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Demystifying Nutritional Support in Cancer (FR451)
372
Schedule With Abstracts
discuss the use of the Four Box model for facilitating ethical decision making. Although the method can be applied in many scenarios, the discussion will focus on decisions related to the use of noninvasive ventilation in advanced cardiac, pulmonary, and neuromuscular disease.
Demystifying Nutritional Support in Cancer (FR451) Eric Prommer, MD FAAHPM, Mayo Clinic Hospital, Phoenix, AZ. Thomas LeBlanc, MD, Duke University, Durham, NC. Arif Kamal, MD, Duke Cancer Institute, Durham, NC. Niki Koesel Carolinas Health Care, Charlotte, NC. Michele Szafranski, MS CSO LDN RD, Carolinas Healthcare System, Charlotte, NC. Objectives Describe the pathophysiology and stages of the cancer-related anorexia-cachexia syndrome. Describe methods to assess cancer-related anorexia-cachexia at the bedside. Describe the interventions according to stages of cancer-related anorexia-cachexia. Central to managing nutrition in the cancer patient is recognizing and managing the anorexia-cachexia syndrome. Research characterizes the anorexia-cachexia syndrome as a metabolic syndrome associated with advanced cancer producing loss of muscle with or without the loss of fat mass. Its development is a turning point in the disease trajectory of a cancer patient, with continued weight loss associated with a shorter survival time, and it is responsible for death in up to 20% of cancer patients. Anorexia-cachexia is a significant cause of morbidity that manifests as weight loss, asthenia (loss of energy and strength), anemia, and alterations in immune function. Research now recognizes anorexia-cachexia as a continuum consisting of three stages, defined as precachexia, cachexia, and refractory cachexia. Not all patients traverse the entire spectrum. Interventions potentially modifying the effect of anorexia-cachexia differ according to stages. Patients are often inappropriately recommended extreme types of nutritional support according to the stage of cancer and extent of the metabolic syndrome. Patients also experience messages that force them to adhere to therapies that are no longer appropriate for the stage of anorexia-cachexia. From presenters with diverse backgrounds in oncology, nursing, cachexia research, and community palliative care, and through didactics, case presentations, and audience participation, the session will accomplish four major goals for the attendees: (1) enhance knowledge of the basic pathophysiology of the anorexia-cachexia syndrome, (2) improve clinical assessment of anorexia-cachexia with a focus on clinical bedside assessment and
Vol. 49 No. 2 February 2015
technological advances, (3) characterize interventions according to stage of anorexia-cachexia, and (4) develop attendees’ skills at communicating with patients and families about cancer and nutrition. When this session is completed, palliative care specialists will walk away better equipped to participate in complex nutritional decision making for cancer patients.
Palliative Care in the Seriously Mentally Ill (FR452) Leslie Blatt, MSN APRN, Yale New Haven Hospital, North Branford, CT. Susan Crawford, MSW, Yale New Haven Hospital, Rocky Hill, CT. Objectives Discuss existing literature on the integration of palliative care into care of people with mental illness. Discuss strategies that the practitioner can incorporate into practice to assist the seriously mentally ill in navigating the healthcare system, maintaining a therapeutic relationship with the patient, and helping staff cope with the person’s behavior. The seriously mentally ill (SMI) remain an underserved population in palliative care. The relationship between SMI and poor physical health is well documented. SMI have double the risk of dying from natural causes at any given age than the general population. They are at a higher risk of death from comorbid conditions such as cancer, cardiovascular disease, and respiratory and gastrointestinal illness, leading to an average reduced life expectancy of 815 years. Individuals with a psychiatric disorder are at increased risk for having a comorbid substance abuse disorder. The 2009 Survey on Drug Use and Health found that 26% of all persons with mental illness meet the criteria for substance disorder. This is even higher in patients diagnosed with schizophrenia and bipolar disorder. Engaging people with co-occurring disorders in treatment can be extremely difficult. Psychiatric patients often deny their mental and physical illnesses. Physical illness, especially cancer, compounded with mental illness can be extremely challenging for both patient and provider. Using a case-based approach, we will explore the interdisciplinary approach to assisting this population into treatment, helping them navigate the healthcare system and continuity of care. The case will focus on strategies that the practitioner can incorporate into practice to address behavioral issues that may arise, advance care planning and decision making, and collaboration with mental health specialists to ensure that pain and other symptoms are controlled.
