REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION

COLLEGE OF NURSING TACLOBAN CITY

ASSIGNMENT IN NCM 106

Submitted to: Mr. Nio Archie S. Labordo, RN, MRDA Clinical Instructor

Nutrition in Cancer Care

Sharon Day, Director of Nutrition at CTCA at Western Regional Medical Center, works closely with a patient to develop a personalized nutrition plan. There is a lot you can do to give yourself the best chance to win the fight against cancer. Staying nutritionally fortified is one positive way to take control of your life and your well-being. Optimal nutrition allows your body to function at its best. Maintaining optimal nutrition can provide several benefits for people living with cancer, including: Support immune function Preserve lean body cell mass Rebuild body tissue Decrease your risk of infection Improve strength and increase energy Improve your tolerance to treatment Help you recuperate faster after treatment Improve quality of life Good nutrition is essential to keep you strongto increase the chance that your cancer treatment goes uninterrupted. Your body needs more "fuel" than normal during this time, because it needs to repair from the effects of cancer treatments, such as surgery, radiation therapy and/or chemotherapy. If you are unable to consume the fuel you need, your body will soon draw upon what it has storedfat and protein. When your body uses stored protein, malnutrition and impaired functioning of your immune system may result. According to the National Cancer Institute, about one-third of all cancer deaths are related to malnutrition. Therefore, it is important to give your body a constant supply of nutrients to use as fuel during the healing process. This supply of nutrients includes calories from all macronutrients, including carbohydrates, protein and fat. Dietitians can help by making recommendations for how to keep you nourished with healthful foods and a wellbalanced diet. Dietitians are health professionals with extensive training in nutrition who help with dietary choices.

Nutrition at CTCA The Nutrition Metabolic Support Department at Cancer Treatment Centers of America (CTCA) aims to keep you strong and nutritionally balanced so your cancer treatment is not interrupted. The department is led by licensed and registered dietitians who provide expert care for you through comprehensive nutrition assessment, education and supplementationwith an emphasis on proactive nutrition intervention. Our goal for you is to prevent malnutrition, reduce side effects, promote positive healthy eating habits, and enhance your overall well-being and quality of life. Nutrition Assessment and Plan Upon your arrival at a CTCA hospital, you will be automatically scheduled to meet with one of our dietitians, who will be assigned specifically to you. At that time, you will receive an individualized, comprehensive nutrition assessment and plan. The assessment may include: Laboratory analysis of the blood this determines the status of your immune system (immunocompetence) and protein stores Medical history and nutrition interview this provides the nutrition team with insight into your appetite, food preferences, the status of your digestive system, and any existing or potential complications Nutrition anthropometrics we will take body measurements to determine your percent of body fat and loss of lean tissue During your care, you may receive the following additional tests: Indirect calorimetry a simple breathing test to measure the amount of oxygen consumed (to assess your calorie requirements) Computerized diet profile a three-day nutrient intake analysis completed by you Nitrogen balance a measurement of protein loss to determine if your body is using protein properly Your dietitian is a member of your overall care team and will support you throughout your entire continuum of care. Using your personalized nutrition plan, your dietitian will focus on managing side effects of cancer treatment, recommend supplements to improve your use of calories, and help find foods your body can tolerate. Your dietitian will also consult regularly with your oncologist and the other CTCA departments. This team approach enables you to get the attention you need and deserve.

Nutrition Therapies at CTCA Personal Meal Plans Adequate protein, calories and high-nutrient foods are essential during this time. As part of your care plan, your dietitian will recommend dietary options specific to you, including immune-boosting foods designed to reduce the toxicity of your cancer treatment. The goal is to complement your traditional cancer treatmentswith the fortifying effects of nutritional support. Your dietitian will also work closely with our food service department to combine maximum nutritional benefits with spirit-lifting food enjoyment. The foods suggested in the meal plans are available in the dining rooms in each of ourCTCA hospitals. Our dietitians will often implement new research findings into the menus. Selections include fish, poultry, legumes, low-fat yogurt, fruits and vegetables, whole grains and cereals, and other healthy food choices. We also offer a variety of protein powders and supplements to make sure you are getting the necessary

