Refresher Course: Nutritional Imbalance in Cancer Patients

On Monday and Tuesday was held at the State Cancer Institute, the first refresher course 'Nutritional Imbalance in Cancer Patients', which was full of very interesting lectures.

The course consisted of various topics, such as:

• Feeding tubes.
• Care and handling of the feeding tubes.
• Chemotherapy toxicity.
• Nutrition in children with stress.
• Toxicity of drugs in the pediatric area.
• Radiation toxicity.
• Immunonutrition in cancer patients.
• Oncological surgery and nutritional risk.
• Assessment of nutritional status in cancer patients.

For me the course was incredible, I liked all the topics, but the one that caught my attention was Immunonutrition.

This conference speaks of the use of various nutrients that can improve the health of patients with cancer and was also motivational for the area of nutrition. These nutrients include:

• Glutamine: It's the preferred energy substrate for cells with high proliferative capacity, such as intestinal epithelial cells, the immune system, the renal tubule and erythrocytes. Which they're damaged by chemotherapy and radiotherapy.
• Arginine: It has cytotoxic effects (expels various pathogenic microorganisms), and cytostatic (inhibit the growth of microorganisms). And generates nitric oxide also has tumoricidal function may eliminate tumor cells.
• Omega 3: It has an anti-inflammatory effect and stimulates the immune system function.
• Probiotics: They favor the formation of intestinal microbiota and is a trophic stimulation of gastrointestinal mucosa.

The immunonutrients are added to a complete diet, and depending on the patient can be supplied enteral, parenteral or oral.

A complicated patient

Today at the State Cancer Institute became a a young patient (28 years old) diagnosed with testicular cancer and metastases in the central nervous system. 

The patient is undergoing chemotherapy and being evaluated by a doctor for radiotherapy, also he presented cachexia and weakness on the right side of the body, so it couldn't move or walk.

Therefore, we applied a medical history and nutritional value to determine his energy needs. We consider a nutritional support for the patient, because in this stage of the disease, he need a comfort diet more than a strict food plan.

We put on the patient diet plan foods that he likes and care that food consistencies were soft to avoid fatigue, in addition we recommended a protein module to prevent loss of strength and muscle mass.

I think it was a good decision because we're applying the principles of palliative care (palliative care is care given to improve the quality of life of patients who have a serious disease), which should start from the moment that the patient gets into the health unit (at any age and stage of disease) and not when he or she is in the final stage of the disease.

Also remember that palliative care should be provided by a specialized team of doctors, nurses, nutritionists, psychologists, social workers and other specialists.

"Palliative care is given throughout a patient’s experience with cancer. It should begin at diagnosis and continue through treatment, follow-up care, and the end of life."

Intrathecal Chemotherapy

On Thursday at The State Institute of Cancer took place the application of intrathecal chemotherapy in 3 girls of 2, 4 and 17 years old. They suffer from acute lymphoblastic leukemia.

Intrathecal chemotherapy is used to treat cancers that have reached the central nervous system, such as leukemia and lymphoma. This treatment must be used because chemotherapy drugs don't pass through the blood-brain barrier and some cancer cells spread through the area.

There are 2 ways to make intrathecal chemotherapy. One way is to inject the drugs into the Ommaya reservoir (for which a device is implanted by surgery). The other way is to inject the drugs into the bottom of the spine.

In girls, anesthesiologist first had to administer general anesthesia and then the oncology pediatrician did antisepsis of the area where she will puncture, after that she inserted a long needle into the lumbar area of the child and waited to begin a clear liquid out of the needle. She took a small sample of the fluid and finally in the same needle injected a drug.

Milk consumption and cancer

During this week I searched articles related to milk consumption in patients with cancer. I think that "milk" is a very controversial topic because there are articles that mention that milk is a food that prevents cancer and a rich source of energy, protein, calcium and vitamin D, which are essential nutrients for patients who already have cancer, other articles say that milk shouldn't be consumed because it generates metastasis, increases symptoms and can cause disease recurrence.

The main problem is that we now live in a highly industrialized world where cows are injected with hormones to increase milk production. Companies are using recombinant growth hormones in cows. This hormone can increase milk production by 20%. According to WHO, the injection of this hormone increases the concentration of IGF-1 (insulin-like growth factor-1) in milk.

IGF-1 causes the cells divide and reproduce, but doesn't distinguish cancer cells from healthy cells. 

According to information, I would recommend consumption of organic milk to get all the nutrients that milk provides, but this type of milk isn't processed hygienically and the body of the patient with cancer is susceptible to disease, so it's better to wait during the treatment (surgery, chemotherapy or radiotherapy) of the disease without milk and choose coconut, soy, almond or rice milk and long after you can consume organic milk.

Several options to replace cow's milk.

