Link to This Close. Malnutrition is caused by eating a diet in which nutrients are not enough or are too much such that it causes health problems. Group 10 Created with Sketch. Dr Raghuraj vyas says: On the basis of research among young women with inherited susceptibility to breast cancer, dual-imaging modalities may enhance early detection related to the higher sensitivity of MRI in detecting lesions in premenopausal dense breasts and the superiority of mammography in identifying ductal carcinoma in situ ;[ 91 - 93 ] therefore, the American Cancer Society recommends including adjunct screening with MRI. However, many studies are observational and cross-sectional or retrospective in design. Previous studies have also not demonstrated significant difference in overall risk of high-grade versus low-grade tumors.
How to End the Autism Epidemic
They also may display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions for example, the sensation of insects creeping under the skin.
Psychotic symptoms can sometimes last for months or years after a person has quit abusing methamphetamine, and stress has been shown to precipitate spontaneous recurrence of methamphetamine psychosis in formerly psychotic methamphetamine abusers.
These and other problems reflect significant changes in the brain caused by abuse of methamphetamine. Neuroimaging studies have demonstrated alterations in the activity of the dopamine system that are associated with reduced motor speed and impaired verbal learning.
Studies in chronic methamphetamine abusers have also revealed severe structural and functional changes in areas of the brain associated with emotion and memory, which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers. Methamphetamine abuse also has been shown to have negative effects on non-neural brain cells called microglia. These cells support brain health by defending the brain against infectious agents and removing damaged neurons.
Too much activity of the microglial cells, however, can assault healthy neurons. A study using brain imaging found more than double the levels of microglial cells in former methamphetamine abusers compared to people with no history of methamphetamine abuse, which could explain some of the neurotoxic effects of methamphetamine.
Some of the neurobiological effects of chronic methamphetamine abuse appear to be at least partially reversible. Another neuroimaging study showed neuronal recovery in some brain regions following prolonged abstinence 14 but not 6 months. This recovery was associated with improved performance on motor and verbal memory tests. But function in other brain regions did not recover even after 14 months of abstinence, indicating that some methamphetamineinduced changes are very long lasting.
The dental problems may be caused by a combination of poor nutrition and dental hygiene as well as dry mouth and teeth grinding caused by the drug. Continued assessment and adjustment of nutrition goals and interventions is required throughout this continuum to meet the changing needs of the patient receiving palliative or hospice care services. Ethical issues may arise when patients, families, or caregivers request artificial nutrition and hydration when there is no prospect of recovering from the underlying illness or accruing appreciable benefit from the intervention.
When there is uncertainty about whether a patient will benefit from artificial nutrition, hydration, or both, a time-limited trial may be useful.
Clear, measurable endpoints are outlined at the beginning of a time-limited trial. The caregiving team will explain that, as with other medical therapies, artificial nutrition and hydration can be stopped if the desired nutrition effects are not produced. Randomized controlled trials of enteral or parenteral nutrition in cancer patients receiving formal palliative care are lacking.
Patients with a life expectancy shorter than 40 days may be palliated with home intravenous IV fluid therapy, although this practice is controversial. Patients and caregivers often consider the provision of food and fluids to be basic care. However, the use of artificial nutrition and hydration at the end of life is a complex and controversial intervention that is influenced by clinical, cultural, religious, ethical, and legal factors.
Patients and families often believe the use of these interventions will improve quality and length of life, but evidence of clear benefit is lacking. In addition, agitated or confused patients receiving artificial nutrition and hydration may need to be physically restrained to prevent them from removing a gastrostomy tube, nasogastric tube, or central IV line.
Patients at the end of life who have increased difficulty with swallowing have less risk of aspiration with thick liquids than with thin liquids. For patients at the end of life, the goals of nutrition therapy are directed at alleviating symptoms rather than reversing nutrition deficits.
