1
????? ????? ???? ?? ????? ?????? ????? ??????
?????? ??????, ????? ??? ????

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• ???? 2011

2
 ??????

• National Cancer Institutes - NCI
• Nutrition in Cancer Care. Treatment of Symptoms
  http//www.cancer.gov/
• American Institute Cancer Research - AICR
• Nutrition of Cancer Patient. Dealing with side
  effects http//www.aicr.org
• Memorial Sloan-Kettering's
• Eating Well During and After Cancer Treatment
  http//www.mskcc.org/mskcc/html/92022.cfm
• "?????? ??????? ????? ????? ?????", ?????? ??????
  ?????

3
?????? ?????? ???? ????

• ?????? ?????? ??????? ?????
• ?????? ?????? ???????? (distressing) ?????
• ??????? ? 40-60 / 70-80 ?????? ????? ?? ?????
• ?????? ????? ??????, ???????, ???????, ??????
  ???????
• ??????? ??????? ??????? ????? ??????? ?? ???????
• ?????? ??????
• ?????? ???????
• ?????? ??????? ???????
• ????? ?????? ???? CINV
• Chemotherapy-Induced Nausea and
  Vomiting

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Pathophysiology of chemotherapy induced nausea
and vomiting (CINV)
                                                
 
Stimuli, pathways, and receptors
Peripheral pathway GI track Vagus nerve

• ???
• Chemoreceptor Trigger Zone (CTZ)
• Cortex

Vomiting center
????? ?????????????
Critical Care Nurse. Kitty Garrett, 2003
5
????? ????? ?????? ?????? ????? ????

• ?????? ???? ?????????? ?? ?????? ?????????
• High-----------Risk in nearly all pts (gt 90)
• Moderate-----Risk in 30-90
• Low------------Risk in 10-30
• Minimal-------Fewer than 10 at risk
• Risk without prophylaxis

????? ?????? ?? ????? ????? ?????? ?????????? -
???? ???? ??????????/?????? ??????? ?????????? .
????' ?. ????- ???? ?????????/ ?.?. ???"? NCCN,
2009, Antiemesis
6
????? ????? ?????? ?????? ????? ????

• Emetic Clasiffication of RT
• High..TBI
• Moderate.Upper abdomen
• Low..Lower thorax region, pelvis,
• cranium (radiosurgery)
  craniospinal
• Minimal...HN, Extremities, Cranium, Breast

????? ?????? ?? ????? ????? ?????? ?????????? -
???? ???? ??????????/?????? ??????? ?????????? .
????' ?. ????- ???? ?????????/ ?.?. ???"?
7
?????? ?- CINV

• Pharmacology
• Acupressure
• Acupuncture
• Guided Imagery
• Music Therapy
• Progressive Muscle Relaxation
• Dietary Interventions
• Introduction to Nursing Management of the Breast
  Cancer Patient/Jennifer McKenzie/ M. D. Anderson
  Cancer Center

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NCI Nutritional Managing Chemotherapy Side
Effects - Nausea and Vomiting

• Learn the best time for you to eat and drink
• Stay away from some foods
• Eat less greasy, fried, salty, sweet, or spicy
  foods if you feel sick after eating them
• If the smell of food bothers you, ask others to
  cook for you. Then let the food cool down before
  you eat it

http//www.cancer.gov/
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NCI - These foods and drinks may be easy on your
stomach
Fruits and sweets Meals and snacks Drinks Soups
BananasCanned fruit such as applesauce, peaches, and pears Gelatin (Jell-O)Popsicles and sherbetYogurt (plain or vanilla) Chicken - broiled or baked, without the skin Cream of Wheat or Cream of Rice cereal Crackers or pretzels Oatmeal Pasta or noodles Potatoes - boiled, without the skin White rice White toast Clear soda such as ginger ale Cranberry or grape juice Oral rehydration solution drinks, such as Pedialyte Tea Water Clear broth, such as chicken, beef, and vegetable
http//www.cancer.gov/
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Memorial Sloan-Kettering Eating Well During
and After Cancer Treatment Diana Glauner, RD,
CDN

• Taste Changes
• Vary from person to person
• Bitter and metallic tastes in the mouth, the most
  common changes
• Food may taste better cold or at room temp
• Sometimes, food without taste

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When food seems tasteless

• Change the texture of foods mashed potatoes
  to baked potato
• Choose and prepare foods that look and smell good
  to you
• Serve foods in an attractive manner
• Try sour foods. These may help stimulate taste

Memorial Sloan-Kettering
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If foods taste or smell different than usual
Foods to avoid Foods to try
High-fat, overly spicy or sweet foods Fatty meats Fried foods such as fried eggs, french fries Heavy cream soups and creamed vegetables High-fat, high-sugar pastries, doughnuts, cookies Highly spiced foods made with pepper or chili pepper, onion, hot sause, or salad dressing High carbohydrate, lower-fat, bland foods Dry toast, crackers, bagels Angel food cake, vanilla wafers Sherbet, low-fat ice cream, or frozen yogurt Gelatin Canned, unsweetened fruit Cold foods Cold protein foods such yogurt cheeses, chicken as skinless, Light pasta salads Popsicles Chilled liquids such as clear liquids nutrition supplements
Memorial Sloan-Kettering
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Nausea

• Pay attention to the timing, atmosphere, and meal
  preparation methods
• Eat smaller and more frequent meals.
• Drink most liquids between meals to prevent early
  fullness / bloating
• Nausea in the morning - keep dry crackers or
  toast at your bedside. Eat these before getting
  out of bed

Memorial Sloan-Kettering
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vomit

• Ice chips or small sips of fluids until able to
  handle larger amounts of liquid or solid foods
• if vomiting is severe, drink or sip broth, sport
  drinks, or flat soda to replace salt (sodium) and
  other electrolytes

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AICR-Dealing With Side Effects

• Dif?culty Swallowing
• Aim gt 8 cups of liquids/day
• Liquids at room temp. may be easier to swallow
• Thicken liquids to consistency
• Purée foods - easier to swallow
• Add gelatin to cakes, cookies, crackers,
  sandwiches..

http//www.aicr.org
16
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