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Cytokines are protein mediators produced by

inflammatory cells

Cytokines produce metabolic wasting in the tumor-

bearing host

Cytokines involved:

TNF-E and TNF-F (Cachectin),

Interleukin-1, 6, and

Gamma-interferon

Treatment

x Anticytokine antibodies or inhibitors

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` Chemotherapy Definition

Use

Target of impact

Nutrition-related side effects: Myelosuppression, anemia,

fatigue, nausea, vomiting, loss of appetite, mucositis, changesin taste and smell, xerostomia, dysphagia, diarrhea, andconstipation, adynamic ileus, anorexia, vomiting

Other side effects: neutropenia

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` Why Immunotherapy?

Immune stimulation sensitizes the patients own

immune system, helping it to be more likely to

notice, and therefore destroy deposits of cancer cells

` Side-effects:

Fatigue, chills, fever, flu-like symptoms, decreased

food intake

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` Alkylating agents ( cysplatin, cyclophosphamide,bisulfan)

` Nitrosoureas

` Antitumor antibiotics (doxorubicin, mitomycin,neomycin)

` Hormones or H antagonist (glucocorticoids,antiandrogens, antiestrogens tamoxifen,

progestins)

` Antimetabolites (Fluorouracil, methotrexate)

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` Vinca Alkaloids (vincristine, paclitaxel, docetaxel)

` Taxanes

` Immunologics ( Interferon Alfa, interleukin)

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` Radiation Therapy (Use of ionizing radiation tocure, control or palliate cancer) Acute complications manifest after 2-3 weeks of the

treatment and resolve 2 4 weeks following treatment

exception late effects of radiation

Fatigue, loss of appetite, skin changes, and hair loss inarea treated

Site-specific effects

x Head and neck x Acute effects

x Late effects

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` Hemopoietic stem cell transplantation(Bone Marrow Transplantation)

involves taking cells that are normally found in the bone

marrow (stem cells) from the donor or from cord blood and

giving them back, by intravenous infusion, to the recipient,

either the same person or to another person.

The sources of these stem cells can be:

from the patient (autologous)

from a relative (allogeneic)

from a matched unrelated donor (MUD)

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` Immunosuppression can lead to Nausea, vomiting, anorexia, dysgeusia, stomatitis, oral and esophageal

mucositis (in 75% of transplants) , fatigue, and diarrhea

Patients have no oral intake during 1st few weeks and require enteral orparenteral support usually G-Tubes or TPN

When oral foods introduced, bland liquids or soft solids work best

Dietary precautions with neutropenia:Foods to avoid:x Fresh fruits or vegetables

x Raw or rare cooked meats, fish, or eggs

x Dried fruits or nuts

x Unpasteurized dairy products (such as raw milk, and naturally aged cheeses, and all yogurts).x Fresh herbs and seasonings (unless added during cooking)

x Shellfish

x Unpasteurized beverages

x Raw Honey

x Foods from street vendors, delis, coffee carts and salad bars

Do: Choose foods in portion control packets

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Graft versus host disease (GVHD)

x Possible side effectsx Gastroenteritis, severe diarrhea, pain, nausea, vomiting

x

1st

phase treatment: total bowel restx 2nd phase treatment: liquids that are isotonic, low residue andx lactose-freex 3rd phase treatment: solids low-fiber, lactose-free, low acid

x 4th phase treatment: restrictions are reducedx 5th phase treatment: back to normal diet

Sinusoidal obstructive syndrome (S0S) orVenocclusive Diseasex Causes damage to hepatic venulesx Requires aggressive parenteral support

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` Surgery

Fatigue, pain, loss of appetite

Require additional energy and protein for

wound healing

If certain parts of the digestive system are

removed

Nutritional problems: related to specific site:head & neck, gastric resections

Treat the affected area

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` Determining routes of nutritional therapy

` Oral nutritional management techniques

` Management of chemotherapy-induced vomiting

` Pharmaceutical management of anorexia

syndrome

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` Enteral nutrition

` Parenteral nutrition

` Rehabilitation and physical therapy

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` Palliative Care forAdvanced Cancer

Focus on pain management, weakness, loss

of appetite,dry mouth, etc

Focus on maintaining strength and quality of

life

Nutrition as desired, as tolerated

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` Families and caregivers often have extremepreoccupation with eating and weight

` Creativity in feeding

` Enteral nutrition support

` Individualize requirements

` Requirements for growth and development

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` Whole medical systems` Traditional Chinese Medicine, ayurvedic medicine, homeopathy,

naturopathy

` Mind-body intervention

Mindfulness, meditation` Biologically based therapies

Botanicals, dietary supplements, vitamins, minerals

` Manipulative and body-based methods Massage, yoga, reflexolgy

` Energy therapies Veritable and measurable sound, light, energy

Putative such as biofields

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` Nutrition plays important role throughout the

continuum of cancer care Reducing cancer risk

Caring for patients undergoing CA treatment

Promoting healthy lifestyles forCA survivors

` Nutrition mgt. can help improve patients

tolerence of treatment minimize impact of systems

and maximize quality of life