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NUTRITION THERAPY & ANAL CANCER Stephanie Boyea MS, RD, CSO, LD Clinical Die66an Winship Cancer Ins6tute of Emory University Atlanta, GA Today’s objec6ve •  Discuss my perspec6ve on nutri6on’s role in enhancing the pa6ent-­‐care experience during and aPer anal cancer treatment •  Nutri6on’s role in management of: –  Acute side effects –  Long-­‐term side effects in Survivorship NUTRITION GOALS •  To prevent significant weight loss –  Why? Associated with worse outcomes Decreased chemo doses Decreased treatment response Decreased quality of life & performance status Decreased length of survival Dose-­‐limi6ng toxicity (esp. mucosi6s) Andreyev HJN, et al. Eur J Cancer. 1998; 34(4):503-­‐509 Nutri6on for acute side effects: –  Approach dependent on prescribed treatment: •  Treatment may include one, two, or all: –  Chemotherapy –  External Beam radia6on therapy –  Surgery –  All have acute & poten6ally long-­‐term side effects •  effects intensified when treatment modali6es combined Na6onal Comprehensive Cancer Network . NCCN Guidelines: Anal Cancer, Version 1.2014 Chemoradia6on Acute Nutri6on Impact Symptoms (NIS) •  Chemotherapy –  Mucosi6s –  Nausea/Vomi6ng –  Diarrhea –  Anorexia –  Altered taste (Cispla6n) –  Unintended weight loss •  Radia6on –  Pain –  Nausea/Vomi6ng –  Diarrhea –  Painful bowel movements –  Fa6gue –  Vaginal discomfort and pain Advice during chemoradia6on: • 
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6 small meals daily -­‐ scheduled SoP, moist foods Calorie-­‐dense fluids & supplements For taste altera6ons: –  Try tart or tangy flavors •  soP cheeses, yogurt, canned peaches, fruit cocktail, ripe bananas, cranapple juice, etc. –  Add salt, sugar, herbs Diarrhea management •  Instead of BRAT DIET: –  small, frequent intakes every 3 hours –  Low-­‐fat, low-­‐insoluble fiber, & low-­‐lactose diet •  Low-­‐fat: limit oils (< 8 tsp. per day) & fried, greasy foods; choose low-­‐
fat dairy •  Low-­‐insoluble fiber: <2g fiber per serving •  Low-­‐fat, low-­‐lactose dairy foods: yogurts, aged cheese, cream cheese, ricoka, and cokage cheeses, lactose-­‐free milk and dairy products. –  Protein source
Academy of Nutri6on & Diete6cs. Nutri6on Care Manual. Accessed March 3, 2015. Diarrhea Management •  Avoid sorbitol, sugar-­‐free candies (sugar alcohols) •  Avoid Caffeine •  Can Add: –  Bulking agents (psyllium, pec6n) –  Soluble-­‐fiber foods: applesauce, banana, oatmeal, barley, potatoes, rice –  Probio6cs –  Lean protein sources (eggs, lean meats & poultry, fish, soy) •  Increase non-­‐caffeinated fluids: > 12 cups per day, 4oz. at a 6me •  Pharmacologic Interven6ons Cons6pa6on Management •  Pain-­‐medica6on, Zofran, inadequate fluids (cons6pa6ng) –  Stool SoPeners: (Colace/docusate) •  SoP stool can decrease bowel pain •  If having diarrhea – decrease or hold stool soPeners. Do no discon6nue –  Osmo6c Laxa6ves •  Miralax •  Milk of Magnesia –  Warm Prune juice or other warm decaf fluids Other interven6ons may include: • 
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Appe6te s6mulants (Megace, Marinol) Parenteral Nutri6on IV fluid support Oral lactase enzyme Nutri6on in Survivorship •  Chronic bowel side effects –  Abdominal cramping –  Alterna6ng diarrhea & cons6pa6on –  Malabsorp6on –  Ostomy care in some pts •  Decreased bone density •  Healthy diet for disease risk reduc6on •  Weight Management Managing chronic bowel side effects •  Iden6fy symptoms & triggers: –  Food, drink, & bowel diary –  Fiber modifica6on (reduc6on, increases, or adjustment in types of fibers) –  Fluid modifica6ons (types, amounts, & frequency) –  Assessment of bowel related anxiety •  Aid in colostomy troubleshoo6ng as needed •  Pre-­‐ & probio6cs •  Monitor for vitamin/mineral deficiencies Management of bone health •  Calcium –  Tailor calcium supplementa6on to diet & absorp6on •  Vitamin D –  Monitor levels for proper supplementa6on •  Weight bearing exercise Diet in Survivorship •  World Cancer Research Fund/American Ins6tute for Cancer Research recommends: 1.  If able to do so, follow the recommenda6ons for cancer preven6on for diet, healthy weight, and exercise 2.  All cancer survivors to receive nutri6onal care from an appropriately trained professional World Cancer Research Fund/American Ins6tute, Food, Nutri;on, Physical Ac;vity, and the Preven;on of Cancer: a Global Perspec;ve, 2007. Diet in Survivorship –  AICR recommends all survivors follow diet recommenda6ons for cancer preven6on •  Avoid calorie-­‐dense foods & fluids •  Eat mostly foods of plant origin –  >/= 5 por;ons/day of a variety of non-­‐starch fruits & vegetables –  Unprocessed grains & legumes with every meal •  Limit red meat to < 18oz. Per week & liUle to no processed meats •  Limit alcohol –  < 1 drink a day for women and < 2 drinks a day for men •  Limit salt to < 2400 mg per day •  No diet supplements are recommended to meet needs or prevent cancer •  Achieve healthy body weight -­‐  No known nutri6on-­‐related risk factors for anal CA THANK YOU! If any ques6ons, please email: stephanie.boyea@emoryhealthcare.org