Nutrition and the Cancer Patient

Nutrition, appetite, and involuntary weight loss are issues that affect a large number of cancer patients and cancer survivors. Aspects such as symptom management, behavioural modification, exercise and medication are all important aspects of cancer care, but nutritional issues at the end of life can be accompanied by contentious ethical factors as well as religious and cultural influences that need to be addressed by health professionals. This book enables physicians, nurses and also dieticians to better discuss these complex issues with patients and their families.

This comprehensive reference book provides both background information and practical, clinical advice for managing the cancer patient at all stages of their disease trajectory. It includes information that relates to patients who are continuing to receive disease-specific therapy, the cancer survivor, as well as patients with advanced or recurrent cancer receiving palliative care.

Basic principles such as epidemiology and physiology set the scene, leading into the cachexia/anorexia syndrome, treatment options, nutritional counselling, enteral and parenteral nutrition, complementary/alternative therapies, exercise, clinical outcomes measures in each of the clinical groups, and focus on special populations and their specific needs. Multidimensional, interdisciplinary clinical evaluation and treatment is emphasised, and ethical, religious, and cultural factors are also addressed.

Multidisciplinary in nature, this book draws on the experience of the editors' work across the fields of oncology, palliative care, surgery, primary care, nursing, dietetics and nutritional science. It will prove invaluable to all general practitioners, internists, medical oncologists and surgeons, nurses, palliative care specialists and related professionals involved in the care of the cancer patient.

After medical school at the University of the Witwatersrand, South Africa, Egidio Del Fabbro completed his residency in Internal Medicine at Barnes Jewish Hospital, St. Louis in 1998. Following 5 years of internal medicine practice he completed a palliative care fellowship at MD Anderson Cancer Center. In his current position as Assistant Professor in the Palliative Care and Rehabilitation department and co-director of the Cachexia clinic at MD Anderson the goal is to increase the awareness of conditions affecting the quality of life of cancer patients such as poor appetite, fatigue and testosterone deficiency. He is the Principal Investigator of two prospective clinical intervention trials including melatonin for appetite in patients with cancer and multimodality therapy for cachexia. He is funded by the American Cancer Society to explore the effect of testosterone replacement in male patients with advanced cancer and serves on scientific committees at national and international conferences.

Eduardo Bruera, MD, is Chair of the Department of Palliative Care and Rehabilitation Medicine and holds the F. T. McGraw Chair in the Treatment of Cancer at The University of Texas M. D. Anderson Cancer Center in Houston, Texas. Dr. Bruera is Vice President of the International Association of Hospice and Palliative Care. He is a member of the editorial board of several pain, palliative care, and cancer journals. He has received a number of national and international awards for his clinical and research commitment to the management of pain and other symptoms. Dr. Bruera's research has focused on clinical trials of pain and other symptoms, and health services research regarding supportive and palliative care.

Dr Demark-Wahnefried is a nutrition scientist whose research spans basic science studies focused on determining the role of food-related components on cancer progression, to clinical research that involves nutrition-related concerns of cancer patients, as well as determining effective lifestyle interventions that improve the overall health of cancer survivors and their families. Her laboratory has conducted some of the largest studies exploring metabolic and body composition changes in response to cancer treatment. In 2003 she was named Komen Professor of Survivorship for her work in energy balance and breast cancer. An area of research in which she has particular expertise is in the delivery of home-based lifestyle interventions, where she has led and continues to lead several NIH-funded trials to improve the diet and exercise behaviors of cancer survivors. She also has actively contributed to national guidelines for cancer survivors (e.g., Institute of Medicine and the American Cancer Society).

Dr Bowling qualified at St Bartholomew's Medical School, University of London, in 1986. After a variety of junior posts, he was appointed as a research fellow with Professor David Silk at the Central Middlesex Hospital. For his MD thesis he looked at the in vivo human colonic responses to intragastric and intraduodenal enteral feeding. For this work he was awarded the Sir David Cuthbertson Research Medal. In 1996 he was appointed as a Consultant in Gastroenterology at the University Hospital of North Staffordshire. He started a multidisciplinary nutrition support team, which introduced various innovative practices, that have since been copied by many other UK hospital teams. In 2003 he took up his current post in Nottingham as a Gastroenterologist and running a regional intestinal failure unit. He is clinical lead for nutrition at the Nottingham University Hospitals and leads the nutrition support team.

Jane Hopkinson is a Macmillan Post Doctoral Research Fellow, who specialises in the study of supportive and palliative care for people with cancer. She is a nurse who worked clinically in the fields of cancer and palliative care prior to becoming a full-time academic seven years ago. Since 2002, her research has been investigating the problems of living with weight loss and eating difficulties for people with advanced cancer and their families. The purpose of this programme of research is to develop innovative ways of supporting people living with cancer cachexia syndrome. She regularly speaks about her work at both national and international meetings, in addition to publishing on the subject.

Dr Vickie E. Baracos' research program on muscle and protein metabolism spans two decades and is related to different physiologic and pathologic states where muscle protein growth or wasting occur, including cancer, chemotherapy, sepsis, injury, diabetes, diet, environmental stress and lactation.