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Volume 32 Number 4

August 2010

TABLE OF CONTENTS
2	Guest Editor's Perspective Mary Marian, MS, RD, CSO Cancer is the #2 cause of death in the United States and is expected to rise to the top spot worldwide this year. Malnutrition is a significant challenge for both cancer survivors and the clinicians who care for these individuals. However, malnutrition can have two faces: cachexia and obesity. This issue focuses on both issues.
3	Chair's Column Mary Hise, PhD, RD, CNSD Dietitians in Nutrition Support (DNS) is a dynamic practice group designed to help each member position him/herself better as a recognized leader and expert in nutrition support. In 2007, Ainsley Malone, MS, RD, LD, CNSD, and the leadership team within DNS had the vision and forethought to design a strategic plan to ensure that services, education, and opportunities were considered for the long-term clinical practice needs of the nutrition support dietitian. This plan was designed for optimal implementation in 3 to 5 years, beginning in 2008.s
5	Cancer Cachexia: Pathophysiology and Approaches to Management Carolyn M. Matthews, MD, DABOG, DABIHM( Cachexia is a common pathway for many diseases and is prevalent in patients with cancer. This complex inflammatory syndrome involves marked aberrations in cytokines that can lead to dramatic alterations in metabolism. This article reviews the pathophysiology of cachexia and many of the approaches taken to alleviate its clinical consequences.
9	Nutrition Support of Pancreatic Cancer Patients Heidi B. Larson, RD, CSO, CNSD, CD-NHM( Pancreatic cancer can cause unique symptoms that can have an adverse impact on nutritional status. Poor nutritional status can result in poor tolerance of chemotherapy that may necessitate dose reductions. Further, many pancreatic cancer patients present with weight loss and nutritional decline. Supporting proper provision and intake of nutrients during cancer treatment can play an important role in oncology care. This article discusses frequent nutrition challenges that arise from pancreatic cancer and strategies to address nutritional deficiencies.
16	Medical Nutrition Therapies in Head and Neck Cancers Mary Marian, MS, RD, CSO Individuals who have head and neck cancers often present with malnutrition at the time of diagnosis, and such malnutrition frequently is exacerbated with treatment for a number of reasons. Significant weight loss occurs prior to diagnosis, with another 10% loss commonly experienced during anticancer treatments. Nutrition screening and therapy at regular intervals during treatment can prevent significant deteriorations in nutritional status and quality of life. Nutritional status also can be maintained with ongoing nutrition surveillance and intervention. Prophylactic percutaneous gastrostomy feeding tubes commonly are placed endoscopically before initiating radiotherapy to avoid the deleterious complications associated with dysphagia and dehydration and to prevent malnutrition. A variety of enteral formulations are available for use. Overall, nutrition surveillance and individualized nutrition care are associated with less weight loss, fewer interruptions in treatment, and less frequent other complications such as unplanned hospitalizations.
24	Metabolic Syndrome in Long-term Survivors of Childhood Acute Lymphoblastic Leukemia Following Hematopoietic Cell Transplantation Paula Charuhas Macris, MS, RD, FADA, CSO, CDnts

All material appearing in SUPPORT LINE is covered by copyright and may be photocopied or otherwise reproduced for noncommercial scientific or educational purposes only, provided the source is acknowledged. Written consent from the managing editor is required for any other purpose.

Viewpoints and statements in these materials do not necessarily reflect the policies and/or official positions of The American Dietetic Association or DNS.

SUPPORT LINE (ISSN 1067-3768) is published bi-monthly. $60 for individual non-member subscriptions, $120 for institutions per year (plus postage surcharges for international subscriptions). Newsletter subscriptions are available to interested parties who are ineligible for ADA membership. Published by Dietitians in Nutrition Support, a dietetic practice group of The American Dietetic Association (ADA), 120 S. Riverside Plaza, Suite 2000, Chicago, IL 60606. Send requests for subscriptions to Jamie Diamond, MS, RD, CNSD, 3850 Galt Ocean Drive, Apt. 2009, Fort Lauderdale, FL 33308. For address changes: Please submit name and address changes directly to the Membership Team of the American Dietetic Association using the address change card in the Journal of the American Dietetic Association. SUPPORT LINE is indexed in the Cumulative Index to Nursing and Allied Health Literature.

FOR THIS ISSUE:

Editor

Susan Roberts, MS, RD, LD, CNSD
3911 Kramar Court
Arlington, TX 76016
214/820-6751

Managing Editor

Deborah K. Kuhlman
921 N. Western Avenue
Park Ridge, IL 60068
847/692-3407

Associate Editors

Therese Austin, MS, RD, CNSD

Kathy Logan,, MS, RD, CNSD

Associate Editor, Continuing Education:

Neha Parekh, MS, RD, CNSD

Associate Editor, Writer's Mentoring:

Marcia Kalista-Richards, MPH, RD, CNSD

Contributing Editor, Inquire Here:

Gail Cresci, PhD, RD, CNSD

Membership/Subscriptions:

Jamie Diamond, MMS, PA-C, RD

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