Devita, Hellman, and Rosenberg's Cancer

LWBK1006-45 LWW-Govindan-Review December 13, 2011 15:32

Chapter 45•Supportive Care and Quality of Life 571

Answer 45.23. The answer is A.

Loss of excess of 10% of baseline body weight over 6 months is defined

as critical weight loss.

Answer 45.24. The answer is D.

Cancer cachexia is a complex process, mediated by the induction of

inflammatory response to the tumor. The hallmark of cancer cachexia is

increased catabolism and limited anabolism. This includes an increase in

hepatic gluconeogenesis to compensate for increased body glucose con-

sumption. Lipoprotein lipase activity is decreased, and fat breakdown

is increased. Muscle proteolysis and hepatic protein synthesis are both

increased as well.

Answer 45.25. The answer is C.

Taxanes and depression are associated with dysgeusia and zinc may work

best for sweet dysgeusia. The best tolerated food is the one that can be

swallowed with little chewing and little production of saliva.

Answer 45.26. The answer is D.

TPN is not indicated in patients with rapidly progressive tumor growth

that is unresponsive to therapy, terminally ill patients, and patients with

mild malnourishment. Brief, inpatient TPN is indicated in severely mal-

nourished patients who are responding to chemotherapy and in whom

gastrointestinal or other toxicities preclude adequate enteral intake for

7 to 10 days or longer.

Answer 45.27. The answer is C.

Megestrol acetate improves body weight in cancer patients mainly due to

water retention. Both erythropoietin and recombinant growth factor may

promote tumor growth.

Answer 45.28. The answer is A.

Even though a few small studies, including a well-known study by Spiegel

in 1989, reported improved survival, more recent studies, including a

large multicenter trial, did not confirm these results. However, every

well-conducted study of psychotherapy in patients with cancer improved

quality of life or reduced stress. A study by Goodwin in patients with

metastatic breast cancer showed decreased pain scores, reduced depres-

sion, and overall reduced distress.

Answer 45.29. The answer is D.

There are several indications for corticosteroids in the management of

pain including neuropathic pain, bone pain, headaches due to increased

cranial pressure, and pain associated with capsular expansion or duct

obstruction.