Maureen B. Huhmann

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

Nutrition status has an important effect on quality of life and sense of well-being in cancer patients. Malnutrition and weight loss are often contributors to the cause of death in cancer patients. 1 Cancer cachexia is a syndrome characterized by progressive, involuntary weight loss. Clinical features include host tissue wasting, anorexia, skeletal muscle atrophy, anergy, fatigue, anemia, and hypoalbuminemia. Causes of cancer cachexia include anorexia, mechanical factors affecting the gastrointestinal tract related to tumor, side effects of surgery, chemotherapy and/or radiation therapy, alterations in intermediary and energy metabolism, and changes in the host cytokine and hormonal milieu. The cancer cachexia syndrome (CCS), which is observed in approximately 50% of cancer patients, involves heterogeneous physiologic and metabolic derangements resulting in potentially life-threatening malnutrition. 2 Although often seen in patients with advanced malignancies, CCS may be present in the early stages of tumor growth. Weight loss in cancer patients is of prognostic significance. For any given tumor type, survival is shorter in patients who experience pretreatment weight loss. 3-5

Importance of nutritional screening in treatment of cancer-related weight loss

Weight loss is common in patients with cancer. Many factors, such as physiological abnormalities, response to the tumour, and treatment, contribute to this weight loss. Cancer-related weight loss affects a patients response to treatment, as well as survival and quality of life. Several nutritional screening and assessment tools have been developed for patients with cancer. This review describes the weight loss seen in patients with cancer as well as the methods of screening for nutritional deterioration and weight loss early in a cancer diagnosis. Nutritional approaches to the supportive care of patients with cancer are also discussed.

Review of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines for Nutrition Support in Cancer Patients: Nutrition Screening and Assessment:

It is clear that cancer patients develop complex nutrition issues. Nutrition support may or may not be indicated in these patients depending on individual patient characteristics. This review article, the first in a series of articles to examine the A.S.P.E.N. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients Cancer Guidelines, evaluates the evidence related to the use of nutrition screening and nutrition assessment in cancer patients. This first article will provide background concerning nutrition issues in cancer patients as well as discuss the role of nutrition screening and nutrition assessment in the care of cancer patients. The goal of this review is to enrich the discussion contained in the Clinical Guidelines, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequent published studies. Future articles will explore the guidelines related to nutrition support in oncology patients receiving anticancer therapies.

Nutrition Support in Surgical Oncology

This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies.

Nutritional Care of Cancer Patients

Nutrition plays a central role in cancer pathophysiology and therapy. Nutrition status has an important effect on quality of life and sense of well-being in cancer patients. Recent discoveries have highlighted the importance of nutritional factors in the carcinogenesis process and in cancer prevention. Cancer is frequently characterized as a ‘wasting disease,’ a vividly accurate term to patients, families, and clinicians dealing with cancer. The lay press and professional journals are replete with articles concerning the use of various nutrition interventions to treat, palliate, and support cancer patients.

Bidirectional Impact of Oral Health and General Health

Oral manifestations of systemic disease or its treatment have been the subject of an extensive body of biomedical literature; several textbooks cover the subject in great detail (1,2). More recently, the impact of oral health on systemic health and disease has been the subject of intense investigation, leading to provocative ideas about oral risk factors for systemic disease and novel approaches to health promotion and disease prevention. This collective understanding of the reciprocal oral and systemic risks for disease will require, more than ever before, an expanded scope of dental, medical, and nutrition professional training to achieve competency in risk assessment and risk reduction. Translation into practice will require consultation among and collaboration between clinicians and should lead to innovative health care delivery systems that efficiently bring these caregivers and services to the patient.

Nutrition in Gastrointestinal Cancer

Gastrointestinal cancers can significantly impact nutrition status. Data indicate that the presence of malnutrition in cancer patients negatively impacts response to treatment, quality of life and survival. The nutritional support of patients with gastrointestinal cancer should be individualized and may be dependent upon anticancer treatment modality. Interventions with parenteral nutrition, enteral nutrition and immunonutrition are indicated in certain situations. Nutritional modifications may also be important in the prevention of cancer. This chapter will review some of the nutritional issues related to gastrointestinal cancer patients.

Nutrition in Clinical Practice

Features: NEW data from hundreds of recent studies NEW section: Contemporary Topics in Nutrition Easy-reference format includes short chapters, links to current online articles Contributors representing diverse expertise and practical experience with medical education, nutrition in clinical practice, and preventive medicine Enhanced coverage of controversial topics, such as, the effects of sugar; health effects of obesity and the ‘obesity paradox’; health effects of gluten and grains; nutritional therapy Appendices includes ancillary materials such as clinically relevant formulas, nutrition data tables, and patient specific meal planners, all fully updated