Preoperative Nutrition Assessment and Optimization in the Cancer Patient

Authored by: Shalana O'Brien , Allison Bruff , Jeffrey M. Farma

Handbook of Nutrition and Diet in Palliative Care

Print publication date:  July  2019
Online publication date:  July  2019

Print ISBN: 9781138064072
eBook ISBN: 9781315160627
Adobe ISBN:

10.1201/9781315160627-19

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Abstract

The cancer patient is at significant risk for malnutrition due to a combination of functional, metabolic, and cellular factors. Many cancer patients undergoing surgery have been classified as malnourished in the preoperative state causing there to be a greater chance of having postoperative complications and poor outcomes. However, with proper screening and assessments, nutritional status can be optimized prior to surgery. A multidisciplinary approach is needed to assess a patient's nutritional status. Screening tools such as the patient-generated subjective global assessment (PG-SGA) and nutritional risk screening (NRS-2002) used by registered dieticians can help guide the formation of a care plan to improve nutrient intake while decreasing the rate of weight loss. Interventions based on care plans range from increasing oral intake with the use of supplements or enteral tube feeds to starting parenteral nutrition. With the wide variety of enteral feeding formulations available, nutritional care plans can be tailored to be high calorie, protein rich, and/or immune modulating based on the patient's needs. Studies have shown improved outcomes such as decreased infection rates, complications, and length of stay with the addition of supplements in the malnourished surgical patient. Patients who are identified as malnourished should begin nutritional supplementation 10–14 days preoperatively if able. As the cancer patient is likely to require additional therapies such as systemic chemotherapy or radiation, a perioperative period with few to no complications due to malnutrition is ideal.

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