McGill Cancer Nutrition Rehabilitation Program

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CANCER NUTRITION
Dr. Martin Chasen Medical Oncologist/
Palliative Care Physician Clinical
Director McGill Cancer Nutrition and
Rehabilitation Program
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The McGill UniversityNutrition-Rehabilitation
Programme
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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

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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

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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
•  

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American Society of Parenteral and Enteral
Nutrition recommends that all patients undergo
nutritional screening as a component of their
initial assessment
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Nutritional Status is important

• Predicts the risk associated with treatment
• Predicts response to treatment
• Predicts survival and Quality of Life

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Cancer Cachexia

• Progressive weight loss
• Early satiety
• Generalized weakness
• Decreased function
• Progressive wasting

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Nutritional Screening

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

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Nutritional Assessment

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

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To be effective

• In routine clinical practice
• Patients screened at initial visit
• Early education

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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

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Use of Patient Generated Subjective Global
Assessment Tool
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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
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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

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Evaluation

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

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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)

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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)

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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)

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CANCER REHAB TEAM

• Physician
• Nurse
• Psychologist
• Physiotherapist
• Occupational Therapist
• Dietician
• Nurse Educator
• Medical Secretary

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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

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Gastric Pacesetter and EGG Waves
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EGG ProcedureVisipace Electrogastrogram Analyzer

• Baseline (10 min)
• Water load
• Test (30 min)

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EGG Summary Report
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Studies Carried out at MUHC
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Studies Carried out at MUHC (contd)
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Studies Carried out at MUHC
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EGG Result
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