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."

Enteral Nutrition

I had the opportunity to attend the 2nd. Congress of Clinical Gastronomy and Nutrition, there was a conference about some features that have been updated within nutrition, especially enteral nutrition.

First of all, it's important to define what is enteral nutrition?. Enteral nutrition or tube feeding refers to the delivery of a nutritionally complete feed (with food that contains protein, carbohydrate, fat, water, minerals and vitamins according to patient needs) directly into your stomach or small intestine.

Enteral nutrition can be given through different types of tubes. You can use different connections, devices and other materials. The main problem is that these tubes and materials could be mistaken for medical use, causing infections and health problems in the patient. So in the congress it mentioned that the new material for enteral nutrition will be in accordance with an international color code. The violet color should be used to avoid confusion in the hospital. I think this is a great initiative that gives nutrition the attention it truly deserves in the treatment of patients.

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.

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.

Exercise

In this vacations, all people expect to have a good body to go to the beach, and for this is necessary that you have a good nutrition and make a good exercise routine with dedication and discipline to tone the body.

Don't overdo it, because the body needs to take a break to recover, grow and toning. Our muscles need rest, because if they can enter a phase of overtraining, and we burned the muscle instead of growing.

So you should take a break from 48 to 72 hours between each area that you train. This means that one day train shoulder and back, the next day you train chest and arm, the third day you train leg, and the fourth day you can start again with shoulder and back and so on.

Remember that you shouldn't miss more than 72 hours without training one area of your body because it is like starting again.

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.