seminar 2 cancer

8/2/2019 Seminar 2 Cancer

1/63

Management on Oncology PatientsSiti Farrah Zaidah Bt Mohd Yazid (P60332)

Yusmaeliza bt Istihat (P60324)

ND6073

Medical Aspect In Nutrition


2/63

Outline Presentation

1. Introduction

2. Pathophysiology & risk factor of cancer

3. Treatment option4. Dietary management

5. Complementary and alternative medicine(CAM)

6. Conclusion


3/63

Introduction The National Cancer Registry (NCR) reports that cancer was the third leading cause

of death in PENINSULAR MALAYSIA 2006

10 Principle Cause of Deaths in Ministry of Health, Malaysia (MOH) Hospitals, 2006

Source: MALAYSIAN CANCER STATISTICS- DATA AND FIGURE,PENINSULAR MALAYSIA.2006. National Cancer Registry. Ministry of Health Malaysia

Diseases Percentage (%)

Septicaemia 16.87

Heart Diseases & Diseases of Pulmonary Circulation 15.7

Malignant Neoplasms 10.59

Cerebrovascular Diseases 8.49

Pneumonia 5.81

Accidents 5.59

Diseases of the Digestive System 4.47

Certain Conditions Originating in The Perinatal Period 4.2

Nephritis, Nephrotic Syndrrome & Nephrosis 3.83

Ill-define conditions 3.03


4/63

Prevalence & statistics

21,773 cases diagnosed & registered with theNational Cancer Registry

National Cancer Registry Peninsular Malaysia,2006

54.2%females

(11 799 cases)

45.8%males (9 974

cases)

21,773

cases


5/63

Ten most frequent cancers,

Peninsular Malaysia, 2006

16.5

13.2

9.4

4.9

4.5

4.1

3.6

3.6

3.4

3.2

0 5 10 15 20

BREAST

COLORECTAL

LUNG

CERVIX UTERI

NASOPHARYNX

THYROID GLAND

LIVER

STOMACH

PRSOTATE GLAND

LYMPHOMA



6/63

Cancer Incidence per 100,000 population (CR) by sex in

Peninsular Malaysia 2006

16.2%colorectal

14.5%Lung

7.5% NPC

7.4%Prostate

gland

5.7% Liver

29.9% breast

10.6% Colorectal

9.1% Cervix uteri

5.8% Ovary

5.7%Thryriod

gland

Males Female



7/63

Pathophysiology & Risk Factors Cancer describes a group of more than 150 disease processes

characterized by uncontrolled growth and spread of cells.Cancer is not a singular, specific disease but a group ofvariable tissue responses that result in uncontrolled cellgrowth

(McCance & Roberts, 1998; Fraumeni, 1982).

Malignant cells may also metastasize to other areas of thebody through the cardiovascular or lymphatic systems. Thisuncontrolled growth and spread of cancer cells can eventuallyinterfere with one or more of a person's vital organs orfunctions and possibly lead to death. The primary sites ofcancer metastasis are the bone, the lymph nodes, the liver,the lungs, and the brain

(McCance & Roberts, 1998).

Source: The National Center on Physical Activity and Disability, www.ncpad.org


8/63

Pathophysiology & Risk Factors

Benign neoplasms or tumor cells are made up of the same cell type as theoriginal parent cell, but have abnormal growth rates. Benign cells do notmetastasize or invade surrounding tissue. Benign cells can, however, pose asignificant problem in the body when they grow too large and compress vitalorgans or organ systems. The following will describe both malignant andbenign tissue changes that occur in the body from abnormal growth and

differentiation(McCance & Roberts, 1998).

Factors that affect tumor growth and development include the status of anindividual's immune system, the rate the tumor cells are growing, thenumber of tumor cells actively spreading, and the rate that the normal

tissues are being destroyed by the tumor. Several factors affect normalimmune function, including stress, malnutrition, advancing age, and chronicdiseases. Cancer itself appears to suppress the immune system both earlyand late in the disease process

(McCance & Roberts, 1998).



9/63

Pathophysiology & Risk Factors

Uncontrolled cell growth is a characteristic ofcancer. Cellular growth rates are regulated byproteins produced by the genetic material incells. Genetic material can be altered or

mutated by environmental factors, errors ingenetic replication or repair processes, or bytumor viruses. Altered or mutated genes arecalled oncogenes, and it is these oncogenes

that allow uncontrolled growth in cells(McCance & Roberts, 1998).



10/63

Cancer- related cachexia

Characterized by equal loss of fat & muscle, adipose tissue & increased

energy expenditure.

The Clinical Guide to Oncology Nutrition 2nd edition.2006.ADA

cancer

Tumor product Endocrine alteration Systemic inflammatoryresponse (cytokines)

Metabolic abnormalities

lipolysis Protein loss anorexia

cachexia


11/63

Prevalence of Malnutrition

(National Cancer Institute US, 2007)

80%malnutrition

20-40% dieddue to

malnutrition

60%of Head & neck & GI patients lose weight upon beginningtreatment

40% develop mucositis during chemotherapy &

100% during chemoradiation


12/63

GOALS in cancer patients

Nutritionalgoals

Reduceadverse effectsof anti tumor

therapies

Prevent &treat under

nutrition

Enhancinganti-tumortreatment

effects

Improvingquality of life

Source:ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology.2006


13/63

Nutrition Treatment Goals

Phase 1: Getting Through Treatment

(Primary Goals)

Prevent or correct nutritional deficiencies

Minimize short-term and long-term treatment side effects

Improve tolerance to treatment

Enhance quality of life during treatment

Help achieve and maintain optimal body weight

Educate family members about special nutrition needs

Evaluate the risks and benefits of nutrition-related CAM(supplements, vitamins, minerals, herbs); consider medicationinteraction issues!

Source: National Cancer Institute US, www.cancer.gov


14/63

Phase 2: Cancer Fighting Nutrition For Life

(Secondary Goals)

Maintain healthy weight Incorporate healthy nutrition habits for long-term health

Maximize cancer preventive potential of the diet (minimize

recurrence risk)

Evaluate the risks and benefits of nutrition-related CAM(supplements, vitamins, minerals, herbs); consider medication

interaction issues!

Nutrition Treatment Goals

Source: National Cancer Institute US, www.cancer.gov


15/63

Treatment for Cancer

Local therapy

Surgery.

Radiationtherapy

Systemictreatment

Chemotherapy.

Hormonaltherapy

Monoclonal

antibodies

Radioactivematerial

Supportive careNon-

conventionaltherapy.

Source: British Journal of Pharmacology and Chemotherapy, www.ncbi.nlm.nih.gov


16/63

Chemotherapy

The main treatment available is systemicchemotherapy

Systemic chemotherapy disseminate malignant

disease Progress in chemotherapy resulted in cure for

several tumors

Require multiple cycles

Cytotoxic agent involved in the treatment,categorized to phase nonspecific and phase specific



17/63

Chemotherapeutic Agent

Alkylating agents

Antimetabolites

Antitumor antibiotic Plant alkaloids

Other agents

Hormonal agent Immunotherapy



18/63

Side Effect of Chemotherapy

Short Term:

Nausea

Vomiting

Myelosuppression /Infection

Alopecia

Mucositis

Fatigue Heart failure

Long Term:

Heart failure

Premature menopause

Bone loss

Cognitive impairment

Neuropathy

Weight gain

Sexual dysfunction

Fatigue



19/63

Dealing with treatment side effect

Drink more fluids during chemotherapy,

intravenous hydration may also help.

Chemotherapy-induced menopause, which

may result in a rapid and significant decline inbone density consider adjuvant use of

bisphosphonates

Increase cardiovascular fitness - exerciseimproved cardiorespiratory fitness, physical

functioning, and fatigue.



20/63

Management of locally advanced breast cancer:Neo-adjuvant chemotherapy

However, there are no signs that the cancer has spread beyond thebreast region or to other parts of the body.

Chemotherapy: CPG Guidelines on

Management of Breast Cancer

Locally advanced breast cancer is invasive breast cancer thathas one or more of the following features:

large (typicallybigger than 5 cm)

spread to severallymph nodes in theaxilla or other areas

near the breast

spread to severallymph nodes in the

axilla such as theskin, muscle or ribs

Clinical Practice Guidelines. Management of Breast Cancer. Ministry of Health Malaysia. 2011


21/63



A study showed that neo-adjuvant chemotherapy

can be given to downsize the tumour in an

attempt for BCS or enable subsequent surgery forinitially inoperable breast cancer. In addition to

improving both operability and rates of BCS, neo-

adjuvant chemotherapy also provides a valuablewindow to assess disease response to treatment

and perform correlative tissue analyses.(level I)

Clinical Practice Guidelines. Management of Breast Cancer. Ministry of Health Malaysia. 2011


22/63



RECOMMENDATION

Neo-adjuvant chemotherapy orpre-operative systemic therapycan be offered to patients with

operable locally advancedbreast cancer who are not

suitable candidates for BCS atpresentation. (Grade A)

In locally advanced breastcancer that is inoperable, neo-

adjuvant chemotherapyshould be given to downsize

the tumour to enablesubsequent surgery. (Grade A)

Clinical Practice Guidelines. Management of Breast Cancer. Ministry of Health Malaysia.2011


23/63

Radiation Therapy

Radiation therapy can affect cancer cells and

healthy cells in the treatment area. It kill

cancer cells and healthy cells. The amount of

damage depends on the following:

The part of the body that is treated.

The total dose of radiation and how it is given


24/63

Nutrition impact associated w Radiation therapy

Site of radiation therapy Acute effects Late effects

Central nervous systems

(brain & spinal cord)

nausea, vomiting

Elevated blood glc due to

steroid administration

fatigue loss of appetite

headache, letharge

Head & neck area

(tongue, larynx, pharynx,

oropharynx, nasopharynx,

tonsils, salivary glands

xerostomia

Sore mouth, throat

dysphagia, odynophagia

mucositis

alterations in taste &

smell

fatigue

loss of appetide

Mucosaatrophy,

dryness, ulceration

salivary glands-

xerostomia, fibrosis

Trismus

Alteration in taste & smell

The clinical Guide to Oncology Nutrition 2nd

Edition.2006. American Dietetic Association.


25/63

Nutrition impact associated w Radiation therapy

Site of radiation therapy Acute effects Late effects

Thorax (esophagus, lung

also breast if treatment

field involves esophagus

dysphagia, odynophagia

heartburn

fatigue

loss of appetite

esophageal-fibrosis, stenosis,

necrosis

cardac- angina on effort,

pericarditis, cardiac

enlargement

pumonary-dry cough,

fibrosis, pneumonia

Abdomen & pelvis

(gastrointestinal system,

reproductive organs,

prostate, colon, rectum,

testicles

nausea, vomiting

Changes in bowel function-

diarrhea, cramping, bloating, gas

changes in urinary function-

increased frequency, burning

sensation with urination acute colitis @ enteritis

lactose intolerance

fatigue

Loss of appetite

diarhea, malabsorption,

maldigested

chronic colitis @ enteritis

intestinal-stricture,

ulceration, obstruction

perforation, fistula urinary-hematuria, cystitis

The clinical Guide to Oncology Nutrition 2nd Edition.2006. American Dietetic Association.


26/63

Evidence Based Practice Guidelines for theNutritional Management of Patients

Receiving Radiation Therapy. 2008.

Dietitians Association Of Australia. Journalof the Dietitians Association of Australia,

including the Journal of the New Zealand

Dietetic Association


27/63

NHMRC grades of recommendation (2005)

Level A Body of evidence can be trusted to guide practice

Level B Body of evidence can be trusted to guide practice in most situations

Level C Body of evidence provides some support for recommendation(s) but care

should be taken in its application

Level D Body of evidence is weak and recommendation(s) must be applied withcaution


28/63

RecommendationGrade

Nutrition screeningAll patients receiving RT to the gastrointestinal tract (GIT), head and neck

area should be referred to the dietitian (and/or nutrition support)

B

Nutrition assessment

nutrition assessment tools (e.g. scored Patient Generated-Subjective GlobalAssessment (PG-SGA) or Subjective Global Assessment (SGA) should be

used to assess the nutritional status of patients receiving radiation therapy

B

Dietary counseling and/or supplements are effective methods of nutrition

intervention, and frequent (at least fortnightly) dietitian contact improvesoutcomes in patients receiving radiation therapy.

