Nutrition
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Immunostimulation by anticancer cytotoxic drugs is needed for long-term therapeutic success. Activation of dendritic cells (DCs) is crucial to obtain effective and long-lasting anticancer T-cell mediated immunity. The aim of this study was to explore the effect of capsaicin-mediated cell death of bladder cancer cells on the activation of human monocyte-derived CD1a+ immature DCs. ⋯ Our data show that CPS-mediated cancer cell apoptosis activates DCs via CD91, suggesting CPS as an attractive candidate for cancer therapy.
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Elderly cancer patients account for a growing part of home artificial nutrition patients. Long-term enteral or parenteral nutrition in the older patient with cancer is prescribed for sequels after treatment (dysphagia, intestinal failure) or for bowel obstruction. Home artificial nutrition should benefit from a specialized follow-up. For patients out of therapy, the goal of nutritional care is to optimize quality of life and comfort.
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Intensive individualized nutritional counseling requires nutrition professionals with specific experience in oncology. If the patient is unable to achieve his or her nutritional requirements via regular foods, nutritional supplements may be prescribed, the composition of which is based on detection of dietary deficits as well as a detailed intake questionnaire. Any nutritional intervention must be based on the need for an adequate intake and also must take into consideration other relevant factors such as digestive and absorptive capacity, the need for alleviation or arrest of symptoms, and any psychological issues.
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Parenteral nutrition may be considered when oral intake and/or enteral nutrition are not sufficient to maintain nutritional status and the patient is likely to die sooner from starvation than from the cancer. A detailed assessment should be made prior to the decision about whether parenteral nutrition should be started. A follow up plan should be documented with objective and patient centred treatment goals as well as specific time points for evaluation.
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Cancer in the geriatric population is a growing problem. Malnutrition is common in cancer. A number of factors increase the risk for malnutrition in older people with cancer, including chronic comorbid conditions and normal physiological changes of aging. ⋯ To contribute to the improvement of nutritional support of these patients, nurses need appropriate training to be able to identify risk for malnutrition and offer a range of interventions tailored to individual need. Factors to consider in tailoring interventions include disease status, cancer site, cancer treatment, comorbidity, physiological age, method of facilitating dietary change, and family support. This article identifies ways in which nurses can contribute to the nutritional support of older cancer patients and thus help mitigate the effects of malnutrition.