1. What clinically significant alterations in metabolism occur in animals with cancer cachexia? Dogs and cats with cancer have significant alterations in carbohydrate, lipid and protein metabolism that can result in cancer cachexia. These alterations in metabolism have the potential to decrease quality of life, reduce response to therapy and shorten survival times.
2. How can knowledge about the metabolic alterations in metabolism change the way you use nutrition to treat your cancer patients? While the ideal anticancer diet is not known, research to date would suggest that any nutritional support is better than none. Normal feeding practices should begin early before evidence of cachexia are noted, and plans should be designed to support the patient when voluntary feeding is not optimum. In addition, the following guidelines may be considered early for each patient:
a. Arm clients with appropriate information, dietary plans and appetite stimulants such as cyproheptadine and megesterol acetate from the very beginning. The goal is to prevent anorexia and weight loss from ever happening.
b. Consider foods that are highly bioavailable, easily digested, and highly palatable with a good smell and taste
c. Consider foods that are relatively low in simple carbohydrates, moderate amounts of good quality sources of proteins and soluble and insoluble fiber, and moderate amounts of fats; fats of the n-3 fatty acid series may be effective in reducing or eliminating some of the metabolic alterations associated with cancer cachexia. Antioxidants are essential whenever n-3 fatty acids are used. Hills prescription diet nd is one good example.
d. Enhanced quantities of arginine, cystine and glutamine may be of value in maintaining a more normal immune, hematologic and gastrointestinal tract.
e. Fiber, both soluble and insoluble, is essential to maintain normal bowel health. A diet with adequate amounts of fiber is essential to prevent or to treat various problems of the gastrointestinal tract.
3. Does surgery, chemotherapy or cancer increase or decrease the energy needs and the amount you should feed your patient? Each patient should be assessed as an individual and the nutritional profile, including the amount to be fed should be prescribed for each animal on a daily basis based on reassessments. As a general rule, with the exception of septic animals, dogs and cats with cancer, critical care illnesses, or that are recovering from surgery do not have energy needs that exceed those of normal animals. A formula that approximates the need for many animals with cancer in a resting state is as follows: 1.1[30(wt in kg) + 70]= kcals required per day.
4. Are there any data on the efficacy of the nutrients my clients constantly ask me about: vitamins, minerals, proteases, enzymes, garlic, tea and shark cartilage? What nutrients should you feed your cancer patient? Data exist demonstrating that many antioxidants, minerals, proteases, garlic, enzymes, and tea all have some potential for reducing the risk of cancer, or the growth and metastases of established malignant diseases. Research must be done to establish ideal dosages, and optimum applications of these nutrients. The lay press and word of mouth can bypass the presence of any research data demonstrating efficacy as it has for shark cartilage. To date, little if any data exist demonstrating that shark cartilage is effective for treating spontaneously occurring cancer in an outbred species. Despite this lack of proof, the public does believe that shark cartilage does have some efficacy.
5. What are the indications for intervening aggressively with appetite stimulants, tube feeding or total parenteral feeding for your cancer patients? For maximum benefit, intervention should begin early in the course of the disease. The owner must have a clear plan for dietary intervention beginning first with the choice of nutrients, followed by appetite stimulants, and then on to feeding tubes for those patients that cannot or will not support themselves.