEQUATE
INTAKE
MUSCLE PROTEIN
DEPLETION
SYSTEMIC
INFLAMMATION
What Happens in Cancer Malnutrition

6. Maintain and Increase
AIM

7. Energy
25-30 Kcal/Kg/Day
Loss of 800 Kcal on average
Resting Energy Consumtion Increases to 10-25%
Glucose and Fat

8. INSULIN RESISTANCE
Weight Loss - Increase Fat Diet
Fat: 0.7 - 1.9 Gm/Kg/Day
Glucose - Sodium Imbalance

9. Protein
1.5 - 2.0 Gm/Kg/Day
Inactivity, Old Age, Systemic Inflammation
Decrease Protein Synthesis

10. Salt
Old Age
Tube Feeding
Taste Alteration

11. Vitamins
Same as Well Nourished Person

12. HOW TO GO ABOUT IT?

13. Different Patients
Already
Malnourished
Surgical
Morbidity
Tumour
Site
Duration
Dose
Radical Adjuvant Palliative

14. Start @
Diagnosis
Avg Weight
Loss 5 kg
Nutritional
Assessment
The Malnutrition Screening Tool
The Interdisciplinary Nutrition Care
Plan
The Patient- Generated Subjective
Global Assessment (F. D. Ottery,
personal communication, 2000)
#1

15. COUNSELLING
#2

16. START ORAL
NUTRITION
SUPPLEMENT
#3

17. Treat Secondary Causes
Radiation Technique
#4

18. Still Losing
Weight???
Naso-Gastric Tube
1 2
PEG Tube
3
Parenteral Nutrition
#5

19. WHEN?
PRE-TREATMENT?
DURING TREATMENT?

20. ASSESSMENT FOR ENTERAL
NUTRITION
PERFORMANCE
STATUS
WHO 2-3
SMOKING
20/DAY
PRE-RX
WEIGHT LOSS
>10%
ADVANCED AGE
>70 YEARS
ADVANCE
STAGE
AJCC 3-4
SERUM ALBUMIN
<40G/L

21. Prophylactic Tube
Oropharynx
Weight Loss >10%
BMI < 20 kg/m2
Age > 70 years

22. OVERALL
SURVIVAL
DEPENDS ON
BMI AND
WEIGHT LOSS
0: Best
4: Worst

23. Naso-Gastric Tube PEG Tube
Economic
Easy to insert
Easy to Remove
Less Care
Few Weeks to Months
Cosmetic
Months to Years
Less Aspiration
Large Bore
Invasive
Surgical Care
Infection Rate 15%
Peritonitis
Expensive
Cosmetic
Discomfort
Small Bore
Chance of Aspiration

24. NUTRITION
ORAL NUTRITION
SUPPLEMENT
COUNSELLING
ENTERAL NUTRITION
NG OR PEG
PROPHYLACTIC OR ELECTIVE
START AT DIAGNOSIS

25. REHABILITATION

26. 01
Social Dinner Salivation/
Trismus
Dental
Prophylaxis
Physical
Activity
Self
Confidence
Speech
Therapy
Swallowing Clinic

27. Thank You