pages 25-28. Cancer-related malnutrition.
- 1.elebrateLifeFor Home TPN and Tube Feeding PatientsIssue Focus:The Importance ofNutritionalH E A LT HwHeN coPINg wITHCancer A publication ofSeptember 2011 | Issue 25
2. ContentsSeptember 2011 | Issue 25 4 Quality of Life and Nutrition Support for the cancer Patient For most people, the main thing that determines quality of life is our ability to enjoy everything life has to offer with no major health symptoms. Learn about how nutrition support can help improve quality of life for cancer patients. 7 Eating Healthy to Help Prevent Cancer Celebrate Life The Quarterly Magazine for Home TPN Healthy food choices are a key to the prevention of many diseases, including cancer. A plant- and Tube Feeding Patients based diet is a great place to start to benefit from the disease-fighting abilities of diet.Celebrate Life StaffCarlota Bentley, Managing EditorKaren Hamilton, Clinical Editor11 Nutrition and Cancer Care: Resource OrganizationsLaura Persons, Senior EditorNancy Geiger Wooten, Senior Designer12 The Effects of Cancer Therapy on Nutritional Well-Being Contributing WritersElaine Arthur, RD Cancer treatment can affect nutritional health, while nutritional health can impact a cancer Michelle Barford, ConsumerTiffany Fancher, PharmD patients recovery. Learn how to anticipate, understand and alleviate nutrition problems asLinda Gravenstein, Consumer Advocate they relate to cancer therapy. Karen Hamilton, MS, RD, LD, CNSCCarol Ireton-Jones, PhD, RD, LD, CNSD18 Home Care Therapies for Cancer PatientsRoaxana Tamijani, MS, RD, LDCorrie Trottier, MS, RD, LD /NPankaj Vashi, MD Cancer rates continue to rise in the U.S., but at the same time, treatment options have grown by leaps and bounds. Learn about what treatment options are available to cancer patients in Celebrate Life is published quarterly and provided as a free the comfort of their homes. service to parenteral and enteral consumers. Opinions expressed by contributing authors and sources are not20 My Great Adventurenecessarily those of the publisher. Information contained in this magazine is for educational purposes only and is not Sometimes nutrition support is short-term and uneventful and sometimes it is anything intended as a substitute for medical advice. but! With a positive attitude and a sense of humor, Michelle Barford, a Coram nutrition Do not use this information to diagnose or treat a health problem or disease without consulting a qualified support patient, shares her dramatic story. physician. Please consult your physician before starting any course of treatment or supplementation, particularly25 Tube Feeding: A Smart Weapon Against Cancer-Related Malnutritionif you are currently under medical care. Never disregard medical advice or delay in seeking it because of Studies have shown that cancer patients experience a good quality of life when they are something you have read in this publication. able to maintain their nutritional well-being. One way to battle cancer-related malnutrition 2011 Coram Specialty Infusion Services. All rights reserved. No part of this publication may be distributed, and one that can be used in the home is enteral nutrition (EN), or tube feeding.reprinted or photocopied without prior written permission of copyright owner. All service marks,29 Advocacy Corner: In Case of a Drop in Cabin Pressure, Put Your Mask trademarks and trade names presented or referred to in this magazine are the property of their respective owners. On First A Survival Guide for the Caregiver of a Cancer Patient We welcome your comments, stories and suggestions. Please send all correspondence to: In the unsettling atmosphere of cancer, the caregiver is a patients lifeline. But to be an effective supporter and advocate, a caregiver must take precautions to stay strong. Read Coram Specialty Infusion ServicesCelebrate Life about how to take care of yourself as you care for your loved one. 555 17th Street, Suite 1500Denver, CO 80202 COR09007-0911 3. A Note from Our Guest EditorCelebrate Life is a magazine dedicated to providing home nutrition care patientswith very practical information and useful tips for managing their condition. It isa great honor to be guest editor of this issue, which focuses on cancer nutritionand includes articles on a variety of related topics.As a gastroenterologist and a medical director of the nutrition and metabolicsupport team at Cancer Treatment Centers of America (CTCA), I have always hada challenging job of managing severe cancer-associated malnutrition. Over thepast two decades, home healthcare services have made big strides in helpingmy patients with their nutritional needs. With great evidence-based studies, we have shown that aggressivenutritional therapies using TPN and tube feeding can be delivered very efficiently and safely to cancer patientsin the comfort of their own homes.I have dedicated the last 17 years to the nutritional needs of patients with advanced cancer. There are