Transcript File - Janna Neitzel, Sage Dietetic Intern

Comprehensive Case Study:
Cancer Patient and Malnutrition
INTERN: JANNA NEITZEL
PRECEPTOR: LORI HOUGHTALING
FACILITY: ALBANY MEMORIAL HOSPITAL
ROTATION: CLINICAL
Identification Information
 Age: 67
 Sex: Female
 Date of admission: 9/17/13
 Admit HT and WT: 5’6”, 125#
 Weight classification: BMI 20.2—within normal
limits
Chief Complaint
 Admitting diagnosis:
 Patient admitted with
nausea
 vomiting,
 UTI


Patient admitted 1 month prior

Back pain
History of Present Illness
 History of colon and bladder cancer
 Metastatic colon cancer with chemo
 Cancer: group of diseases characterized by uncontrolled growth and spread of
abnormal cells



Tumor growth and immune-mediated tumor destruction
Endogenous and exogenous risk factors exist for cancer development
Cancer is a genetic disease caused by chronic inflammation which elicits a
chronic inflammatory response, eventually compromising the function ad
structure of cells, creating uncontrolled proliferation (programmed cell death)


Endogenous factors: can initiate or promote development of cancer; free radicals,
hormones, growth factors, specific genes (oncogenes)
Exogenous factors: lifestyle, environmental/occupational exposures, infectious
organisms
 Suspect poor nutrition prior to admit based on dietary recall


The National Cancer Institute and the American Cancer Society estimate that 1/3 of
cancer deaths relate to poor dietary choices, physical inactivity, or obesity
Tobacco use accounts for additional 1/3 annual deaths from cancer
Past Medical History
 Colon cancer
 Bladder cancer
 Pyelonephritis
 Uropsepsis
 Cecal mass
 CKD III
 ARF
 Symptomatic anemia
Medications, Eating Habits, Weight Hx
 Medications
Lopressor
 Xanex
 Mylanta
 Dilaudid
 Fentanyl patch
 Cefepine
 Megace
 Colace
 Ativan

 Eating habits:
“Healthy” diet at home,
unable to tolerate
>1000cal/day, stated;
restricts Na, K, and
phosphorus intake/renal
diet
 Loss of appetite

 WT Hx
UBW 142#
 120-125# @ admit
 112# most recent per bed
scale

Laboratory Data
 Current (12/5/13):
Low GFR
 Low Na
 Low Cl
 Low Ca
 High WBC
 Low RBC
 Low HGB
 Low HCT

Assessment
 Estimating needs:
 1600-1800kcal, 60-70g protein, 1.8L fluid per day
 PES statement:
 Suboptimal intake, unintentional WT loss, malnutrition in the
context of chronic disease
 Interventions:
 Monitored intake at meals & reinforced importance of
adequate intake
 Provided magic cu/ ensure supplementation with meals
 TPN rec—followed nutrition support team
 Monitored WT and serial labs
Plan of Care
 Exhausted all efforts to meet patient’s nutritional
needs PO
 TPN discontinued due to patient request
 Follow case manager plan for patient to transfer to
nursing home
 Hospice to consult
Resources

Evidence Analysis Library and eatright.org

Copeiand, Edward M., Daly, John M., and Dudrick, Stanley J. Nutrition as an Adjunct to Cancer Treatment in the Adult. Cancer
Research. 1977;37:2451-2456.

Tsai, Susan. Importance of Lean Body Mass in the Oncologic Patient. Nutrition in Clinical Practice. 2012;27(5): 593-598.

Vargas, Ashley J., Thompson, Patricia A. Diet and Nutrient Factors in Colorectal Risk. Nutrition in Clinical Practice. 2012;27(5):
613-623.

Ross PJ, Norton A, Priest K, Waters JS, Eisen T, Smith IE, O'Brien MER. Do patients with weight loss have a worse outcome when
undergoing chemotherapy for lung cancers? British Journal of Cancer. 2004; 90: 1,905-1,911.

Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma
M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head
Neck. 2008 Apr; 30(4): 503-508.

Eriksson KM, Cederholm T, Palmblad JE. Nutrition and acute leukemia in adults: Relation between nutritional status and
infectious complications during remission induction. Cancer. 1998; 82: 1,071-1,077.

Prado CM, Baracos VE, McCargar JL, Mourtzakis M, Mulder KE, Reiman T, Butter CA, Scarfe AG, Sawyer MB. Body composition
as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007 Jun 1; 13(11): 3,264-3,268.

Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB. Sarcopenia
as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving
capecitabine treatment. Clin Cancer Res. 2009 Apr 15; 15(8) :2,920-2,926.

Gottschlich, Michele M. The A.S.P.E.N. Nutrition Support Core Curriculum: A Case-Based Approach—the Adult Patient. Pg 651671