Professional Documents
Culture Documents
Palliative KentSmith
Palliative KentSmith
2003
Organised by the Israel Society for Clinical
Nutrition
Education and Clinical Practice Programme
email LKS@fcna.up.pt
Nutritional Management
in Palliative Care
Is Nutrition Support
needed / justified
in Palliative Care ???
Presentation Outline
n Palliative Care
– Definition (WHO 2002)
– Principles
n Nutrition in Palliative care
– What changes?
– EAPC guidelines
– Nutrition support options
Palliative Care:
(WHO 2002)
n Physical care
n Symptom management
n Psychosocial & spiritual care
n Multidisciplinary team
n Patient & family F care decisions
(WHO 2002)
Multidisciplinary approach
Constant follow-up
(Power, 1999)
Patient’s Perspective:
n Disease progression
n Symptoms
n Progressive nutritional deterioration
– Weight loss
– Changes in body image
n Altered food intake
n The meaning of “Food”
Food”
4Physical
4Comfort/ nurture
4Tradition/ culture
4Socialization
4Psychological Food is life
Food means:
+ -
Ñ Hope Ñ Guilt
Ñ Confort Ñ Fear
Ñ Pleasure Ñ Pain
(Gallagher, 1989)
Overall Objective:
Nutrition Support
Palliative Care
n Maintain/improve QOL
n Control symptoms
Nutritional Assessment
n Advanced metastatic cancer (n=352)
n No single measurement is adequate!
– CRP – increased in 74%
– Severe fat deficiency by TSF in 51%
– High muscle mass loss by AMA in 30%
– BMI – normal or increased
– Wt loss in 87% (≥ 10% Wt loss in 71%)
– Anorexia in 81%
– Early satiety in 69%
n Bioimpedance (body composition & BCM)
(Sarhill et al, 2003)
WWW.albertapalliative.net
Oral Feeding
Oral Supplements
Enteral Nutrition
Parenteral Nutrition
od rt
Fo nfo
s
Hydration
Co
Comfort Foods...
Oral Feeding
Practical Approach
n Individual preferences n Diet counselling
n “à la carte” meals n Flexible timetables
n Appealing presentation n Agreeable environment
n Personalized portions n Family involvement
n Adapted consistency n Staff participation
Oral Supplementation
n Allows for:
– Increased energy intake
– Increased protein intake
Frequent bolus
Reduced volume
Easy ingestion
(Power, 1999)
4Clinical indications:
¸ head & neck / esophagus tumours
¸ inoperable fistulae
¸ esophageal obstructions
(Boyd, 1994)
Enteral Nutrition
n Adjust:
– delivery method
– volume
– duration of delivery
4Changes with:
¸ disease progression
¸ new symptoms
¸ interruption (?) (Boyd, 1994)
4Selected patients
4Prolonged survival
Parenteral Nutrition
n Limited Use:
– Increased complications
– Difficulties in Home Care implementation
– Cost
– Ethical Dilemas
(Torelli, 1999)
(Faisinger, 1997)
PCU hospitalization
n Motive
ñ Symptom control – 92.3 %
ñ Terminal care – 7.7 %
n Duration ( 7 – 98 dias )
ñ mean = 31; median = 19
¢ 46.1% discharged
¢ 53.8% deceased
(Porto Cancer Centre)
n h patient comfort
n No evidence that prolongs death
n Dehydration – delirium & renal failure
n Good in opioid toxicity delirium
n Good in hypercalcemia
Hydration Methods
n Enteral route
n Parenteral route
– peripheral
– central
n Easier access
n Facilitates mobility
Ordering Hypodermoclysis
Research Perspectives
The Answer ?
Nutrition Support
is an integral part
of Palliative Care