Workshop: "El plato del bien comer"

This month my colleagues and I are organizing a workshop for hospitalized children and their parents to learn should be your dish as breakfast, lunch and dinner, in addition they can classify foods and so they see which are the healthiest options for them.

We got some food replicas that are sold in the supermarket for children and collect the boxes of some products such as biscuits, jelly, cereal and milk to make the dish didactically and so patients and their parents understand better.

In addition to the plate, we will make other material in which patients can classify fats and sugars and they realize that certain products aren't suitable to consume them.

The workshop starts this week, we hope to be successful and that people take something home to put it into practice.

Gastric cancer

This week I attended a patient with gastric cancer for the first time, so I had to research the topic to learn more.

Stomach (gastric) cancer is a cancer that starts in the stomach. Therefore, they are patients who need  nutritional care since your digestive system is compromised. The main causes or risk factors of this cancer are:

The condition that usually is associated with gastric cancer is the Dumping Syndrome, which is generated because food come faster and fill the intestine, causing inflammation and abdominal pain, diarrhea, sweating and palpitations in the patient.

The nutritional therapy consists of:

• Consume only small amounts of simple carbohydrates (2 teaspoons) at each meal.
• Increase consumption of protein and fats to prevent weight loss and gastric emptying.
• Don't drink liquids with meals, consume only 30 - 60 minutes before or after.
• Eat every 2 - 3 hours, eat slowly!
• Keep regular mealtimes.
• Avoid extreme temperatures of food.

Talking about 'thrombocytopenia'

On Tuesday some of my colleagues in the social service provided an exposition to parents of hospitalized pediatric patients at The State Institute of Oncology about thrombocytopenia.

It's any disorder in which there is a low amount of platelets (they're parts of the blood that help blood to clot). Which is a very common condition in patients with cancer, because it's a side effect of medications or treatments like chemotherapy. So they're patients who need special care in their nutrition to prevent bleeding and increase the number of platelets.

In the exhibition my colleagues showed nutritional recommendations and examples of foods to increase platelets.

The image shows some examples of foods. In addition, you should eat whole grains, meat and eggs.

But I also found that there are some foods that avoid clotting and therefore shouldn't be eaten, such as omega 3 (you can find it in fish and seeds. It generates decrease the connection between platelets), garlic (it improves blood flow which avoids that platelets forming clots), onion (it contains quercetin, which destroys free radicals in the body, but inhibits platelet production), ginger (it improves blood flow), kiwi (it improves blood flow, too) and milk.

Palliative Care

This week I attended the session of "palliative care" it takes place every Wednesday at the State Institute of Oncology. Today's topic was management of pain in patients according to WHO. I learned about the different scales that exist for classifying the pain and what are the drugs that you can use in each of the levels of pain.

This is one of the scales of pain, it is known as Visual Analog Scale (VAS):

The drug used for pain management will be according to how the patient is classified on the scale. For this, there is the WHO's Pain Ladder for adults:

The information was given to the staff of the institution is very important because all cancer patients have pain. It is necessary that we know how to manage pain or even to report it to a doctor. So we will be helping to improve the quality of life for patients with cancer. It is useful for people, we don't criticize the famous paracetamol, because it is a first-line drug for pain relief with low cost.

A difficult patient

Today arrived at the office the most difficult and clueless oncology patient that I ever seen. First, in the service of nutrition we used the method called the "pesitos" to explain the portions of food to patients. 

This patient has breast cancer and she is receiving chemotherapy. She has had several symptoms associated with her treatment, such as nausea, vomiting, diarrhea and weakness, in addition she is obese (which can increase the symptoms). From the beginning she didn't understand the method but she didn't tell us the situation. So, she was doing a different, monotonous and low-calorie diet compared to her real diet. The patient's diet even decreased important biochemical parameters.

Even though we try to explain the "pesitos" but she began to despair, anger and shout "I do not understand anything". So we try to calm and explain as 8 times the same and then we ended up explaining to her with drawings.

The moral is "I need a lot of patience and know how to draw for this kind of patients". 

Making a healthy cookbook...

This week I had to search at different websites and writing a kind of cookbook about healthy drinks for the children and adults of the State Institute of Oncology (here is where I am doing my social service for one year), because we always give them industrialized juices for breakfast and dinner. In addition, these kind of juices are unhealthy for the patients.

When I was doing my cookbook I learned how to make some drinks (such as flavored waters) and juices that provide a lot of vitamins and minerals. 

I think that I can make and drink these beverages everyday by its content and the cost. For example, one recipe is a kind of apple soda (kids love apple sodas, at least my nephew says YES!), so you have to liquefy 1 big apple, 6 guavas, 1 teaspoon of honey and 1/2 cup of mineral water. It has the effervescent effect of soda, also it provides fiber, iron, calcium, carotene and vitamins A, B and C, useful in children with cancer that mostly have malnutrition.

P.S. Today is my best friend's birthday (: