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Istanbul

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Britt-Marie Bernhardson

on 17 October 2016

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Transcript of Istanbul

Britt-Marie Bernhardson
RN, PhD,
Karolinska Institutet,
Department of Learning, Informatics, Management and Ethics
Stockholm, Sweden

Challenges related to symptoms that impact on eating
Thank you for listening
A reference list can be found at the podium
“Hard when people
don't understand"
“I can’t eat”
“I forced myself to eat”

“Have to think about what is possible to eat"
“Life has changed”
“No interest in food”
“Retching just from
the sight of food”
“The week after the treatment
I didn’t want to eat anything”
”No taste, no hunger, no appetite”
“It’s up and down did not want to talk about food, could desire a food but when it come to the
table, I couldn’t eat”
“Everything tastes the same …
I started vomiting and couldn't eat”
Food intake
Symptoms and quality of life
Functional status
Weight – BMI (Body mass index)
Body composition
Systemic inflammation (CRP)

Symptoms impacting on eating
Anorexia
Early satiety
Nausea / vomiting
Taste and smell alterations
Mouth problems
Xerostomia
Stomatitis
Dysphagia

Fatigue
Depression
Poor sleep
Pain
"To eat is boring"
Interventions
Do health care staff discuss weight loss with the patients and their families?
Appetite
anorexia
stomatitis
dry mouth
dyspnea
fatigue
taste and smell alterations
depression
pain
poor sleep
dysphagia
constipation
diarrhea
nausea
vomiting
early satiety
delayed gastric emptying
Do health care staff underestimate
patients symptoms?
Malnutrition
Starvation
Cachexia
Body composition
Dual energy x-ray imaging (DEXA)
Computer tomography (CT-scans)
Magnetic resonance imaging (MRI)
What to measure to be able to distinguish between starvation and cachexia
Bioelectrical impedance analysis (BIA)
Anthropometry
We may be underestimating the patients symptoms and nutritional status
We need to measure symptoms and nutritional status with an instrument that is reliable and suited for the purpose
We have to take action and both talk about weight loss with the patients and their families and observe their status
Differentiate between starvation and the three stages of cachexia
Give advices regarding nutrient intake and exercise
In the end of life discuss ethical issues regarding food intake
Conclusion
“I had to force myself to have more than a bite of my lunch, it didn’t taste good to me”
Do health care staff underestimate
patient's symptom intensity or burden?
Symtom som påverkar ätandet
Viktnedgång
Påverkan på behandlingen
Nedsatt respons på behandling
Lägre aktivitetsnivå
Påverkad livskvalitet
Kortare överlevnad
(Dry mouth)
(Difficulties swallowing)
"Nothing taste good anymore"
Pre-cachexia
- early clinical and metabolic signs, anorexia - weight loss

- Prevent weight loss
- Increase food intake
Cachexia
- systemic inflammation and metabolic changes.

- Treat metabolic changes with anti-inflammatory or cancer treatment
- Physical exercise to minimize atrophy and catabolism
- Increase food intake
Refractory-cachexia
- rapidly progressive cancer

- Discuss ethical issues regarding nutritional support
Karolinska Institutet
Karolinska University
Hospital
Stockholm, Sweden
Full transcript