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N U T R I T I O N &
R E H A B I L I T A T I O N
D R . M A L H A R P A T E L
Don't Think of Your Past Patient
Don't Think of Your Future Patient
Just Think of Your Present Patient
The Patient Who is ...
N U T R I T I O N I S I M P O R T A N T
C A N C E R P A T I E N T S A R E A T R I S K O F
M A L N U T R I T I O N
P h y s ...
40% are Malnourished at Diagnosis.
"Head and neck cancer, pre-treatment
weight loss is an independent predictor of
surviva...
I T ' S D I F F E R E N T F R O M
S I M P L E M A L N U T R I T I O N
N E G A T I V E E N E R G Y B A L A N C E
S K E L E ...
ENERGY INTAKE�
<60% FOR 1-2 WEEKS
80% SUFFERS
WEIGHT LOSS
PRIMARY
SECONDARY
MID ARM CIRCUMFERENCE
MEN: 32
FEMALE:18
MORTAL...
Maintain and Increase
AIM
Energy
25-30 Kcal/Kg/Day
Loss of 800 Kcal on average
Resting Energy Consumtion Increases to 10-25%
Glucose and Fat
INSULIN�RESISTANCE
Weight Loss - Increase Fat Diet
Fat: 0.7 - 1.9 Gm/Kg/Day
Glucose - Sodium Imbalance
Protein
1.5 - 2.0 Gm/Kg/Day
Inactivity, Old Age, Systemic Inflammation
Decrease Protein Synthesis
Salt
Old Age
Tube Feeding
Taste Alteration
Vitamins
Same as Well Nourished Person
HOW TO GO ABOUT IT?
Different Patients
Already
Malnourished
Surgical
Morbidity
Tumour
Site
Duration
Dose
Radical Adjuvant Palliative
Start @
Diagnosis
Avg Weight
Loss 5 kg
Nutritional
Assessment
The Malnutrition Screening Tool
The Interdisciplinary Nutrit...
COUNSELLING�
#2
START ORAL
NUTRITION
SUPPLEMENT
#3
Treat Secondary Causes
Radiation Technique
#4
Still Losing
Weight???
Naso-Gastric Tube
1 2
PEG Tube
3
Parenteral Nutrition
#5
WHEN?
PRE-TREATMENT?
DURING TREATMENT?
ASSESSMENT FOR ENTERAL
NUTRITION
PERFORMANCE
STATUS
WHO 2-3
SMOKING
20/DAY
PRE-RX
WEIGHT LOSS
>10%
ADVANCED AGE
>70 YEARS
...
Prophylactic Tube
Oropharynx
Weight Loss >10%
BMI < 20 kg/m2
Age > 70 years
OVERALL
SURVIVAL
DEPENDS ON
BMI AND
WEIGHT LOSS
0: Best
4: Worst
Naso-Gastric Tube PEG Tube
Economic
Easy to insert
Easy to Remove
Less Care
Few Weeks to Months
Cosmetic
Months to Years
L...
NUTRITION
ORAL NUTRITION
SUPPLEMENT
COUNSELLING
ENTERAL NUTRITION
NG OR PEG
PROPHYLACTIC OR ELECTIVE
START AT DIAGNOSIS
REHABILITATION
01
Social Dinner Salivation/
Trismus
Dental
Prophylaxis
Physical
Activity
Self
Confidence
Speech
Therapy
Swallowing Clinic
Thank You
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Nutrition and Rehabilitation in Oncology

Nutrition and rehabilitation are very important aspect of cancer treatment. Sadly many a times they are not given utmost importance from patients, family and even doctors.
I have summarised the international guidelines for nutrition on treatment of cancer.

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Nutrition and Rehabilitation in Oncology