Regular nutrition intervention (dietary counseling and/or supplements)

improves energy and protein intake and nutritional status during radiation

therapy.

A


29/63

Grade

Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) feeding areeffective in achieving higher protein & energy intakes and weight maintenance in head

and neck cancer patients undergoing RT compared with oral intake alone

B

Aim for energy and protein intakes of at least 125 kJ/kg/day and 1.2 g protein/kg/day

in patients receiving RT. Patients should have their weight and food/energy intakemonitored regularly to determine whether their energy requirements are being met.

C

Aim to minimise weight loss and maintain quality of life and symptom management in

patients receiving radiation therapy

C

Recommendation


30/63

Use intensive dietary advice and oral nutritional

supplements to increase dietary intake and to prevent

therapy-associated weight loss and interruption of

radiation therapy. (grade A )ESPEN Guidelines on Enteral Nutrition:Non-surgical oncology.2006

All patients receiving radiation therapy to the head and

neck area should be referred to the dietitian for

nutrition support (Grade A)Clinical Oncology Society of Australia (COSA),2011


31/63

Nutrients Requirement


32/63

Estimating Energy Intake by using Equation

Harris Benedict Equation Validation studies :original studies conducted on healthy volunteers. Note that

for obese individuals (BMI>29.9), formula may overestimate REE 5% to 15%

actual weight is used

Mifflin-St Jeor Validation studies: equation developed from a sample of obese & nonobese

healthy individuals. Some research has indicated that this equation may

provide a more accurate estimation of REE that the HBE in both obese &

nonobese individual, therefore this equation deserves consideration

Ireton-Jones Validation studies: equation developed from a sample of hospitalized patients

including criticality ill patients & patients with burn. Recent research has

reported that this equation underestimates energy requirements


33/63

Energy Estimation based on Body Weight

Useful as initial estimation of energy req. and

should be adjusted as individual nutritional

status & activity level changes

Still lack evidence based validation.Condition present Energy needs (kcal/kg)

Cancer, nutritional repletion, weight gain 30 35

Cancer ,nonambulatory, inactive 25 30

Cancer, hypermetabolic, stressed 35

Sepsis 25 30

Stem cell transplant 30 -35

Laura et al., The clinical Guide to Oncology Nutrition 2nd Edition.2006. American Dietetic Association


34/63

Protein

Most patients found to be negative nitrogen balance, worsen

as the malignancy progresses

Table: Estimating daily protein needs in adult Cancer Patients

Medical condition Estimation protein Needs (g/kg)Normal maintenance 0.8 -1.0

Nonstressed cancer patients 1.0 1.2

Hypercatabolism 1.2 1.6

Severe stree 1.5 -2.5

Requiring nutrition support 1.6 2.0

Stem cell transplant 1.5 2.0

Laura et al., The clinical Guide to Oncology Nutrition 2nd Edition.2006. American Dietetic Association


35/63

ESPEN Guidelines on Enteral Nutrition:Non-surgical oncologyClinical Nutrition (2006) 25, 245-259

ESPEN Guidelines on Parenteral Nutrition

Non-surgical oncologyClinical Nutrition (2009) 1-10

Subjects ESPEN Guidelines on Enteral Nutrition: ESPEN Guidelines on Parenteral


36/63

Subjects ESPEN Guidelines on EnteralNutrition:

Non-surgical oncology

ESPEN Guidelines on Parenteral

Nutrition: Non-surgical oncology

General

Indication

TEE can be made for non-obese

patients using the actual body weight:

Ambulant patients : 30-35 kcal/kg/d

Bedridden patients : 20-25 kcal/kg/d

Start nutrition therapy if undernutrition

already exists or if it is anticipated that

the pt will be unable to eat for > 7 days

(Grade C)

Total daily energy expenditure in cancer

patients may be assumed to be similar to

healthy subjects, or

Ambulant patients : 25-30 kcal/kg/d

Bedridden patients : 20-25 kcal/kg/d

(Grade c)

Start EN if inadequate food intake

(< 60% of ER) for > 10 days is expected.

