ONCOLOGY
defective Cori-cycles which promote the formation of lactate, and furthermore rob the patient
of energy in the form of expenditure required to
correct this very abnormality.
Tumour tissue consumes glucose anaerobically,
leaving a net gain of only 2 moles of ATP, versus
normal metabolism using the Krebs Cycle, which
generate 38 moles of ATP from the same amount
of glucose.1, 5-8
οο Clinical consequence – hyperlactataemia
and metabolic acidosis. This affects the function of almost every body system, enzyme
and membrane by altering the ionisation
and movement of electrolytes, the pKi of enzymes (as proteins their binding to substrate
is specific to a pH and temperature band) and
broader processes such as vascular tone and
muscle and nerve impulse conduction. Hyperlactataemia can suppress appetite, further
worsening cachexia.
BCS is graded 1 to 5, with 2.5 – 3.0 being considered
“normal”, 1 cachexic and 5 grossly obese.
MCS is graded from 0 to 3, with 3 = no wasting, 2 =
mild, 1 = moderate, and 0 = severe.
The nutritional needs assessment
Why is a nutritional assessment necessary?
It appears that the majority of patients presenting to
vets with cancer are in an abnormal body (BCS) or
muscle condition score (MCS).9
It is important to grade BOTH BCS and MCS to have
a fuller appreciation of the patient’s needs. Do this at
each visit, along with the weigh-in and TPR.
For example, a patient may have BCS 4.5 and MCS 1, if
it had a functional adrenocorticotrophic tumour – fat
but with little muscle. Some practical considerations
for such a patient might include:
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•
•
•
•
•
•
Poor wound healing.
Increased infection rate.
Increased friability of the skin.
Fewer sites for safe or comfortable intramuscular
injection.
Poor muscle strength resulting in slower return to
mobility after anaesthesia, and increased risk of
tendon or ligament rupture.
Osteopenia and joint pain from excessive weight
without matching supportive strength.
Easy spread of infection along muscle planes e.g.
injection site reactions.
What would be appropriate here, in this patient?
This is the line of reasoning the vet would need to
pursue, which requires an understanding of metabolic physiology, diet characteristics and so forth.
Another relevant example might be a rostral mandibulectomy for a fibrosarcoma.
• The patient would require a temporary oesophagostomy tube and then transition onto
solid food after 2 weeks.
• The non-nutritive characteristics of the diet are
therefore important. Can it be tube fed? What is
its water content? What is the patient’s water requirement?
• Water intake (in the form of liquidised food) reduces the caloric and nutrient density of the diet.
Is this taken into account?
• What is the patient’s stomach capacity?
• An adult cat can tolerate 300ml of stomach
fluid given over 10+ minutes.
• A dog of 15kg can tolerate 450ml; a dog of
55kg+ up to 3L over the same period.
Never feed a sick animal >5% of its body weight at a
time if it has not eaten properly in over 3 days; transition it back with small, frequent meals. For dogs
undergoing chemotherapy, the prophylactic use of
antiemetics (maropitant, ondansetron, metaclopramide) before therapy, and feeding on the morning of
chemotherapy, helps offset catabolism from repeated
and extended periods of hyporexia some drugs cause.
Diet Selection
In general, aim for a diet with:
• A high quality protein at 35 – 45% DMB (dog) or
40 – 50% (cat) which is readily available and diverse in amino acid profile
• Low readily-soluble carbohydrates (<25%), but dietary fibre of 2.5%+
• Fats 25 – 40%, with ω3 fatty acids >5%
Adjust this according to comorbidities e.g. chronic
kidney disease, joint disease. Avoid excessive antioxidant supplementation directly before or during radiation therapy, as this reduces the efficacy of treatment.
Some suitable diets of various manufacturers have
been graphically represented as examples of diets you
can use in SA. This list is not all-inclusive. (Fig 1)
NEVER use raw meats or unwashed vegetables in patients with cancer as they have less tolerance to the
myriad of potential parasites and infections carried in
unprocessed food, which also has NO improvements
in digestibility or nutrient profile over premium ingredient, quality-assured commercial diets. Client compliance with recipes provided for home cooked diets
is also abysmally poor; it cannot be recommended at
all.10-16
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