Oncology Case Studies
Case #1: Sharon R. is a 42-year-old mother of four, recently diagnosed with breast cancer. She is scheduled to have a lumpectomy and node dissection in seven days. After surgery, she is scheduled to begin chemotherapy followed by radiation therapy. She is 5’4” tall and weighs 190 pounds. Her usual body weight is 210 pounds. She states she is under a lot of stress since her diagnosis.
1. What recommendations do you have to prepare Sharon for surgery?
Answer: Monitor weight for change. Ask if she knows why she lost 20lbs from UBW. Is she eating less due to the stress? Recommendations should be based on her response. Emphasize adequate calorie & protein intake for healing after surgery.
2. What recommendations do you have to prepare Sharon for chemotherapy and associated side effects? List some dietary alterations that Sharon may follow if she is experiencing the following: weight loss, nausea, vomiting, and taste changes.
Answer: Advise Sharon to inform her physician if the N/V isn’t well controlled with medications. If weight loss occurs it’s important to figure out the underlying etiology, i.e., early satiety, N/V, poor appetite and address that particular nutrition impact symptom. Small, frequent meals would be appropriate for early satiety, poor appetite and nausea. Monitor weight and if >1% weight loss in one week initiate oral supplements prn. If taste changes occur would provide a handout with these strategies: Use a marinade for red meats to mask any metallic taste or switch to other sources of protein such as poultry, fish & dairy. Use plastic utensils instead of stainless steel. Rinse mouth frequently with a baking soda solution. Suck on lemon drops or try sugar free gum.
3. Sharon states, “I am glad to go through chemotherapy because I will probably lose weight and I need to anyway.” What recommendations do you have for Sharon regarding her desire to lose weight?
Case #1: Sharon R. is a 42-year-old mother of four, recently diagnosed with breast cancer. She is scheduled to have a lumpectomy and node dissection in seven days. After surgery, she is scheduled to begin chemotherapy followed by radiation therapy. She is 5’4” tall and weighs 190 pounds. Her usual body weight is 210 pounds. She states she is under a lot of stress since her diagnosis.
1. What recommendations do you have to prepare Sharon for surgery?
Answer: Monitor weight for change. Ask if she knows why she lost 20lbs from UBW. Is she eating less due to the stress? Recommendations should be based on her response. Emphasize adequate calorie & protein intake for healing after surgery.
2. What recommendations do you have to prepare Sharon for chemotherapy and associated side effects? List some dietary alterations that Sharon may follow if she is experiencing the following: weight loss, nausea, vomiting, and taste changes.
Answer: Advise Sharon to inform her physician if the N/V isn’t well controlled with medications. If weight loss occurs it’s important to figure out the underlying etiology, i.e., early satiety, N/V, poor appetite and address that particular nutrition impact symptom. Small, frequent meals would be appropriate for early satiety, poor appetite and nausea. Monitor weight and if >1% weight loss in one week initiate oral supplements prn. If taste changes occur would provide a handout with these strategies: Use a marinade for red meats to mask any metallic taste or switch to other sources of protein such as poultry, fish & dairy. Use plastic utensils instead of stainless steel. Rinse mouth frequently with a baking soda solution. Suck on lemon drops or try sugar free gum.
3. Sharon states, “I am glad to go through chemotherapy because I will probably lose weight and I need to anyway.” What recommendations do you have for Sharon regarding her desire to lose weight?
Answer: Maintain UBW until treatment is completed. Explain that this is necessary due to the possible nutrition impact symptoms she may experience during her treatment. Rapid weight loss could result in clinical malnutrition that could delay treatment or alter the outcome of therapies. Once treatment is completed she may want to consider altering her diet and lifestyle for weight loss and to prevent cancer recurrence.
4. Sharon also inquires about vitamins and herbal supplements at her nutrition consultation with you. She tells you a family friend told her to start taking Essiac tea, IP-6, coenzyme Q10 and selenium immediately? What recommendations do you have for Sharon regarding these supplements with her upcoming surgery and therapies?
Answer: The AICR does not recommend taking supplements for cancer prevention or for cancer survivors. These recommendations are based on a review of thousands of studies from hundreds of experts around the world- The Second Expert Report. Explain that supplements aren’t regulated the same as prescribed medications. Supplements are regulated as food items. Some supplements may interfere with the chemotherapy due to antioxidant activity. Others may increase the risk for bleeding and are contraindicated with an upcoming surgery. Specifically, there haven’t been any human studies completed with IP-6. If desired, Sharon can eat cereal, grains, legumes & meat to increase her oral intake of IP-6. There are some promising studies regarding selenium in cancer patients, but at the present time it’s recommended to eat a healthy diet to obtain our micronutrients. Selenium can be found in seafood, meat & fortified grains.
Readings Read pages 105-109 in the Handbook of Integrative Oncology Nursing Evidence-Based Practice www.cancer.gov/cancertopics/factsheet/therapy/tamoxifen http://www.cancer.gov/cancertopics/pdq/supportivecare/fever/HealthProfessional/page2 Go to the Memorial Sloan-Kettering website and search “About herbs, botanicals and other supplements” at: http://www.mskcc.org/mskcc/html/11570.cfm http://www.nlm.nih.gov/medlineplus/ency/article/000300.htm http://www.ncbi.nlm.nih.gov/pubmed/1618054 http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplications/Patient/page7
4. Sharon also inquires about vitamins and herbal supplements at her nutrition consultation with you. She tells you a family friend told her to start taking Essiac tea, IP-6, coenzyme Q10 and selenium immediately? What recommendations do you have for Sharon regarding these supplements with her upcoming surgery and therapies?
Answer: The AICR does not recommend taking supplements for cancer prevention or for cancer survivors. These recommendations are based on a review of thousands of studies from hundreds of experts around the world- The Second Expert Report. Explain that supplements aren’t regulated the same as prescribed medications. Supplements are regulated as food items. Some supplements may interfere with the chemotherapy due to antioxidant activity. Others may increase the risk for bleeding and are contraindicated with an upcoming surgery. Specifically, there haven’t been any human studies completed with IP-6. If desired, Sharon can eat cereal, grains, legumes & meat to increase her oral intake of IP-6. There are some promising studies regarding selenium in cancer patients, but at the present time it’s recommended to eat a healthy diet to obtain our micronutrients. Selenium can be found in seafood, meat & fortified grains.
Readings Read pages 105-109 in the Handbook of Integrative Oncology Nursing Evidence-Based Practice www.cancer.gov/cancertopics/factsheet/therapy/tamoxifen http://www.cancer.gov/cancertopics/pdq/supportivecare/fever/HealthProfessional/page2 Go to the Memorial Sloan-Kettering website and search “About herbs, botanicals and other supplements” at: http://www.mskcc.org/mskcc/html/11570.cfm http://www.nlm.nih.gov/medlineplus/ency/article/000300.htm http://www.ncbi.nlm.nih.gov/pubmed/1618054 http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplications/Patient/page7
1 comments:
Actually, there are several hundred studies on tens of thousands of patients that say that supplements have no effect on treatment. Your information is wrong. Do a google search. People die from malnutrition, not chemo or radiation.
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