Amount to give = ER actual intake

(Grade C)

Supplemental PN is recommended in

patients ifinadequate food and enteral

intake (


37/63

,

Subjects ESPEN Guidelines on Enteral

Nutrition:Non-surgical oncology

ESPEN Guidelines on Parenteral

Nutrition: Non-surgical oncology

Perioperative Pts with severe nutritional risk

benefit from10-14 days nutritional

support prior to major surgery evenif the surgery has to be delayed

(Grade A)

Perioperative PN is recommended in

malnourished candidates for artificial

nutrition, when EN is not possible(Grade A)

Perioperative PN should not be used

in the well-nourished (Grade A)

Pts on RT /

Radio

chemotharpy

Give intensive dietary advice + oral

nutritional supp :

dietary intake

prevent therapy-assoc. wt loss

prevent interruption of RT

(Grade A)

The routine use of PN during

chemotherapy, radiotherapy or

combined therapy is not

recommended (Grade A)

During

chemotherapy

Routine EN not considered useful-

has no effect on tumour response tochemo or on chemo-assoc.

unwanted effects (Grade C)

If patients are malnourished or facing

a period longer than one week ofstarvation and EN is not feasible, PN

is recommended (Grade C)


38/63

Subjects ESPEN Guidelines on Enteral

Nutrition:Non-surgical oncology

ESPEN Guidelines on Parenteral Nutrition:

Non-surgical oncology

In incurable

pts

give EN to mconsents + dying

phase has not started (Grade C)

inimize wt loss if pt

In intestinal failure, long-term PN should

be offered, if

enteral nutrition is insufficient,

expected survival due to tumor

progression is longer than 23 months),

it is expected that PN can stabilize or

improve performance status and quality

of life

the patient desires this mode of

nutritional support

There is probable benefit in supporting

incurable cancer patients with weight loss

and reduced nutrient intake withsupplemental PN

(Grade B)

Close to end of life , most pts

require minimal amounts of food

and water to reduce thirst &hunger (Grade B)

Small amount of fluid may help to

avoid dehydration induced

confusion (Grade B)

IV drip in hosp or at home may be

helpful and provide route for

drugs administration (Grade C)


39/63

Subjects ESPEN Guidelines on Enteral Nutrition:Non-surgical oncology

ESPEN Guidelines on

ParenteralNutrition: Non-

surgical oncology

Enteral

formula

Use standard formulae (Grade C)

Use preoperative enteral nutrition preferably

with immune modulating substrates (arginine, o-

3 fatty acids, nucleotides) for 57 d in all patients

undergoing major abdominal surgery

independent of their nutritional status(Grade A)

In cachectic patients steroids or progestins are

recommended in order to enhance appetite,

modulate metabolic derangements, and prevent

impairment of quality of life.

(Grade A)


40/63

Immunonutrient

Does supplementation with

w-3 fatty acids & glutamine have beneficial

effect in cancer pts?


41/63

Immunonutrient

RCTs shown :

Evidence is contradictory/controversial

At present, not possible to reach any firm conclusion

with regard to improving nutritional status/ physical

function

( Grade C )

ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology 2006


42/63

Best Bet Complementary Cancer Therapies

Eicosapentaenoic Acid (EPA) (Omega-3s)

Essential fatty acid with potential roles in inflammation, immunity,cachexia

May help decrease cachexia

May improve chemotherapy effectiveness/enhance immune function

Downside:

May have anticoagulant activity so use with caution if platelets low oron coagulation therapy

Generally well tolerated (up to 0.3 g EPA+DHA/kg body weight/day),but diarrhea possible

Dose:

Minimum 2.2 mg EPA /day (best to avoid coagulation complications)

