New Frontiers: Nutrition and Esophageal Cancer

Kacie Merchand MS,RD,LDOncology Dietitian

Conflicts of Interest

No conflicts of interest to disclose

Objectives

• Describe role of clinical dietitian

• Outline the new consensus statement for both malnutrition and cachexia

• Briefly discuss emerging research for esophageal cancer and nutritional therapy

Screening

• Evidence Analysis Library (EAL): All adult patients should be screened for malnutrition risk on entry into oncology services.

• Rate of malnutrition: ~79% patients with esophageal cancer

• Current protocol

• Validated Outpatient Screening Tools: o Patient Generated Subjective Global Assessment (PG-SGA)o Malnutrition Screening Tool (MST )

Baker et. al, Int J Environ Res Public Health. 2011 Bower et. al, J Surg Oncol. 2009

Role of Clinical Dietitian• Assessment

o Anthropometric measureso Food/Nutrition related historyo Biochemical data, medical tests,

procedureso Nutrition focused physical findings

• Diagnosis

• Intervention/goals

• Monitor/Evaluate

Intervention

• Cancer: Dysphagia, heartburn-like pain, regurgitation, hoarseness, coughing, anorexia, weight loss

• Chemotherapy : Nausea, Vomiting, Diarrhea, Constipation, Anorexia, Mucositis, Altered taste, fatigue

• Radiation Therapy: Esophagitis, anorexia, fatigue, worsening dysphagia, odynophagia, heartburn

• Stent placement

• Esophageal Resection: Jejunostomy, transition to oral diet, dumping syndrome

Ilson, Gastrointest Cancer Res, 2008NCI 2013

Malnutrition

• Increase LOS and hospital admissions

• Decrease QOL & treatment tolerance

• Increase risk of post-op infection, delay wound healing and dehiscence of surgical anastomosis

• Increase treatment breaks or treatment termination, ineligibility for surgery

• Increase morbidity and mortality

• Clinical Characteristics to Support Malnutrition Diagnosis• Presence of 2 or more of 6 characteristics:

o Insufficient energy intakeo Weight losso Subcutaneous fat loss o Muscle mass losso Fluid accumulationo Decreased grip strength

ASPEN/Academy, 2012

Malnutrition

Cachexia

DeVita et al. 2008

“Profound destructive process characterized by skeletal muscle

wasting and harmful abnormalities in fat, carbohydrate, and protein

metabolism in spite of adequate caloric and nutrient intake”

Cachexia

• Early intervention likely to be more effective (pre-cachexia)

• “Symptom management alone can improve survival in patients with advanced cancer”

Fearon et al Lancet Oncol. 2011

Emerging Research• Immunonutrition

o Arginine, omega 3 FA, and nucleotides

• Omega 3 fats & Lean Body Mass

Questions?