The pleasure of tasting food and the social benefits of participating in meals with family and friends can be emphasized over increasing caloric intake. Other studies found no effect on terminal delirium, thirst, chronic nausea, or fluid overload. The American Academy of Hospice and Palliative Medicine suggests that providers facilitate respectful and informed discussions about the effects of artificial nutrition and hydration near the end of life among physicians, other health care professionals, patients, and families.
Ideally, patients will make their own decisions on the basis of a careful assessment of potential benefits and burdens, consistent with legal and ethical norms that permit patients to accept or forgo specific medical interventions.
Decisions about whether to provide artificial nutrition and hydration to patients in the late stages of life are complex and influenced by ethical, legal, cultural, and clinical considerations, and by patient and family preferences. Guidelines on the ethical considerations about whether to forgo or discontinue hydration and nutrition support have been published by a number of organizations, including the American Medical Association,[ 25 ] the American Academy of Hospice and Palliative Medicine,[ 11 ] the Hospice and Palliative Nurses Association,[ 18 ] the American Society for Parenteral and Enteral Nutrition,[ 26 , 27 ] and the Academy of Nutrition and Dietetics.
Religion and religious traditions provide a set of core beliefs about life events and an ethical foundation for clinical decision-making. To provide an optimal and inclusive healing environment, all palliative team members need to be aware of their own spirituality and how it may differ from that of fellow team members and the spirituality of the patients and families they serve.
Religious beliefs are often closely related to cultural views. Individuals living in the midst of a particular tradition can continue to be influenced by it, even if they have stopped believing in or practicing it. Patients may rely on religion and spirituality as important means to interpret and cope with illness. The wide range of practices related to neutropenic diets reflects the lack of evidence regarding the efficacy of dietary restrictions in preventing infectious complications in cancer patients.
Studies evaluating various approaches to diet restrictions have not shown clear benefit. A meta-analysis and a systematic review of articles evaluating the effect of a neutropenic diet on infection and mortality rates in cancer patients found no superiority or advantage in using a neutropenic diet over a regular diet in neutropenic cancer patients.
Even after the observational study was omitted from the analysis, the results persisted. The review concluded that these individual studies provided no evidence showing that the use of a low-bacterial diet prevents infections. Other studies have demonstrated potential adverse effects of neutropenic diets. One group of investigators [ 6 ] conducted a retrospective review of patients who had undergone hematopoietic cell transplantation HCT.
The patients who received the neutropenic diet experienced significantly more documented infections than did the patients receiving the general hospital diet that permitted black pepper and well-washed fruits and vegetables and excluded raw tomatoes, seeds, and nuts.
The neutropenic diet group had a significantly higher rate of infections that could be attributed to a gastrointestinal source, as well as a trend toward a higher rate of vancomycin-resistant enterococci infections. Without clinical evidence to define the dietary restrictions required to prevent foodborne infection in immunocompromised cancer patients, recommendations for food safety are based on general food safety guidelines and the avoidance of foods most likely to contain pathogenic organisms.
The effectiveness of these guidelines is dependent on patient and caregiver knowledge about, and adherence to, safe food handling practices and avoidance of higher-risk foods.
Leading cancer centers provide guidelines for HCT patients and information about food safety practices related to food purchase, storage, and preparation e. Comprehensive food safety information designed by the U. Food and Drug Administration for people with cancer and for transplant recipients is also available online.
Recommendations support the use of safe food handling procedures and avoiding consumption of foods that pose a high risk of infection, as noted in Table 7.
Maintaining adequate nutrition while undergoing treatment for cancer is imperative because it can reduce treatment-related side effects, prevent delays in treatment, and help maintain quality of life. Patients are likely to search the Internet and other lay sources of information for dietary approaches to manage cancer risk and to improve prognosis.
