Cancer Cachexia and Fatigue
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THE IMPORTANCE of NUTRITION AS the BEST MEDICINE for EATING DISORDERS Carolyn Coker Ross, MD, MPH
DIET AND NUTRITION THE IMPORTANCE OF NUTRITION AS THE BEST MEDICINE FOR EATING DISORDERS Carolyn Coker Ross, MD, MPH ver seven million girls and women groups. Current research demonstrates to 24, and the suicide rate was 75 times and one million boys and men that eating disorder symptoms may be as higher. will suffer from an eating disorder common or more common among certain Medical consequences of eating disor- in their lifetime. Up to 3.7% of ethnic groups (Asians, blacks, and Hispan- ders include arrested sexual maturity and O 6 females will be diagnosed with anorexia ics) when compared with whites. There growth failure in prepubertal patients. nervosa and an estimated 4.2% will have was no difference found in dieting and Many with eating disorders may look and bulimia nervosa.1 The majority of adoles- restraint scores between Asian, Latino, feel deceptively well and may have normal cent patients seen in referral centers fit and white adolescent girls and boys7 and electrograms but are still at high risk for into a third category, “eating disorder not no difference in binging or BED in obese cardiac arrhythmias and sudden death. otherwise specified” or EDNOS and do patients who sought to lose weight with Prolonged amenorrhea is associated with not fit strict criteria for either anorexia or bariatric surgery.8 These changes may be an increased risk of osteopenia and rate of bulimia.2 Nineteen percent of college- related to an extension of cultural ideals in fractures. Neuroimaging studies with com- aged females are bulimic; many go undi- these ethnic populations of what is attrac- puterized tomography (CT) have demon- agnosed until much later. -
Symptom Management for Cardiac Anorexia/Cachexia
Hospice Palliative Care HPC Consultation Services Waterloo Wellington Tip of the Month [email protected] May 2019 Palliative Approach to Care Tips: Symptom Management for Cardiac Anorexia/Cachexia • Focus interventions on treatment of Anorexia symptoms and reduction of psychological and social burden for patient and family. Anorexia is a syndrome characterized by loss of appetite, nausea, early satiety, weakness, fatigue, food aversion, and • Cachexia is not starvation. In cachexia, significant physical and/or psychological symptoms. Causes are complex and can include fatigue, dyspnea, medication side- effects, nausea, depression, anxiety and sodium-restricted diets, which are common to patients with heart failure. catabolism and subsequent weight loss continue to occur, even if caloric intake is Cachexia maintained or increased. Cachexia is a syndrome characterized by severe body weight, fat and muscle loss and increased protein catabolism due to • Educate patient/family about the underlying disease. This occurs in both chronic right-sided heart failure and the advanced stages of heart failure. difference between weight loss related to How is cachexia diagnosed? The patient with cachexia has: cachexia versus diuresis. • >5% non-edematous weight loss in <12 months; or body mass index (BMI) <20kg/m2; and • Artificial nutrition in the context of • 3 out of 5 of the following: fatigue, decreased muscle strength, anorexia, low muscle mass, abnormal biochemistry advanced cachexia is ineffective and will Screening not improve quality of life. • Screen with Edmonton Symptom Assessment System (ESAS-r) for issues with appetite, nausea, fatigue, depression. Assessment Figure 1: Understanding the Effects • of the Cachexia Cycle Obtain a thorough history of nutritional intake, weight loss, and symptoms (nausea, early satiety, dyspnea, poor oral hygiene, dysphagia, malabsorption, bowel habits). -
Common Signs and Symptoms of Eating Disorders (Anorexia/Bulimia)
Common Signs and Symptoms of Eating Disorders (Anorexia/Bulimia) 1. Dramatic weight loss in a relatively short period of time. 2. Wearing big or baggy clothes or dressing in layers to hide body and/or weight loss. 3. Obsession with calories and fat content of foods. 4. Obsession with continuous exercise. 5. Frequent trips to the bathroom immediately following meals (sometimes accompanied with water running in the bathroom for a long period of time to hide the sound of vomiting). 6. Visible food restriction and self-starvation. 7. Visible bingeing and/or purging. 8. Use or hiding use of diet pills, laxatives, ipecac syrup (can cause immediate death!) or enemas. 9. Isolation. Fear of eating around and with others. 10. Hiding food in strange places (closets, cabinets, suitcases, under the bed) to avoid eating (Anorexia) or to eat at a later time (Bulimia). 11. Flushing uneaten food down the toilet (can cause sewage problems). 12. Vague or secretive eating patterns. 13. Keeping a "food diary" or lists that consists of food and/or behaviors (ie., purging, restricting, calories consumed, exercise, etc.) 14. Pre-occupation or obsession with food, weight (even if “average” weight or thin), and/or cooking. 15. Visiting websites that promote unhealthy ways to lose weight. 16. Reading books about weight loss and eating disorders. 17. Unusual food rituals: shifting the food around on the plate to look eaten; cutting food into tiny pieces; making sure the fork avoids contact with the lips (using teeth to scrap food off the fork or spoon); chewing food and spitting it out, but not swallowing; dropping food into napkin on lap to later throw away. -
