Chapter 3: Nutrition Risk Screening and Assessment of the Oncology Patient

Question 1

The benefits of good nutrition during cancer treatment include…

Answer 1

fewer complications,
better quality of life,
the ability to tolerate full treatment as prescribed

Question 2

What is the purpose of nutrition screening and assessment?

Answer 2

To identify patients who are at risk for malnutrition.

Question 3

What percent of people experience anorexia and weight loss prior to diagnosis?

Answer 3

40%

Question 4

What percent of people experience malnutrition at some point during their treatment?

Answer 4

40-80%

Question 5

A weight loss as little as ___ predicts a reduced response to oncology treatment, reduced survival, and reduced quality of life.

Answer 5

6%

Question 6

What percentage of upper GI cancer patients experience weight loss?

Answer 6

80%

Question 7

Which 2 cancers are at the highest risk of weight loss and malnutrition?

Answer 7

gastrointestinal and head and neck

Question 8

What are the recommendations for weight loss for overweight/obese cancer survivors undergoing treatment.

Answer 8

There appears to be no contraindication to modest weight loss (max of 2 lbs per week) during treatment as long as the treating oncologists approve and weight loss is closely monitored and it does not interfere with treatment. However, weight loss of 6% can interfere with treatment, so that may disqualify many.

Question 9

T/F: The later oncology nutrition care is implemented, the more difficult it is to modify a patient’s nutritional status.

Answer 9

True

Question 10

T/F: Patients only need to be nutritionally screened once during cancer treatment.

Answer 10

False. Due to the length of treatment and the cumulative effect of treatment, nutrition screenings should be done several times throughout treatment.

Question 11

How frequently should nutrition screening tools be administered?

Answer 11

Prior to physician visit. Weekly during radiation therapy, and every 2-3 weeks during chemotherapy and at each follow-up visit.

Question 12

Name 4 Nutrition screening tools. Which 2 are best for outpatient setting?

Answer 12

PG-SGA (Patient-Generated- Subjective Global Assessment)
MST (Malnutrition Screening Tool)
MSTC (Malnutrition Screening tool for Cancer patients)
MUST (Malnutrition Universal Screening Tool)
** PG-SGA and MST better for out-pt setting**

Question 13

Diet History Covers…

Answer 13

Food allergies, food logs/portion sizes, patterns of meals and snacks, use of functional foods (Ensure), alcohol, food aversions, foods tolerated.

Question 14

Medication History Covers…

Answer 14

Amount and frequency of medications, OTC, stool softeners, laxatives, enzymes, vitamins, herbal supplements, probiotics, fiber medical marijuana or appetite stimulants.

Question 15

Patient Efforts Covers…

Answer 15

Assessment of current strategies used by the patient to overcome difficulty with nourishment; “what is working” and willingness to modify behaviors.

Question 16

Anthropometric Measurements Covers…

Answer 16

Measures, categorize and assess: height, current weight, usual weight, weight changes over time, BMI, adjusted if overwt, grip strength, triceps skin fold mid-upper arm circumference.

Question 17

Biochemical Data Covers…

Answer 17

Blood work, hydration status, bioimpedence, GI function tests, etc.

Question 18

A C-reactive protein (CRP) value of ____ can be used to indicate if inflammation is present.

Answer 18

> /= 10

Question 19

Examples of nutrition focused physical findings.

Answer 19

NIS, vital signs, O2 levels, pulse, BP, temp, grip strength (changes in grip strength over time), stomatitis, glossitis, anemia, appearance of nails, general appearance, abdomen, dermatologic, head/neck, intra-oral cavity, assessment of taste.

Question 20

What is NIS and give some examples?

Answer 20

Nutrition Impact Symptoms: Issues that impede intake, digestion and absorption or utilization. Anorexia, cachexia, muscle wasting, dysphagia, xerostomia, changes to taste and smell, mucositis and stomatitis, N/V, D/C, SOB, dehydration, espohagitis.

Question 21

What is stomatitis?

Answer 21

Inflammation or soreness of the mouth.

Question 22

What is glossitis?

Answer 22

Inflammation of the tongue.

Question 23

What is mucositis?

Answer 23

Inflammation and ulceration of mucus membranes lining the digestive tract.

Question 24

What is xerostomia?

Answer 24

Dry mouth.

Question 25

What is angular cheilitis?

Answer 25

Inflammation and small cracks in one or both corners of the mouth.

Question 26

Client/Social History covers…

Answer 26

cancer diagnosis and treatment regimen, anticipated side effects, age, cormobidities, age, social history, family setting, support system, food security, ability to obtain and prepare food, religious and cultural factors, financial concerns, level of literacy.

Question 27

What is malnutrition?

Answer 27

the undernutrition and changes in body composition which occur due to the cancer itself or from the impact of treatment.

Question 28

The effects of malnutrition on the body?

Answer 28

impact the immune response, muscle strength, level of fatigue, wound healing, psycho-social function, quality of life, tolerance of treatment regimen, and treatment outcome.

Question 29

The effects of malnutrition on cancer treatment?

Answer 29

Increase treatment and disease complications, increase frequency of hospitalizations, increase length of stay, utilization of support services, increasing cost of care.

Question 30

____% of pts with advanced cancer have cancer cachexia?

Answer 30

80%

Question 31

What is cancer cachexia?

Answer 31

a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.

Question 32

What is the pathophysiology of cachexia?

Answer 32

It is characterized by a negative protein and energy balance driven by reduced food intake and/or abnormal metabolism.

Question 33

When does refractory cachexia occur?

Answer 33

The last 3 months of life.

Question 34

What is the criteria for moderate and severe malnutrition in the context of acute illness or injury?

Answer 34

Moderate: <75% of est energy requirements for >7 days
Severe: 50% of est energy requirements for >/= 5 days

Question 35

What is the criteria for moderate and severe malnutrition in the context of chronic illness?

Answer 35

Moderate: <75% of est energy requirements for >/= 1 month.
Severe: <75% of est energy requirements for >/= 1 month.

Question 36

What is the criteria for moderate and severe malnutrition in the context of social or environmental circumstances?

Answer 36

Moderate: <75% est energy requirements for >/= 3 months.
Severe: 50% of est energy requirements for >/= 1 month.

Question 37

What is severe weight loss in the context of acute illness or injury?

Answer 37

> 2% / week
5% / 1 month
7.5% / 3 months

Question 38

What is severe weight loss in the context of chronic illness and social/environmental circumstances?

Answer 38

> 5% / 1 month
7.5% / 3 months
10% / 6 months
20% / 1 year

Question 39

What clinical characteristics are used to determine malnutrition? How many are needed to diagnose malnutrition?

Answer 39

Insufficient energy intake, Unintended weight loss, Loss of subcutaneous fat, Loss of muscle mass, Fluid accumulation, Diminished functional status.
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