New Frontiers:
Nutrition and Esophageal Cancer
Kacie Merchand MS,RD,LD
Oncology 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 measures
o Food/Nutrition related history
o Biochemical data, medical tests,
procedures
o 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, 2008
NCI 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
Malnutrition
• Clinical Characteristics to Support Malnutrition Diagnosis
• Presence of 2 or more of 6 characteristics:
o
o
o
o
o
o
Insufficient energy intake
Weight loss
Subcutaneous fat loss
Muscle mass loss
Fluid accumulation
Decreased grip strength
ASPEN/Academy, 2012
Cachexia
“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”
DeVita et al. 2008
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?