FROM START TO FINISH: AN INTEGRATIVE ONCOLOGY CASE STUDY. Tanya Wells

Transcription

1 FROM START TO FINISH: AN INTEGRATIVE ONCOLOGY CASE STUDY. Tanya Wells

2 Patient Background Background: 62 yo female Anne Generally well and fit exercises 3-4/7 Pesco-vegetarian diet, alcohol (red wine) 3/7 Ex smoker (30/day for 30 years) quit 12 years ago Past History Non Hodgkins Lymphoma Melanoma (cheek) Currently mild Rheumatoid Arthritis on both hands

3 Consultation 1: 14 th Sept 2011 She felt a lump in the shower in L breast 6 weeks ago GP/radiologist: 10 mammograms 2 Ultrasounds 9 biopsies Diagnosis: invasive ductal carcinoma, infiltrating lobular carcinoma: oestrogen dependant. Current Oncologist recommending mastectomy with removal of all axillary lymph nodes, then chemotherapy and/or radiotherapy, and finally reconstruction in 12 months. Surgery is scheduled for the following Monday: Anne is in shock and unsure of her options. Discussed surgery options recommended a 2 nd opinion.

4 Consultation 2: 19 th Oct 2011 Saw new surgeon at Cabrini/Alfred. As suggested, Anne had a biopsy of the sentinel node: all clear. Long discussion regarding reconstructive surgery options. Current URTI with cough herbal mix

5 Consultation 3: 2 nd November 2011 Date set for surgery: 21 st November. Worried that mastectomy + reconstruction = 14 hr surgery. Very concerned about the prospect of having a general anaesthetic she had never had one before. Suggested further appt with surgeon and anaesthetist in order to ask her list of questions. Contact initiated with surgeon/oncologist and Anne started taking customised perioperative nutritional formula and fish oil.

6 Background Reading

7 Glutamine

8 Peri- and Postoperative nutrition: Heys et al

9 Heys, Walker and Smith:

10 Key phrase: Immunonutrition Perioperative nutrition appears to be more important than postoperative nutrition. Glutamine: essential amino acid that is fuel for lymphocytes, repairs and protects mucosal tissue and enhances immune function. (Estivariz et al (2008) J.Parenteral and Enteral Nutrition 32(4) ) Zinc: participates in the regulation of a wide range of immune functions, including T-lymphocytes, CD4 cells and NK cells, and supports Th1-dependant cellular immune activity. (Mizock & Sriram (2011) Expert Rev. Clin. Immunol. 7(1) 1-3)

11 Key phrase: Immunonutrition Omega-3 fatty acids: alter the phospholipid content of the cell membrane, and shift the balance of leukotriene and prostaglandin production to less inflammatory and less immunosuppressive mediators. Recent attention has also focused on the synergistic interaction of Omega-3 fatty acids from fish oil and arginine to modulate immune function after surgery. Luiking et al (2004) Crit Care Med 32(10)

12 Arginine: a key immunonutrient. Arginine, an essential amino acid, stimulates tissue regeneration, T-cell proliferation, IL-2 production, NK cell cytotoxic effects & produces nitric oxide to improve macrophage effects and bactericidal activity. Following surgery, arginine improves wound healing and protects against infection and ischemiareperfusion tissue injury by restoring macrophage function and lymphocyte responsiveness. (Waitzberg et al 2006)

13 Perioperative nutritional support:

14 Arginine: essential postoperative nutrient.

15 US Perioperative Formulas: Arginine Content.

16 Pre- and Postoperative Nutritional Formula: Customised formulas allow multiple nutrients and amino acids to be supplemented at relatively high doses. A customised formula for this patient consisted of a multivitamin base with the following nutraceuticals added (daily doses): Glutamine 3000mg Vitamin C 3000mg L-Arginine 6000mg Vitamin E (mixed tocopherols) 400IU Zinc piccolinate 50mg Beta Carotene 3000IU Co-Enzyme Q10 300mg Folic acid 3000mcg

17 Base formula: Vitamin A 2500 IU Chromium piccolinate 200 mcg Vitamin B1 5 mg Ferrous gluconate 25 mg Vitamin B2 (R-5-P) 20 mg Folic acid 500 mcg Vitamin B3 25 mg Folinic acid 100 mcg Vitamin B5 25 mg Magnesium glycinate 200mg Vitamin C 1500 mg Molybdenum 25 mcg Vitamin D3 200 IU P-5-P 10mg Vitamin E (mixed 100 IU Selenomethionine 80 mcg tocopherols) Cyanocobalamin 200 mcg Zinc picolinate 30mg Beta Carotene 5000 IU Manganese 5 mg Biotin 150 mcg Boron 1 mg Calcium citrate 400 mg

18 Post-Surgery Bedside Consultation: 23 rd November 2011 Checked on her recovery from surgery: Mastectomy and reconstruction went well. Continuation of post-operative nutritional formula. Rash present (anaesthetic ADR) 17 th January 2012: Call received from surgeon: He was very surprised about her accelerated healing rate and requested a copy of the post-surgery nutritional formula and supporting documentation.

19 Final Consultation: 19 th Jan 2012 Physical recovery has been outstanding. Finished nutritional powder the previous week. Oncologist recommended Arimidex 1mg daily for 5 years has given her 1 month to think about it. Long talk about her realisation of what has just happened (delayed response) time for readjustment of priorities and values. Referred to psychologist for change support.