Two new products on the market Prosure & Resource Support

N t iti l l t i h d ith 3 f tt id


43/63

0

0.05

0.1

0.15

0.2

0.25

0.3

Control EPA SupplementTreatment Group

MeanChan

geinPAL

80

82

84

86

88

90

92

94

96

Baseline 3 Weeks 7 Weeks

KPSMeanScore

Mean Change in Physical Activity Level

Following 8 Weeks of Oral Supplementation

Karnofsky Performance Status Following

Supplementation with EPA-Enriched Supplement

Source: Moses, et al, 2001 examined a subset of alarge randomized trial conducted in pancreatic cancerpatients and compared the intake of nutritionalsupplements with and without EPA (1.1g 2.2g/day)and the effects on total energy expenditure andphysical activity level.

Source: Barber MD, et al, 1999. Prospective study in20 patients with pancreatic cancer experiencingongoing weight loss. Patients consumed average 1.9cans/day of a nutritional supplement containing 1.1gEPA/can along with normal intake for 7 weeks.

Nutritional supplements enriched with omega-3 fatty acids

(EPA/DHA) have been shown to improve QOL and performancestatus


44/63

0

50

100

150

200

250

300

With EPA Supplement Without EPA Supplement

Treatment Group

LifeExpec

tancy(days)

Source: Voss AC, et al, 2003. Voss, et al, examined survival rates in pancreatic cancer patients from2 different studies. In one study patients received an omega-3 fatty acid nutritional supplementcontaining 1.1g EPA/can and in the other a supplement containing no omega-3.

Impact of EPA Supplement on Survival

Nutritional supplements enriched with omega-3 fatty acids(EPA/DHA) have been shown to increase life expectancy


45/63

What Is Glutamine?

Neutral, gluconeogenic nonessential amino acid

Stored primarily in skeletal muscle (75%) and liver (25%)

Nitrogen carrier between tissues

Primary energy source for rapidly proliferating cells (e.g.intestinal epithelium, activated lymphocytes, & fibroblasts)

Maybe conditionally essential; depleted in stress states (e.g.

surgery, sepsis, & cancer)

Appears to be synthesized in muscle tissue in substantialamounts

Plasma concentrations are quite high, second only to alanine

Needed for renal acid-base balance


46/63

Why Glutamine For Oncology?

Neuropathy

Arthralgias

Myalgias

Diarrhea

Enteritis & GI Mucosal Damage

Stomatitis

Muscle Mass Preservation??


47/63


48/63

Best Bet Complementary Cancer Therapies

Glutamine

Amino Acid May help with diarrhea/GI symptoms & sore mouth/throat

May help decrease mucositis (5-FU)

May help decrease radiation enteritis

May help With Aching Muscles/Nerves (Taxol)

Downside:

No major side effects, some minor side effects

Do not take if you have poor kidney and/or liver function

Dose:

10 grams glutamine powder, three times per day, dissolved inliquid (research has been done with Cambridge Nutraceuticals-Baxter Pharmaceuticals & Glutasolve by Novartis)


49/63

Cancer and Exercise

The cancers that are reported to occur less frequently inactive people are cancers of the colon, breast, prostate, andpossibly the lung, digestive system, thyroid, bladder andthe hematopoietic system (Lichtenstein, et al. 2000;Sternfeld, et al., 1992; Frisch, et al., 1985).

aerobic exercise has been shown to provide benefitsspecifically to people undergoing treatment for cancer.These benefits include improved physical function andrelief from fatigue, nausea, and depression (Pinto &Maruyama, 1999).

exercise enables people who survive cancer with a meansto recover their physical functions and return to a healthyand active lifestyle (Augustine & Gerber, 2000,Friendenreich & Courneya, 1996).

The National Center on Physical Activity and Disability, www.ncpad.org


50/63

Evidence-Based Clinical PracticeGuidelines for Integrative

Oncology: ComplementaryTherapies and Botanicals

Gary E. Deng et al. 2009. Journal of the Society for Integrative Oncology, Vol 7, No 3 (Summer).: pp 85120

h i f d iti it t th


51/63

emphasizes awareness of and sensitivity to themental emotional, and spiritual needs of apatient, combining the best of evidence-based,complementary therapies and mainstream care

in a multidisciplinary approach to evaluate andtreat the whole person.

