Reference no: EM133958951

Question

Mrs. Sim is 61-year old female referred to the outpatient Registered Dietitian at the oncology clinic during her regular clinic visit. She was diagnosed with breast cancer-Stage IIB Invasive Ductal Carcinoma T2N1miM0 18 months previously. She was treated with a mastectomy followed by radiation and chemotherapy. She received chemotherapy with Docetaxel, doxorubicin, and cyclophosphamide every three weeks for six cycles. This was followed with radiation therapy to the chest wall. She has completed treatment and most recently completed reconstructive surgery.

Height: 5'5" Weight: 175 lbs

Onset of disease: Dx: Stage IIB Invasive Ductal Carcinoma T2N1miM0
Medical history: Type 2 DM
Surgical history: s/p Hysterectomy, s/p R mastectomy, s/p deep inferior epigastric perforator flap reconstructive surgery 6 weeks ago
Medications at home: metformin
Tobacco use: none
Alcohol use: 1-2 x per week-white and red wine
Family history: Mother and sister-breast cancer; father-diabetes, CHD

General: Patient reports that her usual weight prior to breast cancer diagnosis was 195 lbs. She experienced loss of appetite, nausea, vomiting, diarrhea, and mucositis during chemo treatments. She also states that she had extreme fatigue throughout both chemo and radiation. She states that she is feeling much better and appetite "unfortunately" has returned to normal. She admits that she is glad she has lost weight and would like to continue to lose weight--|I know that this will keep me healthier". Mrs. Sim is interested in changing her diet to try and keep her cancer from coming back and wants advice on how to do this. She has considered becoming a vegetarian and wonders if this will be a good thing for her. She is not exercising yet due to the recent reconstructive surgery but would like to start something besides just walking -which she does every day with her dogs. She walks her golden retrievers twice a day for about 1⁄2 mile each time.

24 hour recall:
AM: 1 c coffee (brewed black)
Cheerios-1 c 1⁄2 c fresh strawberries
Almond milk-1 c
Snack: 2 c coffee (brewed black)
Granola bar
Lunch: Tuna salad-made with egg and mayonnaise-3/4 c in a fresh tomato
20 wheat thins eaten with tuna salad
1 can diet cola
PM: 8 oz filet mignon grilled
1 large baked potato with 2 tbsp butter, salt, and pepper:
Dinner salad with ranch-style dressing (3 tbsp)-lettuce, spinach, croutons, sliced cucumber 1 glass of Riesling white wine (~ 6 oz)

HS snack: 1 glass of Riesling white wine (~6 oz)-3 oz cheese and ~ 10 wheat thin crackers Food allergies/intolerances/aversions: none known Food nutrition therapy? Yes, several years ago at local diabetes association-attended diabetes classes

Food purchase/preparation: Spouse and self Vit/min intake: multivitamin/mineral daily.

1. What are Mrs. Sim's risk factors for developing breast cancer? Explain potential genetic and environmental risk factors.

2. Explain Mrs. Sim's diagnosis: Stage IIB Invasive Ductal Carcinoma T2N1miM0.

Specifically discuss the type of breast cancer and the staging of her diagnosis.

3. She was treated with Docetaxel, Doxorubicin, and Cyclophosphamide chemotherapy regimen. What are these medications and how do they work?

4. Mrs. Sim was also treated with radiation therapy. What is the basic mechanism of using radiation therapy as a component of treatment for breast cancer?

5. What are the major side effects of her chemotherapy and radiation therapy?

6. Mrs. Sim recently underwent reconstructive surgery. She had the deep inferior epigastric perforator (DIEP) flap reconstructive procedure. Describe this procedure.

7. Assess Mrs. Sim's height and weight. Calculate her BMI and % UBW.

8. Identify any abnormal biochemical indices and discuss the probably underlying etiology.

9. Determine Mrs.Sim's energy and protein requirements. Explain the rationale for the method you used to calculate these requirements.

10. Identify three major changes in Mrs. Sim's dietary intake that would be consistent with cancer prevention and survivorship guidelines, allow for continued weight loss and support the care of her Type 2 Diabetes.