Cachexia: the Physical and Psychosocial Impact
Cachexia: The physical and psychosocial impact Caroline Quilty RD, MSc Specialist Palliative Care Dietitian/Therapies Services Manager Aims What is cachexia & why should we be concerned about it? Consider the impact of anorexia in cachexia What are the physical and psychosocial effects of cachexia Identify our role in the management of patients with cachexia What is Cachexia? Cachexia in any disease refers to a state of severely and pathologically low weight, due principally to the loss of mass of tissues other than fat • a serious and under-recognised consequence of cancer (von Haeling and Ankers 2010) • Cachexia is a hallmark of certain diseases including cancer and COPD (Wagner 2008) What is cachexia? “a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutrition support, and progressive functional impairment. The pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism.” Fearon et al 2011 Prevalence Prevalence of cancer cachexia is high, ranging from 50-80% in advanced cancer (von Haeling and Ankers 2014) 20 – 40% of people with COPD have cachexia (von Haeling 2010) What does cachexia look like? The word cachexia has Greek roots, “kakos” meaning bad and “hexus” meaning habit, appearance, condition. Cachexia has been known for centuries (von Haehling 2010) and was described by Hippocrates “…the shoulders, clavicles, chest and thighs melt away” (Katz and Katz 1962). Some terms: Term Definition Ref Anorexia loss of appetite and diminished intake. Poole and Prevalent in cachexia Frogatt 2002 Malnutrition A state of nutrition in which a deficiency of energy, Elia 2003 protein and/or other nutrients causes measurable adverse effects on tissue/body form, composition, function or clinical outcome. -
High-Dose Vitamin C in Advanced-Stage Cancer Patients
nutrients Review High-Dose Vitamin C in Advanced-Stage Cancer Patients Anna Zasowska-Nowak 1,* , Piotr Jan Nowak 2 and Aleksandra Ciałkowska-Rysz 1 1 Department of Palliative Medicine, Chair of Oncology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; [email protected] 2 Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Ul. Pomorska 251, 92-213 Lodz, Poland; [email protected] * Correspondence: [email protected] Abstract: High-dose intravenously administered vitamin C (IVC) is widely used in cancer patients by complementary and alternative medicine practitioners. The most frequent indications for IVC therapy result from the belief in its effectiveness as a potent anti-cancer agent which additionally enhances chemosensitivity of cancer cells and reduces chemotherapy-related toxicities and fatigue intensity. In this narrative review, we decided to deal with this issue, trying to answer the question whether there is any scientific evidence supporting the rationale for application of high-dose IVC therapy in advanced-stage cancer patients. Although results obtained from preclinical studies demon- strated that millimolar ascorbate plasma concentrations achievable only after IVC administration were cytotoxic to fast-growing malignant cells and inhibited tumor growth as well as prolonged the survival of laboratory animals, such positive effects were not found in human studies with advanced-stage cancer patients. We also have not found the rationale for the use of IVC to increase the effectiveness of chemotherapy and to reduce the chemotherapy-induced toxicity in the above mentioned group. Nevertheless, in palliative care, high-dose IVC might be considered as a ther- apy improving the quality of life and reducing cancer-related symptoms, such as fatigue and bone Citation: Zasowska-Nowak, A.; pain. -
Hypokalaemia in a Woman with Eating Disorder
Grand Rounds Vol 11 pages 53–55 Specialities: Acute Medicine; Nephrology; Psychiatry Article Type: Case Report DOI: 10.1102/1470-5206.2011.0013 ß 2011 e-MED Ltd Hypokalaemia in a woman with eating disorder Zachary Z. Brenera, Boris Medvedovskya, James F. Winchestera and Michael Bergmanb aDivision of Nephrology, Department of Medicine, Beth Israel Medical Center, Albert Einstein School of Medicine of Yeshiva University, New York, USA; bDepartment of Medicine, Campus Golda, Rabin Medical Center, Petah-Tikva, Tel-Aviv University, Israel Corresponding address: Dr Zachary Z. Brener, 350 E. 17th St., Division of Nephrology, Beth Israel Medical Center, New York, NY 10003, USA. Email: [email protected] Date accepted for publication 13 April 2011 Abstract Chronic hypokalaemia often remains a diagnostic challenge, especially in young women without hypertension. A concealed diuretic abuse should be suspected, especially in young women with eating disorders. This case describes a woman with chronic hypokalaemia in whom a thorough medical history and proper laboratory tests were essential to early and accurate diagnosis. Keywords Hypokalaemia; eating disorders; diuretics. Introduction Chronic hypokalaemia often remains a diagnostic challenge, especially in young women without hypertension. After the exclusion of the most obvious causes, a concealed diuretic abuse associated with or without surreptitious vomiting and laxative abuse should be suspected, especially in young women concerned with their body image. A conclusive diagnosis may be difficult as such patients often vigorously deny diuretic intake[1]. Also, only a minority of patients with eating disorders (approximately 6%) abuse diuretics[2–4]. This case describes a woman with chronic hypokalaemia in whom a thorough medical history and proper laboratory tests were essential to an early and accurate diagnosis. -