nutrients if you are not able to keep whole foods down. We want to ensure that you receive a well-balanced diet rich in phytochemicals, vitamins and minerals. Vitamin and Mineral Supplementation Vitamin and mineral supplements provide nutrients that your diet may not, and offer a boost where illness may have depleted your body. The CTCA supplementation plan includes nutrients that may help support your immune system and reduce toxic side effects. Your care team at CTCA may recommend daily dosages of various nutrients, including: Beta carotene Selenium Vitamin C Eicosapentaenoic acid (EPA) Vitamin E Others as appropriate Many of the supplements we recommend at CTCA hospitals come from our own line of 70 highly-pure and potent nutritional supplements. Cancer Nutrition Centers of America (CNCA) supplements are science-based and abide by rigorous quality standards. These supplements were designed specifically with input from medical professionals to meet the needs of patients with compromised immune systems. Nutrition Education In addition to making dietary suggestions and helping design meal plans, our nutrition team provides continued support through education, including programs and classes on the relationship between a healthy diet and wellness. We aim to empower you with information and guide you in maintaining proper nutrition. CTCA also offers a weekly nutrition class and a monthly cooking class. These classes feature presentations on cooking with herbs, protein and calorie supplements, nutrition and cancer, superfoods, immune boosting foods, healthful cooking and more. Nutritional Support Should you require nutritional support, the dietitians from the nutrition team at CTCA, along with a physician, nurse and pharmacist, will work closely with you to make sure you receive proper nourishment. If you are unable to eat or digest food, we will provide nutrition parenterally (through a vein) or enterally (through a feeding tube).

Nutrition during treatment

There is a Hippocratic principle that states: "Let your medicine be your food and your food be your medicine." In other words, eating right will keep your body in good condition. Cancer patients find it even more important to eat right - during treatment, their dietary intake can literally become a matter of life and death. Surgery, radiation therapy, and chemotherapy are the most common treatments designed to stop the spread of cancer by killing and/or removing cancerous cells. Unfortunately, in the process of radiation therapy and chemotherapy, many of the body's healthy cells are also damaged or destroyed. During these treatments the body is working unusually hard: fighting the cancer cells, and attending to the damage to healthy cells caused by the therapy by repairing and replacing already-damaged cells. The strain of these combined tasks is considerable, and the body requires a proportionally higher amount of nutrients just to maintain standard body functions. Those same nutrients are also needed as building blocks for the functions that will repair all the collateral cellular damage caused by therapy which may be distant from the actual site of treatment. If there aren't enough nutrients to go around, this will lead to malnutrition, a condition where the body is not taking in enough of the right kind of nutrients, forcing it to take them from stores in the fat or actually breaking down existing lean body mass (muscle tissue) to obtain what is needed. Malnutrition is very dangerous -- many studies have shown that weight loss drastically increases the mortality rate for most types of cancer while also lowering the response to chemotherapy. Of course, the reverse also seems to be true - in fact, a diet rich in the proper nutrients can often lessen the side effects of treatment and may even shorten recovery time. In most cases, malnutrition can be prevented by simply eating enough foods rich in vitamins and anti-oxidants. This includes plenty of fruits and vegetables (at least 5 servings a day), whole grain breads and cereals, lean cuts of meat (chicken, turkey or fish), and low-fat dairy products. For patients with oral cancer, eating properly can pose a difficult problem. The proper nutrients assist the body in rebuilding damaged cells, but anti-oxidants may actually fight the cancer directly. An article published last year in the International Journal of Integrative Medicine states that an increase in survival has been demonstrated for patients who received Vitamin A or other antioxidants in combination with chemotherapy or radiation therapy. This finding was observed for patients with oral and several other kinds of cancer. Patients who were given beta-carotene and other anti-oxidants while undergoing surgery, chemotherapy, and radiation lived longer, with an increase in disease-free intervals. What not to eat is nearly as important. Cutting back on salt, fat, alcohol and sugar intake is essential. Not only are these "empty calories", but in some cases they may assist the continuing development of cancer in the body. For instance, researchers now feel that some tumors are primarily obligate glucose metabolizers; in other words, these tumors are "sugar feeders". In one animal study, there was even a clear dose-dependent response, the more sugar in the diet, the quicker the cancer metastasized in the test animals.

