Susan Holmes

Use of a modified symptom distress scale in assessment of the cancer patient

Symptom distress was assessed in a heterogeneous sample of cancer patients using a modified version of the McCorkle and Young (Cancer Nurs. 1, 373-378, 1978) Symptom Distress scale based on a linear analogue self-assessment (LASA) scale. Validity was assessed. Reliability, based on estimation of internal consistency (Cronbachs coefficient alpha), was high (alpha = 0.97) showing the tool to be reliable and effective in assessment of symptom distress. Of the 120 patients included 73% indicated significant distress from at least one symptom, 55% from two or more and 28% from at least five. Only 25% were suffering widespread or advanced disease suggesting that the incidence of symptom distress is not, of necessity, dependent on the extent of disease. The results obtained using the modified index were compared with those previously obtained by McCorkle and Young (1978) and showed marked similarities between the different cancer patient populations. This indicates that the modified scale is no less effective in assessing symptom distress but this has considerable advantages due to its simplicity and ease of administration.

Food avoidance in patients undergoing cancer chemotherapy

Cancer and its treatment are known to cause malnutrition in significant numbers of patients. Although a variety of contributory factors have been identified it is clear that the aetiology of malnutrition is complex and multifactorial. Taste aberrations are believed to be amongst the causative factors and to contribute to the development of food avoidance/aversion in affected patients. The study described investigates the incidence of food avoidance in a random sample of 72 patients undergoing cancer chemotherapy. The results show that 59 (82%) had avoided one or more foods since the instigation of treatment. The foods most commonly affected were coffee, tea, citrus fruit, chocolate and red meat. Changes were noted in the consumption of both sweet and salty foods. In terms of food avoidance no apparent relationships were demonstrated between its incidence and either the type of disease or the drugs used in therapy. In men, the pattern of avoidance showed no differences between the younger (up to 49 years) and older (50 years and older) patients; marked differences were observed between younger and older women. Although the foods avoided in general have little nutritional implication their omission may affect the quality of the patients life. Food avoidance per se may, however, affect nutritional status; suggestions for overcoming its effects are made. The results of this study, obtained by subjective assessment of food acceptability, highlight the individual anture of food avoidance in affected patients and suggest that each must be individually assessed if appropriate nutritional advice is to be given.

The oral complications of specific anticancer therapy

Oral complications commonly affect cancer patients undergoing active treatment. These include oral infection, gingival bleeding, stomatitis/mucositis, xerostomia, dental caries and periodontal disease. The oral cavity also acts as an entry site for systemic infection, particularly in those who are myelosuppressed. This paper reviews the structure and function of the oral cavity and how this may be affected by anticancer therapy. Oral care procedures are discussed and controversial areas highlighted showing that, although it is generally agreed that oral care is essential in preventing/minimizing complications and maintaining general comfort, there is no general agreement about the frequency with which care is required or about the tools and agents to be employed. Areas for future research are highlighted.

Malignant disease: nutritional implications of disease and treatment

Protein-energy malnutrition (PEM) is common in cancer patients and may develop into the syndrome known as ‘cancer cachexia’. This is characterised by complex disturbances in carbohydrate, lipid, protein, and electrolyte metabolism. The actiology is equally complex, with host and therapeutic factors contributing to the reduced food intake and effects on host tissues. Anorexia is of prime importance, differing in its cause from one patient to another and often presenting a barrier to successful nutritional support. Further research is necessary to elucidate the interaction of central and peripheral factors that may be involved in the aetiology of anorexia. Because of the interplay of biochemical, physiological, and psychological consequences of cancer, the nutritional support of the patient presents a considerable challenge to the caring professions.

Food Intake and Quality of Life in Cancer Patients

Protein-energy malnutrition is of considerable importance in the clinical management of the cancer patient when it may be associated with a poor prognosis, a reduced response to therapy, an increased risk of therapeutic side-effects and a reduced quality of life (QL). This paper reports the findings of three studies designed to evaluate food intake in hospitalized cancer patients and to investigate the relationship between total food consumption and the patients QL. The findings indicate firstly that data provided through 24 h dietary recall bear little relationship to those obtained by direct weighing. The second study shows that three-day weighed intakes provide accurate data but are time-intensive, intrusive and disruptive to normal food distribution practices. The results suggest, however, that food consumption in hospitalized cancer patients is generally inadequate and, finally, that it is closely linked to QL although no clear cause and effect relationship is demonstrated. Further research is clear...

Nutrition in the Cancer Patient

HE INTERACTIONS between nutrition and t cancer are many and varied ranging from the role of nutrition in the etiology of the disease to its supportive role in its treatment. This paper briefly reviews some of these interactions; the role of diet as a treatment for cancer has been covered elsewhere (Dickerson, 1986). Epidemiological evidence suggests that some 90% of all cancers are caused by the environment (Doll & Peto, 1981 ); food forms just one part of that environment yet it has been estimated that diet contributes to some 35% of all cancers arising in the Western World. The ’Western diet’ tends to be high in fat and low in dietary fibre and is commonly implicated in the causation of many of the so-called ’diseases of affluence’. It is possible that at least some types of cancer fall into this category; for example, a high fat diet has been implicated in the aetiology of breast cancer and a ’Western type diet’ in the causation of colon cancer. A second area of interaction becomes clear when the nutritional effects of the disease are considered and, when it is recognised that a large percentage of affected patients die not from cancer but from an associated malnutrition, its importance becomes evident. Progressive malignant disease is commonly accompanied by protein energy malnutrition (PEM) (Blackburn & Bothe, 1978) which affects some 40% of all patients hospitalised for its treatment (Landel et al., 1985). Such malnutrition is associated with a poor prognosis, a reduced response to anti-neoplastic therapy, prolonged or enhanced morbidity of therapeutic side effects and a reduced quality of life (DeWys, 1980; Harvey et al., 1980). Its onset is variable occurring at different stages of the disease; it is not directly correlated with food intake, stage, histological type or site of the tumour, duration of disease or the site, or number, of metastases. Malnutrition, and the concurrent weight loss, are not always associated with massive tumour growth and may arise with a small primary tumour even preceding diagnosis (DeWys, 1980). Shils (1977) has reported that 45% of newly hospitalised adult cancer patients had lost at least 10% of their body weight whilst 25% had lost 20% or more. This ’starvation’, known as cancer cachexia, is characterised clinically by emaciation, debilitation and inanition associated with anorexia, early satiety, anaemia and asthenia. It is accompanied by profound metabolic abnormalities including disturbances of carbohydrate, fat and protein metabolism which may account for the nutritional disabilities accompanying malignant disease although there are other contributory factors which act synergistically to create the clinical picture (Calman, 1982) (Table 1 ). These may be due to one or more of the following: 0 The systemic effects of cancer 0 Localised effects of cancer