Section 15: Treatment of Eating Disorders
Formulary and Prescribing Guidelines SECTION 15: TREATMENT OF EATING DISORDERS Section 15. Treatment of eating disorders 15.1 Introduction Please review the Trust document “Guidelines for the assessment and treatment of eating disorders” in the CAMHS Operational Policy. When screening for eating disorders one or two simple questions should be considered for use with specific target groups 1. Do you think you have an eating problem? 2. Do you worry excessively about your weight?’ Early detection may be helped by five screening questions using The SCOFF questionnaire. A score of two or more positive answers should raise clinical suspicion and lead to an in depth diagnostic evaluation. 1. Do you ever make yourself Sick because you feel uncomfortably full? 2. Do you worry you have lost Control over how much you eat? 3. Have you recently lost more than One stone in a three month period? 4. Do you believe yourself to be Fat when others say you are too thin? 5. Would you say that Food dominates your life? It is important to take into account that clients with eating disorders can develop Acute Kidney Injury through a variety of mechanisms associated with each condition. Clinicians should be vigilant in the monitoring of physical health especially serum creatinine and levels of hydration.3 15.2 Anorexia nervosa The following would represent a reasonable initial screen for Anorexia Nervosa in primary care if there are no other indications or diagnostic concerns: Full Blood Count, ESR, Urea and Electrolytes, Creatinine, Liver Function Tests, Random Blood Glucose, Urinalysis, ECG (should be considered in all cases and essential if symptoms/signs of compromised cardiac function, bradycardia, electrolyte abnormality and/or BMI less than 15 kg/m2 or equivalent on centile chart). -
Anorexia/Cachexia Heart Failure Symptom Management Guideline for Adults, Age 19 and Older in British Columbia
Anorexia/Cachexia Heart Failure Symptom Management Guideline For adults, age 19 and older in British Columbia What is anorexia? Anorexia is a syndrome characterized by some or all of the following symptoms: loss of appetite, nausea, early satiety, weakness, fatigue, food aversion, and significant physical and/or psychological symptoms. Causes of anorexia are multifactorial and include fatigue, dyspnea, medication side-effects, nausea, depression, anxiety and sodium restricted diets, which may all be found in patients with heart failure. What is cachexia? Cachexia is a syndrome characterized by severe body weight, fat and muscle loss and increased protein catabolism due to underlying disease. The prevalence of cachexia is 16–42% in the heart failure population and is associated with a 50%, 18 month mortality risk independent of variables such as ejection fraction, age and functional ability. How is cachexia diagnosed? Chronic condition with >5% weight loss in <12 months; or body mass index (BMI) <20kg/m2; and 3 out of 5 additional criteria: 1) Fatigue, 2) Decreased muscle strength, 3) Anorexia, 4) Low muscle mass, 5) Abnormal biochemistry *Blood testing to diagnose cachexia in advanced stages of disease is not advocated. Reminder: Malnutrition also affects prognosis in patients with heart failure and is often found in early transitions of the disease. However this symptom management guideline will focus on the assessment and treatment of anorexia and cachexia. Approach to Managing Anorexia/Cachexia Assessment History: When did weight loss begin? How much weight was lost? Obtain baseline (dry) weight. How is [the patients] appetite? What do they eat or drink on a typical day? How has weight loss affected mood? Ask about: nausea, early satiety, dyspnea, poor oral hygiene, dysphagia, malabsorption, bowel habits. -
Dsm-5 Diagnostic Criteria for Eating Disorders Anorexia Nervosa
DSM-5 DIAGNOSTIC CRITERIA FOR EATING DISORDERS ANOREXIA NERVOSA DIAGNOSTIC CRITERIA To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met: 1. Restriction of energy intaKe relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. 2. Intense fear of gaining weight or becoming fat, even though underweight. 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia. BULIMIA NERVOSA DIAGNOSTIC CRITERIA According to the DSM-5, the official diagnostic criteria for bulimia nervosa are: • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: o Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. o A sense of lacK of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating). -