Integrativeoncology

A substitute for mainstream care, not scientificallyproven, often have no scientific foundation and

have sometimes even been disproved

Alternative

therapy

Medicine that makes use ofunconventional

treatment modalities and approaches that arenonsurgical and nonpharmaceutical but thathave known efficacy and when combined withmainstream care, can enhance effectivenessand reduce adverse symptoms

Complementarytherapy

Complementary and alternative


52/63

Complementary and alternative

medicine (CAM)

Complementary medicine means nonstandard

treatments that you use along with standard ones

(conventional treatment) for supportive care &improve QOF

Alternative medicine means treatments that you use

instead of standard ones (conventional treatment)


53/63

Categories of Complementary Therapy

Therapeutic Approaches Characteristics

Biologically based practices Herbal remedies, vitamins, other dietary

supplements

Mind-body techniques Meditation, guided imagery, expressive arts (music

therapy, art therapy, dance therapy)

Manipulative and body-based

practices

Massage, reflexology, exercise

Energy therapies Magnetic field therapy, Reiki, Healing Touch, qi gong

Ancient medical systems Traditional Chinese medicine, ayurvedic medicine,

acupuncture


54/63

recommendation

Mind-Body Medicine Mind-body modalities are recommended as part of a

multidisciplinary approach to reduce anxiety, mood disturbance,

chronic pain and improved QOL.

Grade: 1B

Manipulative and

Body-Based Practice

For cancer patients experiencing anxiety or pain, massage therapy

delivered by an oncology-trained massage therapist is

recommended as part of multimodality treatment.

Grade: 1C

Exercise and Physical

Activity

Regular physical activities can play many positive roles in cancer

care. Patients should be referred to a qualified exercise specialist

for guidelines on physical activity to promote basic health.

Grade: 1B


55/63

recommendation

Energy Therapies Therapies based on a philosophy of bioenergy fields are safe and may

provide some benefit for reducing stress and enhancing QoL. There islimited evidence as to their efficacy for symptom management,

including reducing pain and fatigue.

Grade: 1B (for anxiety)

1C (for pain, fatigue and other symptom management)

Acupuncture Acupuncture is recommended as a complementary therapy whenpain is poorly controlled, when nausea and vomiting associated with

chemotherapy or surgical anesthesia are poorly controlled, or when

the side effects from other modalities are clinically significant.

Grade: 1A

Acupuncture Acupucture is recommended as a complementary therapy forradiation-induced xerostomia.

Grade: 1B


56/63

NHMRC levels of evidence (1999)Level I Evidence obtained from a systematic review of all relevant randomised

controlled trials

Level II Evidence obtained from at least one properly designed randomised

controlled trial

Level III-1 Evidence obtained from well-designed pseudo-randomised controlled

trials (alternate allocation or some other method)

Level III-2 Evidence obtained from comparative studies with concurrent control

and allocation not randomised (cohort studies), casecontrol studies, or

interrupted time series with a control group

Level III-3 Evidence obtained from comparative studies with historical control, two

or more single arm studies, or interrupted time series without a parallel

groupLevel IV Evidence obtained from case studies, either post-test or pre- and post-

test.

d l d f


57/63

Dietary guidelines & recommendation for cancer prevention

Organization Dietary pattern Physical activity Alcohol other

USDA,US Deptof health &

Human

Service.2005

make smart choicefrom every foods

Get most nutrition

from your calorie

Variety of fruit &

vege.