Eating the right foods and avoiding the wrong ones may be difficult to adjust to at times, but it is certainly possible. Unfortunately, the nutrition battle often doesn't stop there. The very side effects of the treatment that make a proper diet essential can often interfere with the act of eating itself, particularly for those with oral cancers. Since the healthy cells suffering damage include those in the mouth or digestive tract, an oral cancer patient can develop serious eating problems such as loss of appetite, nausea, vomiting, diarrhea, constipation, blistered mouth or throat tissues (mucositis), dry mouth (xerostomia), changes in taste, and fatigue. For those who suffer these side effects, eating the proper foods is difficult if not impossible; and as a cancer patient's survival can be dependant on how he or she takes care of their body during treatment, these considerations must be addressed. Those experiencing nausea or loss of appetite should press themselves to eat small frequent meals. Another method is to time meals to coincide with periods during the day when the patient is feeling best (generally, patients tend to feel better and have improved appetites early in the day with a progressive decrease in appetite as the day progresses.) Avoid strong aromas if they contribute to the feeling of nausea, such as serving cold rather than hot foods, since odors come from the rising steam. Also, here's a medical excuse to order out! Food ordered from outside (so that preparation odors are not detected) will often be more tolerable if consumed immediately after arrival. For those with changes in taste, dieticians have developed many different suggestions to make meals more palatable. Always rinse your mouth before eating. Serve meats chilled rather than hot, and try to substitute poultry, fish, eggs, and cheese for red meat. Another substitute for red meat: milk shakes, puddings, ice cream, cheese, and other high-protein foods. Lemon-flavored drinks will stimulate saliva and taste, but avoid artificial lemon and use sweeteners sparingly. As radiation treatments produce mucositis, it may not be possible to tolerate acidic foods or strongly spiced foods, as treatment progresses. Finally, use disposable plastic utensils if patient experiences unpleasant metallic tastes while eating. Dry mouth sufferers can eat soft or moist foods, (process foods in a blender if applicable). Creams, gravies, or oils can "lubricate" foods to make them easier to eat. Poaching fish in broth yields a tasteful and moisture rich food vs. cooking it by other methods that may be difficult to swallow. It may also help to avoid excessively hot or cold foods, or foods that adhere to the roof of the mouth. Take small bites and chew thoroughly. Nearly all chemotherapy patients should drink more fluids in general and especially after certain chemotherapy treatments, but for those with a sore or blistered mouth or throat, fluids can become absolutely essential. Water, juice, soups, ice cream, ice pops, tea, milk, and gelatin are all suitable fluids. If your doctor has not restricted your fluid intake, try to drink at least six 8-ounce glasses of fluids a day. It may be easier to sip fluids frequently throughout the day as opposed to drinking full servings all at once. Many patients find that drinking nutritional supplements (such as Ensure , Resource , Boost ), or instant breakfast drinks add the essential vitamins and protein when the actual act of swallowing may be too discomforting. We recommend that oral cancer patients try making their own shakes in a blender. The combination of fresh fruits and protein powder derived from soy or whey, with yogurt, milk, or fruit juices, can make the difference when the actual act of eating or chewing is too painful. For those on a feeding tube, the blender drinks will be their first transition to real food, and an important step in regaining a sense of normality to eating.

Cancer patients may also consider nutritional supplements, especially for the times when they feel they cannot eat enough. Although certain nutrient supplements may not work as well as whole foods, there is a general feeling that taking recommended doses of certain vitamins can assist the process in most cases. Many of these are available in liquid or powder form which can be incorporated into a blender drink. Consult your doctor or dietician for more information. No matter what the symptoms of the treatment, a person with cancer should try to maintain a positive attitude toward maintaining their diet. A change in one's diet "because the doctor told me to" is the easiest and least helpful attitude, while eating better "because I want to do everything I can to beat this thing" is much more productive. After all, any cancer patient who tries to keep a good diet is contributing to his or her treatment as much as the medical professional. This is one area in which the patient can feel some sense of control and involvement; two things that many feel are lost during the treatment process. Also, keeping a good nutritional state can help people with cancer feel and look better and can help them maintain the physical strength to optimize dayto-day life. Because, in the end, this battle is fought day-to-day, and the best assistance the patient can provide is good nutrition and a positive attitude.