Cancer is an illness that can affect nearly every organ system in the body. Its prognosis is vastly variable, from nearly 100% survival to almost 100% mortality depending on the site of primary cancer.
Nutritional status plays an important role in the success of treatment and the healing processes in cancer patients. An inadequate diet has negative effects on the immune status and tolerance of treatment, as well as on various organ and metabolic functions. The effectiveness of chemotherapy and radiotherapy to destroy cancer, as well as the response to such therapy may be reduced, while the rate of adverse effects and the risk of treatment-associated complications are increased. Cancer patients who have deficient diets have higher morbidity and mortality. Malnourished cancer patients have about 30% higher mortality.
Malnutrition is a commonly occurring and serious problem in patients with cancer. Nutritional and metabolic derangements, common in cancer patients, carry prognostic significance and are often responsive to treatment. Patients with lung, prostate, head and neck, and gastric cancers are affected the most.
Hormonal and metabolic abnormalities and reduced food intake cause advance starvation state known as cancer cachexia. Cancer cachexia presents as progressive, involuntary weight loss with depletion of lean body mass, muscle wasting and weakness, edema, impaired immune response, and declines in motor and mental function. Cancer produces abnormalities in lipid, carbohydrate, and protein metabolism, reduce the efficiency of energy metabolism, and this elevates resting energy expenditure (REE), which may be a major determinant in patients developing cachexia.
Nutritional support provides patient with energy and nutrients to maintain or improve their nutritional status and immune function, minimize gastrointestinal symptoms, and improve their quality of life.
Main Objectives of Nutritional Therapy
- To meet the increased metabolic demands for the disease and prevent catabolism as much as possible and To
- alleviate symptoms resulting from the disease and its treatment production of food and feeding process.
Factors to Consider while Planning your Diet
To prevent excessive weight loss and to meet increased metabolic demands the total energy value of the diet must be increased calorie density sufficient to counter catabolic or hyper metabolic state and to support necessary enable a Gym is necessary of this total dietary kilo calorie value that must be sufficient carbohydrates to spare protein for vital tissue synthesis for an adult patient with good nutritional status about 2000 kcal will provide for maintenance needs and malnourished patient may require 3000 to 4000 kcal depending on the degree of malnutrition and body trauma calorie requirement are
*20-25 kcal/kg -non-ambulatory or sedentary proteins.
*30-35 kcal/kg -Slightly hypermetabolic; for weight gain /anabolism.
*40-45 kcal/kg -hypermetabolism or extreme wasting.
Protein energy malnutrition is common in cancer patients. Additional protein is required to provide essential amino acid ands and nitrogen necessary for tissue regeneration, healing, and rehabilitation. Branched-chain amino acid infusions can decrease protein catabolism in cancer patients. An adult patient with good nutritional status will need about 80 to 100 g to meet maintenance needs and to ensure anabolism. A malnourished patient will need more to replenish tissues and to ensure positive nitrogen balance.
*0.5 g/kg – minimal daily requirement
* 0.8 g- 1.0g/kg – normal maintenance level
*1.5-2.5 g/kg – if increased protein demands exist e.g, protein losing enteropathy, hypermetabolism or extreme wasting.
Glutamine suggested for clinical use.
Tumor located in the digestive tract have the potential of causing obstruction resulting in poor intake. Deficiency of B vitamins can arise from prolonged general malnutrition. Normal metabolism of micronutrients may also alter the disease progress. Reaction of the lower gastrointestinal tract may result in child in malabsorption and micronutrient deficiencies. In all these circumstances supplementation may be required.
Radiation and chemotherapy induced side-effects like nausea vomiting, diarrhea can lead to electrolyte imbalance.
A daily multivitamin and mineral supplement may be recommended for patients whose intake is limited for a prolonged period. In addition, dietary supplements are given to improve the nutritional status.
Increased intake up fluids is ideal to compensate losses from gastrointestinal problems as well as any additional losses caused by infections and fever. Also, sufficient food intake is necessary to help the kidneys to get rid the body of the breakdown products from destroyed cancer cells and drugs themselves. Increased fluid also helps to protect the urinary tract from irritation and inflammation.