nutritional challenges for esophageal cancer patients.pptx

New Frontiers: Nutrition and Esophageal CancerKacie Merchand MS,RD,LDOncology Dietitian 2Conflicts of InterestNo conflicts of interest to discloseObjectives?Describe role of clinical dietitian?Outline the new consensus statement for both malnutrition and cachexia ? Briefly discuss emerging research for esophageal cancer and nutritional therapy Screening ?Evidence Analysis Library (EAL): All adult patients should be screened for malnutrition risk on entry into oncology services. ?Rate of malnutrition: ~79% patients with esophageal cancer ?Current protocol?Validated Outpatient Screening Tools: oPatient Generated Subjective Global Assessment (PG-SGA)o Malnutrition Screening Tool (MST ) Baker et. al, Int J Environ Res Public Health. 2011 Bower et. al, J SurgOncol. 20095Role of Clinical Dietitian?AssessmentoAnthropometric measuresoFood/Nutrition related historyoBiochemical data, medical tests, proceduresoNutrition focused physical findings ?Diagnosis?Intervention/goals?Monitor/Evaluate6Intervention?Cancer: Dysphagia, heartburn-like pain, regurgitation, hoarseness, coughing, anorexia, weight loss?Chemotherapy : Nausea, Vomiting, Diarrhea, Constipation, Anorexia, Mucositis, Altered taste, fatigue?RadiationTherapy: Esophagitis, anorexia, fatigue, worsening dysphagia, odynophagia, heartburn?Stent placement?Esophageal Resection: Jejunostomy,transition to oral diet, dumping syndromeIlson, Gastrointest Cancer Res, 2008NCI20137Malnutrition?Increase LOS and hospital admissions?Decrease QOL & treatment tolerance?Increase risk of post-op infection, delay wound healing and dehiscence of surgical anastomosis?Increase treatment breaks or treatment termination, ineligibility for surgery?Increase morbidity and mortality 89