Nutrition in Palliative Care
Malnutrition is an immense problem worldwide in palliative care, and it is a primary cause of death in about 20 % of cancer in the USA. Patients with tumors of the head and neck and of the upper digestive tract often present with moderate to severe malnut
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Nutrition in Palliative Care M. Khurram Ghori and Susan Dabu-Bondoc
Introduction and Epidemiology Malnutrition is an immense problem in palliative care. It occurs in about a third of all patients newly diagnosed with cancer. It is an independent risk factor for increased morbidity and mortality, and is a primary cause of death in about 20 % of patients with cancer [1]. Worldwide statistics have revealed that malnutrition can develop in as much as 30–90 % of the time over the course of a malignancy [2]. It has been a second leading cause of death in developed countries [3]. Cachexia is a debilitating and distressing condition. It can prolong hospital stay and can cause delayed, missed, or decreased tumor treatments and decrease cost–benefit and risk–benefit ratios of anticancer therapies [4]. Cachexia is most commonly associated with tumors of the head and neck, lung and central nervous system, pancreas and gastrointestinal (GI) tract. Patients with tumors of the head and neck and of the upper digestive tract such as the esophagus, stomach, pancreas, etc., often present with moderate to severe malnutrition at time of diagnosis. On the other hand, patients with hematological tumors, such as leukemia, develop the lowest rates and severity of weight loss. This may be due in part to the rapid development of such tumors in relatively young patients. Nutritional interventions have been developed in an attempt to prevent or counteract the deleterious effects of cancer cachexia during different stages of the disease and its therapy that often compromise nutritional status. With expanding knowledge and understanding of the pathophysiology of cancer cachexia, research and investigations have focused on the efficacy and efficient use of pharmacoimmunological nutrients, and on the development of new strategies for nutritional planning and counseling. M.K. Ghori, M.D. • S. Dabu-Bondoc, M.D. (*) Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA e-mail: [email protected] N. Vadivelu et al. (eds.), Essentials of Palliative Care, DOI 10.1007/978-1-4614-5164-8_8, © Springer Science+Business Media New York 2013
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M.K. Ghori and S. Dabu-Bondoc
Nutritional Care in Cachexia Definitions Anorexia is loss of appetite. Cachexia is defined as a significant weight loss due to disease. Although cachexia often occurs with anorexia, cachexia is not caused merely by decreased nutritional intake. It is a catabolic state that results from an imbalance between nutritional demand and nutrient availability. Such imbalance can be a result of multiple factors, such as metabolic and pathophysiological changes, induced inability to ingest or utilize nutrients, social or psychological factors, or to toxicity resulting from treatment. Cachexia is characterized by increased resting energy expenditure, preferential loss of skeletal muscle and fat, and increased proteolysis and lipolysis. Chronic systemic inflammation and circulating tumorderived factors have also been implicated as possible causes [5, 6].
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