Wasting and Body Composition of Adults with Pulmonary Tuberculosis in Relation to HIV-1 Coinfection, Socioeconomic Status, and Severity of Tuberculosis
European Journal of Clinical Nutrition (2006) 60, 163–171 & 2006 Nature Publishing Group All rights reserved 0954-3007/06 $30.00 www.nature.com/ejcn ORIGINAL ARTICLE Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis E Villamor1, E Saathoff1, F Mugusi2, RJ Bosch3,4, W Urassa5 and WW Fawzi1,6 1Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; 2Department of Internal Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; 3Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA; 4Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA; 5Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania and 6Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Objective: To examine the impact of HIV coinfection, socioeconomic status (SES) and severity of tuberculosis (TB) on the body composition and anthropometric status of adults with pulmonary TB. Design: Cross-sectional study. Setting: Five TB clinics in Dar es Salaam, Tanzania. Subjects: A total of 2231 adult men and women diagnosed with pulmonary TB, prior to the initiation of anti-TB therapy. Methods: We compared the distribution of anthropometric characteristics including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin-fold (TSF), and arm muscle circumference (AMC) by HIV status, SES characteristics, and indicators of TB severity (bacillary density in sputum and Karnofsky performance score). Similar comparisons were carried out with body composition variables from bioelectrical impedance analysis and albumin concentrations, in a subsample of 731 subjects. -
Workforce Prevention and Influenza Illness Policy Guidelines
Workforce Prevention and Influenza Illness Policy Guidelines This document provides guidance to (Company) _________________ supervisors and employees on how to handle influenza-like illness in the (Company) _________________ workplace. OVERVIEW Influenza is a respiratory disease caused by the influenza virus. Influenza is spread primarily person-to-person through coughing, sneezing, or nasal secretions from infected people, or when someone touches something with flu viruses on it before touching their mouths or noses. Infected people can spread the virus to others even before symptoms develop, and can be contagious for several days after becoming sick. Employees experiencing flu-like symptoms such as fever and chills with cough, sore throat, head and muscle ache, nasal congestion and fatigue should not come to work or should leave work to go home. Employees should stay home and avoid contact with other people until they have no symptoms for 24 hours without medication. Employees can plan to return to work 24 hours after fever subsides, without use of fever lowering medications. Supervisors are responsible for ensuring their staff members to stay away from work when experiencing influenza-like illness. Employees have a duty to practice healthy hygiene habits to prevent the spread of disease, and an expectation of working in an environment free of influenza-like illness. Those with severe symptoms, such as difficulty breathing, or at higher risk for complication from influenza should call their health care provider. If you are an employee who is experiencing flu-like symptoms: • Inform your supervisor that you are experiencing flu-like symptoms and leave the workplace as soon as possible. -
Nutrition Status of Children in Nepal
Review Article Nutrition status of children in Nepal: Analysis from the findings of Nepal Demographic Health Survey 2016 Ridesh Pokharel1, BPH; Bibhor Pokharel2, BPH; Rajan Bhusal1, BPH; Deepika Chapagain1, BPH 1 Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal 2 National Open College, Lalitpur, Nepal Corresponding author Ridesh Pokharel, BPH Email: [email protected] Received 24 Jul 2019 Accepted 13 Nov 2019 ABSTRACT Introduction Nutrition is simply the process of intake of food which is required according to the body need. A well balanced food with regular physical activity is a foundation for a good health. Some effects in health such as reduced immunity, increased susceptibility to disease, poor physical and mental development and reduction in productive capacity can be seen as a result of poor nutrition. The indicators of nutrition are stunting, wasting, underweight and overweight among the children. Methods The 2016 Nepal Demographic Health Survey (NDHS) measured the height and weight of eligible children under age 5 in sample households. Weight measurements were taken from lightweight SECA infant scales with a digital display (model no. SECA 878U), designed and supplied by the United Nations Children’s Fund (UNICEF). Height was measured with a measuring board (Shorr Boards®). Recumbent length was measured for children younger than age 24 months, and standing height was measured for older children. Results Overall, 36% of children under age 5 were stunted, with 12% being severely stunted (too short for their age); 10% were wasted, with 2% severely wasted (too thin for their height); and 27% were underweight, with 5% severely underweight (too thin for their age), while around 1% of the children were overweight (heavy for their height).