Nutrition Support in Cancer and AIDS Chapter 23 Nutrition Support in Cancer and AIDS

Chapter 23 Lesson 23.1 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts Environmental agents, genetic factors, and weaknesses in the body’s immune system can contribute to the development of cancer. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts, cont’d The strength of the body’s immune system relates to its overall nutritional status. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Cancer Malignant tumor (neoplasm) can express itself in multiple forms Tumors identified by primary site of origin and state of growth Stages of tumor development depend on growth rate, degree of functional self-control, and amount of spread No single treatment or special diet exists to arrest cancer. Relation between cancer care and nutrition centers on prevention and therapy. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Causes of Cancer Cell Development Underlying cause is the functional loss of cell control over normal cell reproduction from: Mutations Chemical carcinogens Radiation damage Viruses Epidemiologic factors Stress and dietary factors A mutant gene may be inherited or arise from environmental stimulus. Several chemical substances can interfere with structure or function of regulatory genes. Radiation damage may come from radiographs or sunlight. Viruses take over the cell machinery to reproduce themselves. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Epidemiology Figure information: Incidence rates for United States. From National Cancer Institute: Cancer state profile, http://statecancerprofiles.cancer. gov/map/map.withimage.php?00&001&053&00&0&1&0&1&6&0#map, accessed October 2007.) Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

The Body’s Defense System Two populations of lymphocytes in immune system T cells Derived from thymus cells Activate phagocytes that attack antigens B cells Derived from bursal intestinal cells Produce antibodies that attack antigens Lymphocytes develop early in life from a common stem cell in the bone marrow. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

