New Frontiers: Nutrition and Esophageal Cancer Kacie Merchand MS,RD,LD Oncology Dietitian Conflicts of Interest No conflicts of interest to disclose Objectives • Describe role of clinical dietitian • Outline the new consensus statement for both malnutrition and cachexia • Briefly discuss emerging research for esophageal cancer and nutritional therapy Screening • Evidence Analysis Library (EAL): All adult patients should be screened for malnutrition risk on entry into oncology services. • Rate of malnutrition: ~79% patients with esophageal cancer • Current protocol • Validated Outpatient Screening Tools: o Patient Generated Subjective Global Assessment (PG-SGA) o Malnutrition Screening Tool (MST ) Baker et. al, Int J Environ Res Public Health. 2011 Bower et. al, J Surg Oncol. 2009 Role of Clinical Dietitian • Assessment o Anthropometric measures o Food/Nutrition related history o Biochemical data, medical tests, procedures o Nutrition focused physical findings • Diagnosis • Intervention/goals • Monitor/Evaluate Intervention • Cancer: Dysphagia, heartburn-like pain, regurgitation, hoarseness, coughing, anorexia, weight loss • Chemotherapy : Nausea, Vomiting, Diarrhea, Constipation, Anorexia, Mucositis, Altered taste, fatigue • Radiation Therapy: Esophagitis, anorexia, fatigue, worsening dysphagia, odynophagia, heartburn • Stent placement • Esophageal Resection: Jejunostomy, transition to oral diet, dumping syndrome Ilson, Gastrointest Cancer Res, 2008 NCI 2013 Malnutrition • Increase LOS and hospital admissions • Decrease QOL & treatment tolerance • Increase risk of post-op infection, delay wound healing and dehiscence of surgical anastomosis • Increase treatment breaks or treatment termination, ineligibility for surgery • Increase morbidity and mortality Malnutrition • Clinical Characteristics to Support Malnutrition Diagnosis • Presence of 2 or more of 6 characteristics: o o o o o o Insufficient energy intake Weight loss Subcutaneous fat loss Muscle mass loss Fluid accumulation Decreased grip strength ASPEN/Academy, 2012 Cachexia “Profound destructive process characterized by skeletal muscle wasting and harmful abnormalities in fat, carbohydrate, and protein metabolism in spite of adequate caloric and nutrient intake” DeVita et al. 2008 Cachexia • Early intervention likely to be more effective (pre-cachexia) • “Symptom management alone can improve survival in patients with advanced cancer” Fearon et al Lancet Oncol. 2011 Emerging Research • Immunonutrition o Arginine, omega 3 FA, and nucleotides • Omega 3 fats & Lean Body Mass Questions?