  1. 1. N U T R I T I O N & R E H A B I L I T A T I O N D R . M A L H A R P A T E L
  2. 2. Don't Think of Your Past Patient Don't Think of Your Future Patient Just Think of Your Present Patient The Patient Who is Yours Today; Was Someone Others' Yesterday And Tomorrow, He/She Will be Someone Others' What You Think Yours is Not Yours
  3. 3. N U T R I T I O N I S I M P O R T A N T C A N C E R P A T I E N T S A R E A T R I S K O F M A L N U T R I T I O N P h y s i c a l & M e t a b o l i c E f f e c t o f C a n c e r E f f e c t o f A n t i - C a n c e r T h e r a p i e s
  4. 4. 40% are Malnourished at Diagnosis. "Head and neck cancer, pre-treatment weight loss is an independent predictor of survival in advanced stage disease." Weight Loss - Greater Morbidity and Poor Tolerance to Treatment 20% Die Due to Effects of Malnutrition FACTS
  5. 5. I T ' S D I F F E R E N T F R O M S I M P L E M A L N U T R I T I O N N E G A T I V E E N E R G Y B A L A N C E S K E L E T A L M U S C L E M A S S L O S S E L E V A T E D R E S T I N G M E T A B O L I C R A T E I N S U L I N R E S I S T A N C E L I P O L Y S I S P R O T E O L Y S I S S Y S T E M I C I N F L A M M A T I O N C A T A B O L I C F A C T O R S
  6. 6. ENERGY INTAKE� <60% FOR 1-2 WEEKS 80% SUFFERS WEIGHT LOSS PRIMARY SECONDARY MID ARM CIRCUMFERENCE MEN: 32 FEMALE:18 MORTALITY� DOSE LIMITING TOXICITY FATIGUE IMPAIRED PHYSICAL ACTIVITY IMPAIR REPAIR INADEQUATE INTAKE MUSCLE PROTEIN DEPLETION SYSTEMIC INFLAMMATION What Happens in Cancer Malnutrition
  7. 7. Maintain and Increase AIM
  8. 8. Energy 25-30 Kcal/Kg/Day Loss of 800 Kcal on average Resting Energy Consumtion Increases to 10-25% Glucose and Fat
  9. 9. INSULIN�RESISTANCE Weight Loss - Increase Fat Diet Fat: 0.7 - 1.9 Gm/Kg/Day Glucose - Sodium Imbalance
  10. 10. Protein 1.5 - 2.0 Gm/Kg/Day Inactivity, Old Age, Systemic Inflammation Decrease Protein Synthesis
  11. 11. Salt Old Age Tube Feeding Taste Alteration
  12. 12. Vitamins Same as Well Nourished Person
  13. 13. HOW TO GO ABOUT IT?
  14. 14. Different Patients Already Malnourished Surgical Morbidity Tumour Site Duration Dose Radical Adjuvant Palliative
  15. 15. Start @ Diagnosis Avg Weight Loss 5 kg Nutritional Assessment The Malnutrition Screening Tool The Interdisciplinary Nutrition Care Plan The Patient- Generated Subjective Global Assessment (F. D. Ottery, personal communication, 2000) #1
  16. 16. COUNSELLING� #2
  17. 17. START ORAL NUTRITION SUPPLEMENT #3
  18. 18. Treat Secondary Causes Radiation Technique #4
  19. 19. Still Losing Weight??? Naso-Gastric Tube 1 2 PEG Tube 3 Parenteral Nutrition #5
  20. 20. WHEN? PRE-TREATMENT? DURING TREATMENT?
  21. 21. ASSESSMENT FOR ENTERAL NUTRITION PERFORMANCE STATUS WHO 2-3 SMOKING 20/DAY PRE-RX WEIGHT LOSS >10% ADVANCED AGE >70 YEARS ADVANCE STAGE AJCC 3-4 SERUM ALBUMIN <40G/L
  22. 22. Prophylactic Tube Oropharynx Weight Loss >10% BMI < 20 kg/m2 Age > 70 years
  23. 23. OVERALL SURVIVAL DEPENDS ON BMI AND WEIGHT LOSS 0: Best 4: Worst
  24. 24. Naso-Gastric Tube PEG Tube Economic Easy to insert Easy to Remove Less Care Few Weeks to Months Cosmetic Months to Years Less Aspiration Large Bore Invasive Surgical Care Infection Rate 15% Peritonitis Expensive Cosmetic Discomfort Small Bore Chance of Aspiration
  25. 25. NUTRITION ORAL NUTRITION SUPPLEMENT COUNSELLING ENTERAL NUTRITION NG OR PEG PROPHYLACTIC OR ELECTIVE START AT DIAGNOSIS
  26. 26. REHABILITATION
  27. 27. 01 Social Dinner Salivation/ Trismus Dental Prophylaxis Physical Activity Self Confidence Speech Therapy Swallowing Clinic
  28. 28. Thank You

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