Schedule With Abstracts
discuss the use of the Four Box model for facilitating ethical decision making. Although the method can be applied in many scenarios, the discussion will focus on decisions related to the use of noninvasive ventilation in advanced cardiac, pulmonary, and neuromuscular disease.
Demystifying Nutritional Support in Cancer (FR451) Eric Prommer, MD FAAHPM, Mayo Clinic Hospital, Phoenix, AZ. Thomas LeBlanc, MD, Duke University, Durham, NC. Arif Kamal, MD, Duke Cancer Institute, Durham, NC. Niki Koesel Carolinas Health Care, Charlotte, NC. Michele Szafranski, MS CSO LDN RD, Carolinas Healthcare System, Charlotte, NC. Objectives Describe the pathophysiology and stages of the cancer-related anorexia-cachexia syndrome. Describe methods to assess cancer-related anorexia-cachexia at the bedside. Describe the interventions according to stages of cancer-related anorexia-cachexia. Central to managing nutrition in the cancer patient is recognizing and managing the anorexia-cachexia syndrome. Research characterizes the anorexia-cachexia syndrome as a metabolic syndrome associated with advanced cancer producing loss of muscle with or without the loss of fat mass. Its development is a turning point in the disease trajectory of a cancer patient, with continued weight loss associated with a shorter survival time, and it is responsible for death in up to 20% of cancer patients. Anorexia-cachexia is a significant cause of morbidity that manifests as weight loss, asthenia (loss of energy and strength), anemia, and alterations in immune function. Research now recognizes anorexia-cachexia as a continuum consisting of three stages, defined as precachexia, cachexia, and refractory cachexia. Not all patients traverse the entire spectrum. Interventions potentially modifying the effect of anorexia-cachexia differ according to stages. Patients are often inappropriately recommended extreme types of nutritional support according to the stage of cancer and extent of the metabolic syndrome. Patients also experience messages that force them to adhere to therapies that are no longer appropriate for the stage of anorexia-cachexia. From presenters with diverse backgrounds in oncology, nursing, cachexia research, and community palliative care, and through didactics, case presentations, and audience participation, the session will accomplish four major goals for the attendees: (1) enhance knowledge of the basic pathophysiology of the anorexia-cachexia syndrome, (2) improve clinical assessment of anorexia-cachexia with a focus on clinical bedside assessment and
Vol. 49 No. 2 February 2015
technological advances, (3) characterize interventions according to stage of anorexia-cachexia, and (4) develop attendees’ skills at communicating with patients and families about cancer and nutrition. When this session is completed, palliative care specialists will walk away better equipped to participate in complex nutritional decision making for cancer patients.
Palliative Care in the Seriously Mentally Ill (FR452) Leslie Blatt, MSN APRN, Yale New Haven Hospital, North Branford, CT. Susan Crawford, MSW, Yale New Haven Hospital, Rocky Hill, CT. Objectives Discuss existing literature on the integration of palliative care into care of people with mental illness. Discuss strategies that the practitioner can incorporate into practice to assist the seriously mentally ill in navigating the healthcare system, maintaining a therapeutic relationship with the patient, and helping staff cope with the person’s behavior. The seriously mentally ill (SMI) remain an underserved population in palliative care. The relationship between SMI and poor physical health is well documented. SMI have double the risk of dying from natural causes at any given age than the general population. They are at a higher risk of death from comorbid conditions such as cancer, cardiovascular disease, and respiratory and gastrointestinal illness, leading to an average reduced life expectancy of 815 years. Individuals with a psychiatric disorder are at increased risk for having a comorbid substance abuse disorder. The 2009 Survey on Drug Use and Health found that 26% of all persons with mental illness meet the criteria for substance disorder. This is even higher in patients diagnosed with schizophrenia and bipolar disorder. Engaging people with co-occurring disorders in treatment can be extremely difficult. Psychiatric patients often deny their mental and physical illnesses. Physical illness, especially cancer, compounded with mental illness can be extremely challenging for both patient and provider. Using a case-based approach, we will explore the interdisciplinary approach to assisting this population into treatment, helping them navigate the healthcare system and continuity of care. The case will focus on strategies that the practitioner can incorporate into practice to address behavioral issues that may arise, advance care planning and decision making, and collaboration with mental health specialists to ensure that pain and other symptoms are controlled.