stillskeptics who are reluctant to consider home nutrition therapy in patients with cancer; however, these numbersare dwindling rapidly. It gives me tremendous professional satisfaction to see the impact of home nutritionaltherapy on the quality of life of my patients. Therefore, I have included an article in this issue discussing thismatter in detail.In another article, Carol Ireton-Jones and Roaxana Tamijani, two well-reputed dietitians, very eloquently discussthe role of healthy eating in preventing cancer. Lifestyle changes including exercise, weight reduction, abstainingfrom tobacco/alcohol, and eating healthy are important not only for healthy individuals, but also for patientswho are under active treatment for cancer.Unfortunately, achieving nutritional well-being can be challenging for patients who are experiencing severe sideeffects from different modalities of cancer treatments. To address this, Karen Hamilton has written a detailedarticle that can help you better understand and manage these challenges.Pharmacists play a key role in helping our cancer patients at home. Tiffany Fanchers article talks about therapiesother than TPN and tube feeding that can be provided at home to aid our cancer patients.The role of a caregiver (a family member or a friend) is a vital part of the success of home nutritional care. Anarticle by Linda Gravenstein a TPN patient advocate will help you better understand this role.For our tube-feeding patients, Elaine Arthur and Corrie Trottier have provided an in-depth commentary on howto successfully manage the different kinds of feeding tubes and specialized enteral formulas.Nutrition in cancer can be very complex. I am proud to be a contributor to this issue, which addresses the mostimportant challenges for patients today. Enjoy this issue, and as always, we appreciate your feedback.Dr. Pankaj Vashi, MDLead National Medical DirectorNational Director Gastroenterology & Nutrition Metabolic SupportCancer Treatment Centers of America at Midwestern Regional Medical Center3 4. Q uality of Lifeand Nutrition Support for the Cancer PatientBy Dr. Pankaj Vashi, MD 4 | Celebrate Life | October 2011, Issue 25 5. The definition of quality of life (QOL) isNutrition Support Options: Enteraldifferent for everyone. But for most people,Nutrition and Parenteral Nutritionthe main factor that determines QOL is ourAn alternate means of nutrition supportability to enjoy everything life has to offer withshould be considered in all cancer patientsno major health symptoms. For cancer patients,when their oral intake of proteins and caloriesone factor that can cause health symptoms and drops below 60% of the recommended intake.have a serious impact on QOL is poor nutrition. Early interventions should focus on controlFor these patients, nutrition support can be an of symptoms (such as pain, nausea, vomiting,effective treatment option. diarrhea and poor appetite). Poor symptomcontrol can have a negative effect on overallPoor Nutrition in Cancer Patients nutrition and QOL. Once the symptoms areWeight loss, loss of appetite, and fatigue with under control, oral supplementation of liquidsgeneralized weakness are seen in more thanand powders high in calories and protein should60% of patients with advanced cancer. These be implemented. If a patients digestive tract issymptoms of malnutrition are more pronouncedintact and functional, nutritional support withwith pancreatic, stomach, lung and colonenteral nutrition (EN), or tube feeding, is alwayscancers. Malnutrition in cancer patients resultspreferred. EN can be given through severalfrom multiple factors. Nausea, vomiting and types of feeding tubes: nasogastric, nasojejunal,diarrhea associated with cancer, as well as the gastrostomy or jejunostomy. These tubes areeffects of cancer treatments, play a major role.differentiated based on where and how they areAlso, cancer cells produce chemicals that can placed in the digestive tract. All commerciallycause loss of appetite, weight loss and wasting.available enteral feeding formulas are designedOther factors include infections, surgeries and to deliver adequate amounts of calories, proteinsunderlying depression.and vitamins.Early detection and aggressive intervention ofUnfortunately, a patients digestive tract may notmalnutrition in cancer patients have been shown work well due to either severe gastrointestinalto have a positive impact on overall recovery and side effects of the cancer therapy, or conditionsQOL. Unfortunately, the effect of malnutrition on such as malabsorption syndrome, or bowelQOL is not well recognized. In fact, in spite of very obstruction that cannot be treated surgically. Ineasy-to-use nutritional evaluation tools availablepatients with such digestive problems, parenteralto us, many professionals taking care of cancer nutrition (PN), or intravenous nutrition, is thepatients dont diagnose early malnutrition. Itonly nutrition support option. The role of PN inis not unusual for a physician to come acr