Nutritional Support in Cancer and AIDS Chapter 23

Nutritional Support in Cancer and AIDS Although AIDS and cancer share a direct relation to the body’s immune system and basic nutritional needs, their courses and fatal outcomes are distinct This chapter looks at nutritional support in relation to both cancer and AIDS Both conditions have important nutritional connections in prevention and therapy.

Objectives: Describe process of cancer development Describe nutritional support for cancer treatment Identify conclusions of cancer therapy and prevention Describe the process of AIDS development

Nutritional Support in Cancer and AIDS Key Concepts: Environmental agents, genetic factors, and any weaknesses in the body’s immune system can contribute to the development of cancer. The strength of the body’s immune system relates to its overall nutritional status

Nutritional Support in Cancer and AIDS Key Concepts cont. Nutritional problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS The progressive effect of the human immunodeficiency virus (HIV) through its three stages of white T-cell destruction requires aggressive nutrition therapy

Cancer – It’s Nature Malignant tumor (neoplasm) can express itself in multiple forms The relationship of nutrition and cancer care focus on the following 2 fundamental areas: Prevention Therapy

Cancer – It’s Nature Normal cell: the process of individual cell growth and reproduction occurs continually Cell division is guided by the genetic code contained in the cell nucleus, DNA This orderly cell operation can be lost by: Mutation (change in the regulatory genes)

Cancer – It’s Nature Cell growth may form malignant tumors when normal gene control is lost Tumors are identified by primary site of origin and stage of growth The misguided cell and its tumor tissue represent normal cell growth that has gone wrong

Causes of Cancer Cell Development Underlying cause is the fundamental loss of cell control over normal cell reproduction due to: Mutations – changes in the genes, esp. the regulatory genes

Causes of Cancer Cell Development Chemical carcinogens – Agents that cause cancer are call carcinogens. Chemical substances which interfere with the structure or function of regulatory genes may result in gene mutation, damage to gene regulation, or activation of a dormant virus

Causes of Cancer Cell Development Radiation damage – may come from xrays, radioactive materials, sunlight, or atomic wastes Includes skin cancers such as Basal cell carcinoma, squamous cell carcinoma, and melanoma

Causes of Cancer Cell Development Viruses – Oncogenic (tumor inducing viruses) viruses interfere with the function of regulatory genes, taking over the cell machinery to reproduce themselves

Causes of Cancer Cell Development Epidemiologic factors - race, region, age, heredity, occupation and diet

Causes of Cancer Cell Development Stress and dietary factors – Stress can lead to reduced immune response to disease; poor food behaviors, nutritional status, and overall of oxidative stress make a person more vulnerable to cancer-producing factors.

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 These are part of a “search and destroy” defense for detecting and killing alien, non-self substances that carry potential for disease.

Nutrition and Immunity Inadequate nutrition weakens the immune system Antibodies are the core of the immune system; protein in structure

Nutrition and Immunity Severely malnourished persons show changes in the structure and function of their immune system Changes result from atrophy of losses in the basic tissues involved (liver, bowel wall, bone marrow, spleen, and lymphoid tissue). Nutrition is fundamental in maintaining normal immunity and combating sustained attacks of diseases such as cancer.

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

Nutritional Support for Cancer Treatment 3 major forms of therapy are used today as medical tx. of cancer Surgery Radiation Chemotherapy Each one requires nutritional support

Surgery All surgery requires nutritional support for the healing process General condition of cancer patients is often weakened by the disease process and its drain on body resources

Radiation Therapy Involves high-energy x-rays targeted on the cancer site Often kills surrounding healthy cells as well as cancerous cells Nutritional problems driven by site and intensity of radiation treatment

Radiation Therapy Radiation to the head, neck, and esophagus affects the oral mucosa and salivary secretions  affects taste, sensitivity to food texture and temperature  anorexia and nausea Radiation to the abdominal area affects the intestinal mucosa, causing loss of villi and absorption area  malnutrition

Radiation Therapy Ulcers, inflammation, obstruction, or fistulas may develop from tissue breakdown. Fistula – an abnormal opening or passageway within the body or to the outside.