3 cups low fat @ fat-free/d

3 whole grain

product everyday

choose lean protein

Low in SFA & trans

fats

balance between food& PA

Regular PA & reduce

sedentary activities to

promote health,

Psychological well being

& healthy body weight.Moderate-intensity PA

30-60minutes/d

moderateamount

choose &prepare foods

with less

salt/sugar

< 2.3 g

sodium daily.

i id li & d i f i


58/63


Organization Dietary pattern Physical activity Alcohol other

AmericanCancer

Society.2002

variety of foods,emphasis on plant

sources

5 fruits & vege

everyday

choose whole grain

limit red meat esp. highfat & processed

physically activelifestyle

Maintain healthful

weight throughout

life

Chose foods help

maintain healthfulweight

limitconsumption

National

cancer

institute.1996

include variety of fruit &

vege in the daily diet

avoid obesity moderation

consumption



59/63


Organizat

ion

Dietary pattern Physical activity Alcohol other

American

Institute

for cancer

Research

1997

choose plant-based

diet rich in vege,

fruits, pulse,

minimally processed

eat 13-30 oz @ > 5

serving vege & fruits

daily eat 20-30 oz @ >7

serving cereal,

legumes, nuts, tuber

red meat should

provide


60/63

Conclusion

Treatment for cancer is a multidisciplinary effort.

Special attention must be given to the establishment &

upgrading of treatment facilities & the training of

specialized personnel. In doing so, many lives will be saved & countless more

patients will have chance of obtaining relief from the

distressing symptoms of cancer

Gerard C. C. L. Overview of Cancer in Malaysia.2000.Jpn J Clin Oncol.S37-S42

References


61/63

References MALAYSIAN CANCER STATISTICS- DATA AND FIGURE,PENINSULAR MALAYSIA.2006.

National Cancer Registry. Ministry of Health Malaysia

Evidence Based Practice Guidelines for the Nutritional Management of Patients withHead and Neck Cancer. Clinical Oncology Society of Australia (COSA).2011

Bozzetti F, et al., ESPEN Guidelines on Parenteral Nutrition: Non-surgical oncology,

Clinical Nutrition (2009),doi:10.1016/j.clnu.2009.04.011

J. Arends et al.2006 European Society for Clinical Nutrition and Metabolism. All rights

reserved.doi:10.1016/j.clnu.2006.01.020

Laura et al., The clinical Guide to Oncology Nutrition 2nd Edition.2006. American

Dietetic Association.

Mary M., Susan R., Clinical Nutrition for Oncology Patients.2007. Jones and Bartlett

Publishers.

Linda et al., Evidence Based Practice Guidelines for the Nutritional Management of

Patients Receiving Radiation Therapy.2008. Journal of the Dietitians Association ofAustralia, including the Journal of the New Zealand Dietetic Association. Nutrition &

Dietetics 2008; 65 (Suppl. 1): S1S20 DOI: 10.1111/j.1747-0080.2008.00252.x

Gary et al., Evidence-Based Clinical Practice Guidelines for Integrative Oncology:

Complementary Therapies and Botanicals.2009. Journal of the Society for Integrative

Oncology, Vol 7, No 3 (Summer), : pp 85120


62/63

References Jacqueline Drouin and Lucinda Pfalzer, Cancer Pathophysiology, NCPAD, University of

Illinois, Chicago Clinical Practice Guidelines. Management of Breast Cancer. Ministry of Health

Malaysia. November 2010.

Clinical Practice Guidelines. Management of Cervical Cancer. Ministry of HealthMalaysia. April 2003.

Clinical Practice Guidelines. Management of Cancer Pain. Ministry of Health Malaysia.July 2010.

C.Decker Baumann, K. Buhl, S. Frohmuller, A.v. Hurbey, M. Dueck and P.M. Schlag.Reduction of induced-chemotherapy-side effects by Parenteral GlutamineSupplementation in Patient with Metastatic Colorectal Cancer. European Journal ofCancer Volume 35, Issue 2, February 1999, Pages 202-207

Shabert JK, Winslow C, Lacey JM, Wilmore DM. Glutamine-anti-oxidantsupplementation increases body cell mass in AIDS patients with weight loss: Arandomized, double-blind controlled trial. Nutrition 1999;15:860-864.

The National Center on Physical Activity and Disability, www.ncpad.org

British Journal of Pharmacology and Chemotherapy

National Cancer Institute, www,cancer.gov
http://www.ncpad.org/http://www.ncpad.org/http://www.ncpad.org/http://www.ncpad.org/http://www.ncpad.org/http://www.ncpad.org/


63/63

Thank You

seminar 2 cancer

Documents