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NUTRITION IN CANCER

INDRAGUNA PINATIH
DEPT. KESEHATAN MASYARAKAT DAN KEDOKTERAN PENCEGAHAN
FAKULTAS KEDOKTERAN UNIV. UDAYANA
CANCER
• Abnormal cell, divided and spread
uncontrollably
• Multicomplex causes : genetical and/or
life style
• Mostly undetected up to tumour
appeared or clinical symptoms/sign
appeared
• Mostly untreated by conventional
remedy but improving quality of life
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CANCER INCIDENCE IN INDONESIA

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World Health Organization - Cancer Country Profiles, 2014
CANCER DEATH RATE IN INDONESIA
MALE FEMALE

World Health Organization - Cancer Country Profiles, 2014


CANCER

MALNUTRITION
(CANCER CACHEXIA)
EPIDEMIOLOGY : CANCER + CACHEXIA
• 390 advanced Cancer
• 140 (35,9%) becomes Cachexia

• 88,9 % pancreatic Ca
• 76.5 % gastric C
• 52,9 % oesophagus Ca
• 63 Cancer + Cachexia; 98,4% sarcopenic
Sun L., Quan XQ., Yu S., Nutr Cancer, 2015;67(7):1056-62
MECHANISM CACHEXIA IN CANCER

Hajime Suzuki etal., 2013


CACHEXIA IN Ca PATIENT
• Loss of appetite
• Nausea and Vomiting
• Increase chemosensory
• Metallic taste especially who got chemotherapy
• Oral mucositis
• Xerostomia
• Constipation/diarrhoea
Hajime Suzuki etal., 2013
CHEMOTHERAPY INDUCE CACHEXIA
CASE REPORT STUDY LONGITUDINAL ON BREAST Ca HAVING
CHEMOTHERAPY

• Diet quality changes, High prevalence of inadequacy


• Reduction on macro and micronutrient
• Reduction of total fruits and dark green and orange
vegetables and legumes being observed.
Isis Danyelle Dias Custódio, IMPACT of CHEMOTHERAPY on Diet AND NUTRITIONAL STATUS
of Women with BREAST CANCER: A Prospective Study, Plos One, 2016.
NUTRITION IN CANCER
• Pharmacotherapy and Nutrition shall worked hand in hand to
prevent/treat cachexia
• Nutrition intervention shall be started as early as possible
• Nutrition screening and Nutrition status shall be monitored
• Anthropometry: Weight, height, BMI, Body composition
• Food intake
• Nutrition counselling
Pharmacokinetic for Nutrition
intervention

• Intended to improve quality of life


regardless to Cancer development
• Target direct organ or via hypothalamus
• Kind :
• Anti cytokines (anti inflammation)
• Appetite enhancer
• Omega 3 etc.

Hajime Suzuki etal., 2013


NUTRITION IN CANCER
• Calorie intake calculate at least 30-35 kcal/kg. BW
• Protein 1-1.5 gr/kg BW up to 2 gr/kg BW (if no Kidney problem)
• High Fat than Carbohydrate
• More PUFA, Omega 3
• Micronutrient following RDA, megadose is not recommended
• Supplement
• Fish oil, omega 3
• Protein: glutamine, BCAA
• Vitamin D, Vitamin A (topical)
NUTRITION IN CANCER

• Oral route shall be encourage


• Enteral route shall be applied if oral is impossible to be done, but
patient shall always encouraged to keep swallowing
• Parenteral route usually used as the last chance in which both
parenteral and enteral is impossible
• Often combination parenteral with enteral and/or oral
• Patient must exercise to maintain nutritional status and muscle mass