Chemotherapy Drugs kill rapidly growing cancer cells but also affect healthy cells Drug side effects on rapidly growing healthy tissue include: GI Bone marrow Hair follicles

Chemotherapy GI tract: numerous problems that interfere with food tolerance: n/v/d; loss of normal taste sensations; lack of appetite, ulcers, malabsorption, stomatitis Bone Marrow: interference with the production of specific blood factors reduced RBCs  anemia; reduced WBCs  lowered resistance to infection; reduced platelets  bleeding

Chemotherapy Hair Follicles: interference with normal hair growth  hair loss

Systemic Effects of Cancer Cancer causes several systemic effects which in turn cause continuing weight loss: Anorexia, loss of appetite  poor food intake Increased metabolism  resulting in increased energy and nutrient need Negative nitrogen balance  more breakdown (catabolism) of body tissue

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

Cachexia

Objectives of Nutrition Therapy Prevention of catabolism Meet increased metabolic demands Relief of symptoms

Principles of Nutritional Care Basic principles of nutritional care underlie all sound patient care: Identify needs Planning care based on these needs

Principles of Nutritional 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

Nutritional Needs Nutritional Therapy must meet specific nutrient needs and goals related to the accelerated metabolism Energy Protein Vitamins and minerals Adequate fluid intake

Nutritional Needs Energy – the hypermetabolic nature of the disease and its healing requirements place great energy demands on a cancer patient Need sufficient fuel from CHO, and some fat to spare protein to do vital tissue rebuilding Increase kcals

Nutritional Needs Protein – To offset tissue breakdown by the disease requires essential amino acids and nitrogen Increase intake of high quality protein

Nutritional Needs Vitamins and Minerals – Key vitamins and minerals control protein and energy metabolism through their coenzyme roles Play a role in building and maintaining strong tissue Often use of vitamin and mineral supplements

Nutritional Needs Fluid To replace GI losses from fever, infection, vomiting or diarrhea To help the kidneys dispose of metabolic breakdown products from destroyed cancer cells and chemo toxins

Nutrition Management 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

Nutrition Management Loss of appetite Mouth problems Anorexia is a vicious cycle A vigorous program of eating that does not depend on appetite for stimulus must be planned with pt./family Mouth problems Taste loss; changes in taste sensations Decreased saliva Consider artificial saliva, adding sauces and gravies to food, good oral care habits

Nutrition Management GI problems Pain and discomfort Nausea and vomiting Small frequent feedings of soft-> liquid cold foods may help; antiemetics Pain and discomfort More able to eat if pain is controlled

Nutrition Management Enteral: Tube feeding Parenteral nutrition PPN TPN

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.

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 1-2 hours

Prevention: Reduce the Risk American Cancer Society 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

Acquired immunodeficiency syndrome

Human Immunodeficiency Virus Virus causes immune system suppression Created a widespread epidemic and pandemic proportions

Process of AIDS Development Parasitic nature of the Human Immunodeficiency Virus No virus can have a life of its own. Can only live through a host When invade and infect a host, they “hijack” the host’s cell machinery to run off a multitude of copies of themselves The “ultimate” parasite The current deadly strength of HIV results from its aggressive growth within an increasing number of hosts.

Stages of Disease Progression Stage 1: Primary HIV infection Transmitted from an infected person to another person through sexual contact, sharing needles, or blood transfusion Flu-like symptoms 2-4 weeks after initial exposure; lasts about 1 wk. Reflects the initial development of antibodies to the virus Subsequent HIV testing is + This “well period” = viral incubation and multiplication

Stages of Disease Progression Stage 2: AIDS-related complex Infectious illnesses invade the body “Opportunistic” infections: at this point, the HIV infection has killed enough host-protective WBCs to damage the immune system severely and lower the body’s normal disease resistance

Stages of Disease Progression Stage 3: Final stages of AIDS Rapidly-declining T-helper lymphocyte counts  < 200/mcL Severe immunodeficiency  several diseases occur (Kaposi's sarcoma, protozoan parasites, CMV, lymphomas, TB, etc.)

Goals of Medical Management Delay progression of the infection and improve the immune system Toxic effects of HIV drugs Prevent opportunistic illnesses Recognize the infection early and provide rapid tx. for complications including infections and cancer

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

Causes of Body Wasting Inadequate food intake Malabsorption of nutrients Disordered metabolism

Lipodystrophy Megace (megestrol) used in treating the cachexia and wasting syndrome in AIDs and cancer patients A synthetic hormone which improves appetite and food intake  weight gain Majority of wt. gain is fat mass, not lean tissue Disproportionate gaining of fat mass = Lipodystrophy, however, there is continued wasting of lean tissue This drug was determined to be not the best choice.

Nutrition Assessment Anthropometry Biochemical tests Clinical observations Diet observations Environmental, behavioral and psychological assessment Financial assessment

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 Community programs Psychosocial support