T- and B-Cell Development Figure information: Courtesy Eileen Draper. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Nutrition and Immunity Inadequate nutrition weakens the immune system and causes atrophy of tissues in gastrointestinal structures Antibodies are proteins Nutrition support is needed to maintain the integrity of the immune system. Severely malnourished people show changes in the structure and function of their immune systems. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Nutrition and Healing Body tissue strength depends on ability to build and rebuild, which requires optimal nutrition intake Protein and key vitamins and minerals, as well as nonprotein energy sources, must be constantly supplied by the diet Careful, early use of vigorous nutrition support provides recovery of normal nutritional status and immunocompetence of cancer patients. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Chapter 23 Lesson 23.2 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts The strength of the body’s immune system relates to its overall nutritional status. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts, cont’d Nutrition problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Surgery All surgery requires nutrition support for the healing process. General condition of cancer patients often is weakened by the disease process. Nutrition support is required before and after surgery. Changes in food texture or nutrient content may be required depending on surgical site or function of the organ involved. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Radiation Therapy Involves high-energy radiographs targeted on the cancer site Often kills surrounding healthy cells as well as cancerous cells Nutrition problems driven by site and intensity of radiation treatment For example, radiation to the abdominal area affects intestinal mucosa, causing loss of villi and, subsequently, absorption. Malabsorption problems follow. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Chemotherapy Highly toxic drugs administered by the bloodstream to kill cancer cells Use of monoamine oxidase inhibitors (pretreatment antidepressant drugs) requires tyramine-restricted diet Side effects include: Food intolerance: nausea and vomiting, loss of normal taste sensations, lack of appetite, diarrhea, ulcers, malabsorption, stomatitis Reduction in red and white blood cells and blood platelets Interference with normal hair growth Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Systemic Effects of Cancer Several systemic effects cause continuing weight loss Anorexia, loss of appetite Increased metabolism Negative nitrogen balance Anorexia results in poor food intake. Increased metabolism results in increased nutrient and energy needs. Negative nitrogen balance results in more catabolism (breaking down of body tissues). Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Cachexia Extreme weight loss and weakness caused by inability to ingest or use nutrients Body feeds off its own tissue protein Experienced by half of all cancer patients Aggressive nutrition therapy is necessary Drugs are used to increase appetite, decrease nausea, spare protein degradation, and improve caloric intake. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Objectives of Nutrition Therapy Prevention of catabolism Meet increased metabolic demands Relief of symptoms Individualized strategies are developed to meet the patient’s nutrition needs and help the patient to eat. Requires multidisciplinary support from member of the health care team. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Principles of Nutrition Care Nutrition assessment Determine and monitor nutritional status Body measurements, calculations of body composition, laboratory tests, physical examination, clinical observation, dietary analysis Personal care plan Daily plan for nutrition therapy incorporated into nursing care plan Personal care plan is revised as required. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Nutrition Needs Energy Protein Vitamins and minerals Adequate fluid intake Energy: Carbohydrate and fat intake frees up protein (essential amino acids and nitrogen) so that it can be used for tissue building. Vitamins and minerals: Control protein and energy metabolism through their coenzyme roles. Adequate fluid intake: Replace losses, help kidneys dispose of metabolic waste from destroyed cancer cells and toxic drugs. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Enteral: Oral Diet Oral diet with supplementation is optimal when tolerated Food plan must include adjustments in food texture and temperature, food choices, and tolerances A well-planned diet provides energy and nutrient density in small quantities of food. Nurses must assist in addressing loss of appetite, mouth problems, gastrointestinal problems, and pain/discomfort. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Tips for Controlling Nausea and Vomiting Try smaller, more frequent meals. Eat more when feeling better. Eat drier foods with fluids in between. Try cold foods, saltier foods. Avoid fatty or overly sweet foods. Do not recline immediately after eating. Replace fluids and electrolytes. Use foods with pleasant aromas. Avoid strong odors. Create a pleasant, relaxed environment. Take breaks in between bites; eat slowly. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Tips for Increasing Energy and Protein Intake Add high-calorie condiments, sauces, dressings Add extra ingredients during food preparation Drink commercial food supplements Avoid low-calorie foods and beverages Have a meal or snack every 1 to 2 hours Patient teaching: Eat more when appetite is good. Prepare foods in small serving sizes for snacks. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Enteral: Tube Feeding When gastrointestinal tract can be used but patient is unable to eat Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Parenteral Feeding When gastrointestinal tract cannot be used Peripheral vein feeding (for brief period) Central vein feeding (for extended period) Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Prevention American Cancer Society U.S. Food and Drug Administration Eat a variety of healthful foods Adopt a physically active lifestyle Maintain a healthful weight Limit alcohol consumption U.S. Food and Drug Administration Low-fat diets rich in grain products, fruits, and vegetables may reduce the risk of some cancers National Cancer Institute is the federal research body funded by the Department of Health and Human Services. Describe their 5-a-Day for Better Health program. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Chapter 23 Lesson 23.3 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts Nutrition problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts, cont’d The progressive effects of HIV, through its three stages of white T-cell destruction, have many nutrition implications and often require aggressive medical nutrition therapy. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Human Immunodeficiency Virus Virus causes immune system suppression Created a widespread epidemic Like all viruses, HIV is a parasite that uses its host to replicate itself. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Stages of Disease Progression Stage 1: Clinical category A Flulike symptoms 4 to 8 weeks after initial exposure Stage 2: Clinical category B Infectious illnesses invade the body Stage 3: Clinical category C Rapidly declining T-helper lymphocyte counts Stage 1: 8 to 10 years of “wellness” as virus incubates Stage 2: Persistent fatigue, mouth sores, night sweats, diarrhea, fever, weight loss, headache, skin rash Stage 3: Tuberculosis, Kaposi’s sarcoma, cytomegalovirus, lymphoma Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Goals of Medical Management Delay progression of the infection and improve the immune system Prevent opportunistic illnesses Recognize the infection early Recognize the infection early and provide rapid treatment for complications, including infections and cancers. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Severe Malnutrition, Weight Loss Decreased appetite, insufficient energy intake in addition to elevated resting energy expenditure Major weight loss, eventual cachexia Malnutrition suppresses cellular immune function, perpetuating the onset of opportunistic infections Megestrol: Used to treat cachexia Majority of weight gained is fat mass (lipodystrophy) with continued wasting of lean tissue Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Causes of Body Wasting Inadequate food intake Malabsorption of nutrients Disordered metabolism Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Nutrition Assessment Anthropometry Biochemical tests Clinical observations Diet observations Environmental, behavioral, and psychological assessment Financial assessment The clinical dietician on the AIDS team conducts this assessment and calculates daily nutrition needs. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Principles of Nutrition Counseling Motivation for dietary changes Rationale for nutrition support Provider-patient agreement on plan Development of manageable steps for change Development of personal food management skills Identification of community programs Provision of psychosocial support Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Summary The general term cancer is given to various abnormal, malignant tumors in different tissue sites. The cancer cell is derived from a normal cell that loses control over its growth and reproduction. Cancer cell development occurs from mutation of regulatory genes and is influenced by environmental chemical carcinogens, radiation, and viruses. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Summary, cont’d Cell integrity is mediated by the body’s immune system, primarily through its two types of white blood cells: T cells that kill invading agents that cause disease and B cells that make specific antibodies to attack these agents. Cancer therapy primarily consists of surgery, radiation, and chemotherapy. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Summary, cont’d Likewise, nutrition care of patients with AIDS must be built on knowledge and compassion, with a sensitivity and concern for individual patient needs. The current worldwide spread of HIV and its fatal consequences have reached epidemic proportions and are still growing. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Summary, cont’d Nutrition management centers on providing individual nutrition support to counteract the severe body wasting and malnutrition characteristic of the disease. The process of nutrition care involves comprehensive nutrition assessment and evaluation of personal needs, planning care with patient and caregivers, and meeting practical food needs. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.