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Nutrition in Palliative Care

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Essentials of Palliative Care

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Abstract

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 malnutrition at diagnosis. Several complex interrelated pathophysiological mechanisms have been implicated in the development of malnutrition in cancer and other terminally ill patients. Nutritional interventions have been developed to modulate tumor growth, prevent or counteract the deleterious effect of cachexia during the different stages of the disease and its therapy, and have shown promising results. Different approaches of nutritional therapies including oral supplements, pharmacologic, enteral- or parenteral- or immune-nutrition, and management of their potential complications are discussed. Strategies for nutritional assessment, planning, and counseling are valuable in palliative care, and the goal is to create an individualized program that will meet patient’s need and improve overall quality of life.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA

    M. Khurram Ghori M.D. & Susan Dabu-Bondoc M.D.

Authors
  1. M. Khurram Ghori M.D.
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  2. Susan Dabu-Bondoc M.D.
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Corresponding author

Correspondence to Susan Dabu-Bondoc M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    Cachexia is most commonly noted in patients suffering from all of the following cancers except

    1. (a)

      Head and neck

    2. (b)

      Pancreas

    3. (c)

      Leukemia

    4. (d)

      Lungs

  2. 2.

    Cachexia in cancer patients is found to be related to imbalance of one of the following factors

    1. (a)

      Carbohydrates

    2. (b)

      Proteins

    3. (c)

      Energy expenditure

    4. (d)

      Fats

  3. 3.

    The following interventions have shown promising results to maintain weight in cancer patients except

    1. (a)

      High medium chain triglyceride and long chain triglyceride mixture nutrition

    2. (b)

      Arginine and glutamine-rich diets

    3. (c)

      Halogenated carbohydrate diets

    4. (d)

      Omega 6 fatty acid rich diets

  4. 4.

    Nutritional assessment tools most commonly used are the followings except

    1. (a)

      Subjective global assessment (SGA)

    2. (b)

      Nutritional risk score (NRS)

    3. (c)

      MUST/MNA/NRS

    4. (d)

      Subscapular/triceps skin fold measurement

  5. 5.

    Nutritional interventions in cancer-related cachectic patients includes all except

    1. (a)

      Modification of taste and smell

    2. (b)

      Calorie and protein modification

    3. (c)

      Use of lipid emulsion

    4. (d)

      Use of high dose narcotic agonists

  6. 6.

    Enteral tube feeding in hospitalized patients with advanced cognitive impairment is increased in all of the followings except

    1. (a)

      For profit ownership vs. government owned hospitals

    2. (b)

      Large hospital size vs. small hospital

    3. (c)

      Greater ICU use in last 6 months of life

    4. (d)

      Presence of advance directives for DNR orders

  7. 7.

    Complications of enteral and parenteral therapy include

    1. (a)

      Dehydration

    2. (b)

      Constipation

    3. (c)

      Refeeding syndrome

    4. (d)

      All of the above

  8. 8.

    The decision to withhold nutritional support in advanced Alzheimer patients includes all of the following factors except

    1. (a)

      Advanced directives

    2. (b)

      Family intentions

    3. (c)

      Futility of treatment

    4. (d)

      Age of the patient

  9. 9.

    In the USA, the approximate prevalence of malnutrition as a primary cause of death in cancer patients is about

    1. (a)

      2 %

    2. (b)

      20 %

    3. (c)

      60 %

    4. (d)

      90 %

  10. 10.

    Ethical decision making for nutritional support of cancer patients is highly influenced by

    1. (a)

      Local State laws in the USA

    2. (b)

      Physician training and belief

    3. (c)

      Advance directive

    4. (d)

      WHO ethical committee

Answers

  1. 1.

    (c) Leukemia

  2. 2.

    (c) Energy expenditure

  3. 3.

    (d) Omega 6 fatty acid rich diets (correct answer Omega 3)

  4. 4.

    (d) Subscapular/triceps skin fold measurement

  5. 5.

    (d) Use of high dose narcotic agonists

  6. 6.

    (d) Presence of advance directives for DNR orders

  7. 7.

    (d) All of the above

  8. 8.

    (d) Age of the patient

  9. 9.

    (b) 20 %

  10. 10.

    (c) Advance directive

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Ghori, M.K., Dabu-Bondoc, S. (2013). Nutrition in Palliative Care. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_8

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