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

2. Chapter 23
Lesson 23.1
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3. Key Concepts
Environmental agents, genetic factors, and weaknesses in the body’s immune system can contribute to the development of cancer.
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4. Key Concepts, cont’d
The strength of the body’s immune system relates to its overall nutritional status.
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5. 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.
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6. 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.
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7. Epidemiology Figure information: Incidence rates for United States.
From National Cancer Institute: Cancer state profile, gov/map/map.withimage.php?00&001&053&00&0&1&0&1&6&0#map, accessed October 2007.)
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8. 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.
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9. T- and B-Cell Development
Figure information:
Courtesy Eileen Draper.
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10. 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.
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11. 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.
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12. Chapter 23
Lesson 23.2
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13. Key Concepts
The strength of the body’s immune system relates to its overall nutritional status.
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14. Key Concepts, cont’d
Nutrition problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS.
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15. 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.
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16. 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.
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17. 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
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18. 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).
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19. 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.
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20. 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.
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21. 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.
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22. 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.
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23. 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.
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24. 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.
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25. 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.
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26. Enteral: Tube Feeding
When gastrointestinal tract can be used but patient is unable to eat
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27. Parenteral Feeding When gastrointestinal tract cannot be used
Peripheral vein feeding (for brief period)
Central vein feeding (for extended period)
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28. 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.
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29. Chapter 23
Lesson 23.3
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30. Key Concepts
Nutrition problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS.
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31. 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.
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32. 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.
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33. 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
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34. 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.
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35. 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
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36. Causes of Body Wasting Inadequate food intake
Malabsorption of nutrients
Disordered metabolism
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37. 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.
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38. 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
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39. 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.
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40. 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.
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41. 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.
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42. 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.
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