Unfortunately, much of this information is not supported by a sufficient evidence base. The sections below summarize the state of the science on some of the most popular diets and dietary supplements. A vegetarian diet is popular, is easy to implement and, if followed carefully, does not result in nutrition deficiencies. There is strong evidence that a vegetarian diet reduces the incidence of many types of cancer, especially cancers of the gastrointestinal GI tract. There are no published clinical trials, pilot studies, or case reports on the effectiveness of a vegetarian diet for the management of cancer therapy and symptoms.
There is no evidence suggesting a benefit of adopting a vegetarian or vegan diet upon diagnosis or while undergoing cancer therapy. On the other hand, there is no evidence that an individual who follows a vegetarian or vegan diet before cancer therapy should abandon it upon starting treatment.
One pilot study has suggested that following a plant-based diet can prevent tumor progression in men with localized prostate cancer. It is a high-carbohydrate, low-fat, plant-based diet stemming from philosophical principles promoting a healthy way of living.
Although there are anecdotal reports on the effectiveness of a macrobiotic diet as an alternative cancer therapy, none have been published in peer-reviewed, scientific journals.
No clinical trials, observational studies, or pilot studies have examined the diet as a complementary or alternative therapy for cancer. In fact, two reviews of the diet and its evidence for effectiveness in cancer treatment concluded that there is no scientific evidence for the use of a macrobiotic diet in cancer treatment.
No current clinical trials are studying the role of the macrobiotic diet in cancer therapy. A ketogenic diet has been well established as an effective alternative treatment for some cases of epilepsy and has gained popularity for use in conjunction with standard treatments for glioblastoma. The ketogenic diet can be difficult to follow and relies more on exact proportions of macronutrients typically a 4 to 1 ratio of fat to carbohydrates and protein than do other complementary and alternative medicine CAM diets.
Because safety and feasibility have been proven, several trials are recruiting patients to study the effectiveness of the ketogenic diet on glioblastoma. Therefore, if a patient diagnosed with glioblastoma wishes to start a ketogenic diet, it would be safe if implemented properly and under the guidance of a registered dietitian,[ 10 ] but effectiveness for symptom and disease management remains unknown.
The use of probiotics has become prevalent within and outside of cancer therapy. Strong research has shown that probiotic supplementation during radiation therapy, chemotherapy, or both is well tolerated and can help prevent radiation- and chemotherapy-induced diarrhea, especially in those receiving radiation to the abdomen. Melatonin is a hormone produced endogenously that has been used as a CAM supplement along with chemotherapy or radiation therapy for targeting tumor activity and for reducing treatment-related symptoms, primarily for solid tumors.
Several studies have shown tumor response to, or disease control with, chemotherapy alongside oral melatonin, as opposed to chemotherapy alone; one study has shown tumor response with melatonin in conjunction with radiation therapy. However, another study did not demonstrate increased survival with melatonin, but did demonstrate improved quality of life. Melatonin taken in conjunction with chemotherapy may help reduce or prevent some treatment-related side effects and toxicities that can delay treatment, reduce doses, and negatively affect quality of life.
Melatonin supplementation has been associated with significant reductions in neuropathy and neurotoxicity, myelosuppression, thrombocytopenia, cardiotoxicity, stomatitis, asthenia, and malaise. Overall, several small studies show some evidence supporting melatonin supplementation alongside chemotherapy, radiation therapy, or both for solid tumor treatment, for aiding tumor response and reducing toxicities, while negative side effects for melatonin supplementation have not been found.
Therefore, it may be appropriate to provide oral melatonin in conjunction with chemotherapy or radiation therapy to a patient with an advanced solid tumor. Glutamine is an amino acid that is especially important for GI mucosal cells and their replication. These cells are often damaged by chemotherapy and radiation therapy, causing mucositis and diarrhea, which can lead to treatment delays and dose reductions and severely affect quality of life.
Some evidence suggests that oral glutamine can reduce both of those toxicities by aiding in faster healing of the mucosal cells and entire GI tract. For patients receiving chemotherapy who are at high risk of developing mucositis, either because of previous mucositis or having received known mucositis-causing chemotherapy, oral glutamine may reduce the severity and incidence of mucositis.
