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McGill Cancer Nutrition Rehabilitation Program

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Title: McGill Cancer Nutrition Rehabilitation Program


1
CANCER NUTRITION
Dr. Martin Chasen Medical Oncologist/
Palliative Care Physician Clinical
Director McGill Cancer Nutrition and
Rehabilitation Program
2
The McGill UniversityNutrition-Rehabilitation
Programme
3
McGill Cancer Nutrition Rehabilitation Program
  • Cancer rehabilitation is a process that assists
    the patient to obtain optimal physical, social,
    nutritional, psychological and vocational
    functioning within the limits created by the
    disease and its treatment

4
McGill Cancer Nutrition Rehabilitation Program
(CNRP)
  • Organizational Structure
  • McGill Department of Oncology
  • Division of Palliative Medicine
  • Departments of Medicine and Oncology MUHC
  • Origin 2003 with clinics at the Sir Mortimer B
    Davis-Jewish General Hospital and Department of
    Medicine MUHC
  • 2006 Cancer Rehabilitation Program RVH

5
Role of the Dietitian
  • complete a thorough nutrition assessment
  • design a nutrition care plan tailored to the
    patients needs
  • provide counseling and information on optimizing
    food intake
  • provide counseling on symptom control such as
    nausea, vomiting, diarrhea, etc
  • ensure adequate food intake to optimize function
    and quality of life
  •  

6
American Society of Parenteral and Enteral
Nutrition recommends that all patients undergo
nutritional screening as a component of their
initial assessment
7
Nutritional Status is important
  • Predicts the risk associated with treatment
  • Predicts response to treatment
  • Predicts survival and Quality of Life

8
Cancer Cachexia
  • Progressive weight loss
  • Early satiety
  • Generalized weakness
  • Decreased function
  • Progressive wasting

9
Nutritional Screening
  • Early recognition Screening
  • Height
  • Weight
  • Weight change
  • Diagnosis, stage
  • Co-morbidities

10
Nutritional Assessment
  • Registered Dietitian
  • Medical history
  • Dietary history
  • Physical examination
  • Antropometric measurements
  • Laboratory data

11
To be effective
  • In routine clinical practice
  • Patients screened at initial visit
  • Early education

12
PG-SGA
  • Weight
  • Present, one month ago, six months ago
  • Weight in last 2 weeks decreased, increased
    unchanged
  • Food Intake
  • Unchanged, more than usual, less than usual
  • Symptoms
  • No problems eating, no appetite, taste changes,
    nausea, vomiting, diarrhea, constipation, mouth
    sores, dry mouth, swallowing problems, smells
    bothersome, feel full quickly, pain
  • Activities and Function
  • Normal with no limitations, not normal but able
    to be up and about with fairly normal activities,
    not feeling up to most things, able to do little
    activity , pretty much bedridden

13
Use of Patient Generated Subjective Global
Assessment Tool
14
Dietary Counseling improves patient outcomes. A
prospective, randomized, controlled trial in
colorectal cancer patients undergoing
radiotherapy.Paula Ravasco, Isabel
Monteiro-Grillo, Pedro Marques Vidal et al.JCO
231431-1438March 1 2005
15
111 colorectal patients45 stage I/II66 Stage
III/IV
  • 37 dietary counseling on regular foods
  • 37 protein supplements (2 cans/day)
  • 37 ad libitum intake
  • RAVASCO

16
Evaluation
  • Nutritional Intake (diet history)
  • 24 hour food recall questionnaire
  • Anthropometric Data
  • PGSGA
  • QoL (EORTC QLQ C30

17
At end of RT
  • Group 1 Energy intake increase of 555kcal/d
    (398 758) p 0.002
  • Group 2 Energy intake increase of 296 kcal/d
  • (286 401) p 0.04
  • Group 3 Energy intake decreased - 285kcal/d
  • (201 398) p lt 0.1
  • Group 1 gt Group 2 (p 0.001)

18
Baseline
  • 15 malnourished in Group 1
  • 14 malnourished in Group 2
  • 13 malnourished in Group 3
  • At 3 month
  • Additional nutritional degeneration in G 2 and G3
    relative to G1 (p lt 0.001)

19
Quality of Life
  • At 3 months
  • G1 patients maintained or improved QoL (p lt 0.02)
  • G2 patients maintained or worsened QoL (p lt
    0.03)
  • G3 patients deteriorated (plt 0.004)

20
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21
CANCER REHAB TEAM
  • Physician
  • Nurse
  • Psychologist
  • Physiotherapist
  • Occupational Therapist
  • Dietician
  • Nurse Educator
  • Medical Secretary

22
January - October 2006
  • 136 new patient referrals 
  • Age Range 18-84 yrs  71 male 65 female
  • Diagnoses Hepato-biliary -- 21
  • Breast 20
  • Gastro/Esophageal 28
  • Pancreatic 10
  • Colorectal 12
  • Lung 12
  • Gynecological- 10
  • Hematological 15
  • Other 9

23
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26
Gastric Pacesetter and EGG Waves
3
27
EGG ProcedureVisipace Electrogastrogram Analyzer
  • Baseline (10 min)
  • Water load
  • Test (30 min)

3
28
EGG Summary Report
3
29
Studies Carried out at MUHC
3
30
Studies Carried out at MUHC (contd)
3
31
Studies Carried out at MUHC
3
32
EGG Result
3
33
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W O R L D !!!
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