For patients receiving radiation therapy to the abdomen, oral glutamine may reduce the severity of diarrhea and can lead to fewer treatment delays.
In addition to reducing GI toxicities, oral glutamine may also reduce peripheral neuropathy in patients receiving the chemotherapy agent paclitaxel. Oral glutamine is a safe, simple, and relatively low-cost supplement that may reduce severe chemotherapy- and radiation-induced toxicities. The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above. Added Carneiro et al.
Nutrition Screening and Assessment. Added Daniel et al. Added text to state that the prevalence of obesity is higher in adult cancer survivors than in those without a cancer history; and that cancer survivors with the highest rates of increasing obesity are colorectal and breast cancer survivors and non-Hispanic blacks cited Greenlee et al.
Added text about the benefits of using immune-enhancing formulas for preoperative and postoperative nutrition support for individuals undergoing gastrointestinal surgery cited Song et al. Added Pharmaceutical management of cancer-associated cachexia and weight loss as a new subsection.
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about nutrition before, during, and after cancer treatment. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. Board members review recently published articles each month to determine whether an article should:.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary. Any comments or questions about the summary content should be submitted to Cancer.
Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries. Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches.
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Permission to use images outside the context of PDQ information must be obtained from the owner s and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online , a collection of over 2, scientific images. The information in these summaries should not be used as a basis for insurance reimbursement determinations.
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Questions to Ask about Treatment Clinical Trials. Drugs Approved for Different Types of Cancer. Drugs Approved for Conditions Related to Cancer. Access to Experimental Drugs. Chronic disease—related malnutrition e. Acute disease—related or injury-related malnutrition e. Loss of muscle mass.
Loss of subcutaneous fat. Localized or generalized fluid accumulation that may sometimes mask weight loss. Diminished functional status as measured by hand grip strength.
Screening Early recognition of nutrition-related issues is necessary for appropriate nutrition management of cancer patients. Education by registered dietitian or other clinician. Intervention by registered dietitian. Critical need for improved symptom management. Food- and nutrition-related history. Biochemical data, medical tests, and procedures.
Localized or generalized fluid accumulation. Diminished functional status e. Subcutaneous fat loss Orbit. Thoracic and lumbar regions. Subcutaneous muscle loss Temple.
Tumor location current or anticipated mechanical function impairment. Anticipated duration of symptoms. Eat foods that are high in protein and calories. Eat high-protein foods first in your meal while your appetite is strongest—foods such as beans, chicken, fish, meat, yogurt, and eggs. Add extra protein and calories to food. Cook with protein-fortified milk. Drink milkshakes, smoothies, juices, or soups if you do not feel like eating solid foods. Prepare and store small portions of favorite foods.
Seek foods that appeal to the sense of smell. Experiment with different foods. Eat larger meals when you feel well and are rested.
Sip only small amounts of liquids during meals. Eat your largest meal when you feel hungriest, whether at breakfast, lunch, or dinner. Be as active as possible to help develop a bigger appetite. Consider asking your health practitioner about blenderized drinks with a high nutrient density.
Tell your doctor if you are having eating problems such as nausea, vomiting, or changes in how foods taste and smell. Perform frequent mouth care to relieve symptoms and decrease aftertastes. Consider tube feedings if you are unable to sustain a certain amount of caloric intake to maintain strength.
Drink plenty of fluids each day, including water, warm juices, and prune juice. Be active each day; take walks regularly. Eat more fiber-containing foods. Drink hot liquids to help relieve constipation, including coffee, tea, and warm milk. Talk with your doctor before taking laxatives, stool softeners, or any medicine to relieve constipation. Limit certain foods if you develop gas, including broccoli, cabbage, cauliflower, beans, and cucumbers.
Eat a large breakfast, including a hot drink and high-fiber foods. Consider a fiber supplement. Drink plenty of fluids to replace those lost from diarrhea, including water, ginger ale, and sports drinks. Let carbonated drinks lose their fizz before you drink them. Eat foods and liquids that are high in sodium and potassium. Very hot or cold drinks. Greasy, fatty, and fried foods. Foods that can cause gas, such as carbonated beverages, cruciferous vegetables, legumes and lentils, and chewing gum.
Milk products unless low lactose or lactose free. Sugar-free products sweetened with xylitol or sorbitol. Sip water throughout the day. Have very sweet or tart foods and drinks — such as lemonade, to help make more saliva. Chew gum or suck on hard candy, ice pops, or ice chips; sugar free is best, but consult your doctor if you also have diarrhea. Eat foods that are easy to swallow. Moisten food with sauce, gravy, or salad dressing. Do not drink any type of alcohol, beer, or wine.
Avoid foods that can hurt your mouth, i. Keep your lips moist with lip balm. Rinse your mouth every 1 to 2 hours. Do not use mouthwash that contains alcohol. Do not use tobacco products, and avoid second-hand smoke. Talk with your doctor or dentist about artificial saliva or other products to coat, protect, and moisten your throat and mouth.
Prepare your own low-lactose or lactose-free foods. Choose lactose-free or low-lactose milk products. These products do not contain any lactose. Some of these effects will get better quickly, others will take time, and still others may become a lasting problem. Every person with TBI has a unique set of physical effects. Each person has a unique pace of recovery.
This chapter describes many physical effects that people with a TBI may experience. Some information may apply now, but not in the future. With the help of the health care team, many physical effects can be treated or managed with positive results. You can also use the suggestions in this chapter. But first, check these ideas out with the health care team. The health care team will have many more suggestions and treatments than are listed here.
Headaches are common following TBI. Fatigue, stress, and a history of migraines make these headaches worse. But he deals with the fatigue factor. It can take some trial and error to find the right medicine to treat post-TBI headaches. Your family member should take all medications exactly as the doctor directs.
He or she should talk with the doctor before changing how much medicine he or she takes, or how often. Stretching and strengthening exercises may help.
Follow the directions of the health care team on these. Exercise, such as swimming in warm water, can help loosen the muscles that cause headaches. If headaches do not improve or worsen, call the doctor. New treatment options can be tried.
Your family member may be referred to a headache specialist such as a neurologist if headaches do not improve with standard treatment.
Altered sleep patterns are very common after TBI. This problem is usually worst in the first several weeks to months after injury. Many people with TBI sleep during the day and are awake at night.
They may nap now, when before they did not. Most people with TBI do usually resume a more normal sleep routine similar to the one they had before the injury. Time, patience, and some creative problem-solving help. Developing a consistent routine, using medications on a temporary basis, and changing the bedroom can improve sleep. He met other people who were in similar situations. He would sit and channel surf. He was just going from one thing to another.
Fatigue is a common complaint among people with TBI. The body needs a vast amount of energy for healing after traumatic injuries. Sleep is often disrupted in the hospital. Usual patterns of rest and activity are often very different for many weeks to months after TBI.
Confusion can make fatigue worse. Central fatigue is the major type of fatigue in TBI patients. Central fatigue affects thinking. Working harder to learn and stay focused can make your family member mentally tired.
In some people, central fatigue causes them to be irritable or have headaches. So it took him a very long time to get over that fatigue, and he still has it at times. But when we first got home, he would be completely wiped out when he came home from work, and every single weekend was a wipe-out. And then that improved, and it was just Saturday that was the wipe-out. Now, most days are pretty normal. Most weekends are pretty normal. Every now and then we hit a time where he just kind of crashes.
Peripheral fatigue is also reported by many. Peripheral fatigue is physical. It can make pain, thinking, and mood worse. Fatigue reduces the speed and quality of rehabilitation.