Medical Nutrition Therapy Guidelines for Cancer in Adults 
                                     Working Group Committee
           Chairperson:                                   Secretary:
           Tah Pei Chien                                  Wan Li Yin
           DieƟ Ɵ an                                      Lecturer
           DieteƟ c Dept.                                 Health Professionals and Food Service Dept.
           University Malaya Medical Centre               Management and Science University
           Members:
           Ng Gaik Lian                                   Celeste Lau Wai Hong
           DieƟ Ɵ an                                      DieƟ Ɵ an
           DieteƟ c Dept.                                 DieteƟ cs & NutriƟ on Services
           University Malaya Medical Centre               Sunway Medical Centre
            
           Nurhidayah binƟ  Mohamad Som                   Nur Suraiya binƟ  Abu Hassan Shaari
           DieƟ Ɵ an                                      DieƟ Ɵ an
           DieteƟ c & Food Services Dept.                 NutriƟ on & Food Services Dept.
           Hospital Kuala Lumpur                          NCI Hospital
           Mohd Firdaus bin Nazri Shaharuddin             Zalina binƟ  Abu Zaid
           DieƟ Ɵ an                                      Lecturer
           DieteƟ c & Food Services Dept.                 Dept of NutriƟ on & DieteƟ cs
           Hospital Kuala Lumpur                          Faculty of Medicines & Health Sciences
                                                          UniversiƟ  Putra Malaysia
           Nurshariza binƟ  A. Aziz
           DieƟ Ɵ an                                      SiƟ  Shafurah binƟ  Abas
           DieteƟ c & Food Services Dept.                 Lecturer
           University Kebangsaan Malaysia                 NutriƟ on & DieteƟ c Dept.
           Medical Centre                                 UITM Shah Alam
           Reviewers 
           Puan Lee Lai Fun                              Prof Madya Dr Zalilah Mohd Shariff 
           Adjunct Senior Lecturer                       Deputy Dean (Academic-Health Sciences)
           NutriƟ on & DieteƟ cs Department              Faculty of Medicine and Health Sciences
           InternaƟ onal Medical University              University Putra Malaysia
           Puan NoriaƟ  binƟ  Ujang                      Dr. Lee Wei Ching
           Head                                          Department of Radiotherapy & Oncology
           DieteƟ c and Food Services Department         Hospital Kuala Lumpur
           Hospital Serdang
           Dr. Marniza binƟ  Saad                        Puan Rosszai@Rozi Ibrahim
           Senior Lecturer and Oncologist                Ketua Jururawat (Nursing Sister)
           Oncology Clinical Unit                        Oncology Clinical Unit
           University Malaya Medical Centre              University Malaya Medical Centre
           Acknowledgement
           We would like to extend out graƟ tude and appreciaƟ on to the following for their contribuƟ ons:
           • DieteƟ c Department of University Malaya Medical Centre for the use of the meeƟ ng room
           •    The Peer Reviewers for their Ɵ me and professional experƟ se 
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       Medical Nutrition Therapy Guidelines for Cancer in Adults 
                Working Group Committee
     Standing (leŌ  to right): 
     Gaik Lian, Nur Suraiya, SiƟ  Shafurah, Li Yin, Mohd Firdaus
     Siƫ  ng (leŌ  to right): 
     Celeste Lau, Nurhidayah, Nurshariza, Pei Chien, Zalina
                        ii
                                                   Contents
          LIST OF WORKING GROUP & REVIEWERS
          ACKNOWLEDGEMENT
           1       IntroducƟ on                                                                  2
           2       ObjecƟ ve of NutriƟ on Management                                             2
           3       List of AbbreviaƟ on                                                          3
           4       NutriƟ on Screening and NCP Flow Chart                                        5
           5       NutriƟ on Screening                                                           6
           6       NutriƟ on Assessment                                                          7
           7       Energy Requirement EsƟ maƟ on                                                 9
           8       Protein Requirement                                                           12
           9       Age Specifi c Fluid Requirement                                                12
           10      Micronutrient Requirement                                                     13
           11      EPA Requirement                                                               13
           12      NutriƟ on Diagnosis                                                           14
           13      Algorithm of NutriƟ onal Support for Cancer PaƟ ents                          20
           14      NutriƟ on IntervenƟ on                                                        20
           15      Sample Menu                                                                   28
           16      NutriƟ on EducaƟ on / Counselling                                             31
           17      CoordinaƟ on of Care                                                          41
           18      Physical AcƟ vity and Cancer                                                  42
           19      NutriƟ on Monitoring & EvaluaƟ on                                             44
           20      NutriƟ on and Cancer Resources for Health Care Professionals                  55
           References                                                                            50
          LIST OF TABLES
           Table 1          Evidence Statement of NutriƟ on Screening                            6
           Table 2          NutriƟ on Assessment Criteria                                        7
           Table 3          Formulas for CalculaƟ on of Energy Requirement                       9
           Table 4          EsƟ maƟ ng Daily Protein Needs in Cancer PaƟ ents                    12
           Table 5          EsƟ maƟ ng Fluid Needs in Cancer PaƟ ents                            12
           Table 6          Common NutriƟ on Diagnosis for Cancer PaƟ ents                       14
           Table 7          Summary of Major NutriƟ on RecommendaƟ ons and Evidence Level        21
           Table 8          Sample Menu of 1500 kcal and modifi caƟ on to increase calories to    28
                            1800 kcal & 2000 kcal
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                                                   Contents
           Table 9          Examples of modifi caƟ on for diff erent food groups                   30
           Table 10         Surgery and Related NutriƟ on Impact Symptoms                        31
           Table 11         Systemic Therapy and Related NutriƟ on Impact Symptoms               33
           Table 12         RadiaƟ on and Related NutriƟ on Impact Symptoms                      34
           Table 13         Tips for Managing NutriƟ on Impact Symptoms                          35
           Table 14         Benefi ts of CoordinaƟ on of Care                                     41
           Table 15         Physical AcƟ vity in Cancer PaƟ ents                                 42
           Table 16         ContraindicaƟ ons and RecommendaƟ ons for Physical AcƟ vity in       43
                            Cancer paƟ ents
           Table 17         NutriƟ on Monitoring & EvaluaƟ on in Cancer PaƟ ents                 44
          LIST OF FIGURES
           Figure 1         NutriƟ on Screening and NCP Flow Chart                               5
           Figure 2         Algorithm of NutriƟ onal Support for Cancer PaƟ ents                 20
          LIST OF APPENDICES
           Appendix 1       The MalnutriƟ on Screening Tool                                      58
           Appendix 2       The scored PaƟ ent Generated SubjecƟ ve Global Assessment            59
                            (PG-SGA)  
           Appendix 3       SubjecƟ ve Global Assessment                                         61
           Appendix 4       Karnofsky Performance Scale                                          62
           Appendix 5       The European OrganisaƟ on for Research and Treatment of Cancer       63
                            Care QoL QuesƟ onnaire (EORTC QLQ-C30)
           Appendix 6       Oral NutriƟ onal Supplement and Enteral Formula ComposiƟ on          65
           Appendix 7       Commonly Used Drug and Dietary Supplement InteracƟ on                67
           Appendix 8       Five categories of T&CM according to NACCM (The NaƟ onal Center      70
                            for Complementary and AlternaƟ ve Medicine)
           Appendix 9       Biologically Based Therapies                                         72
           Appendix 10      NutriƟ on (Diet) and Metabolic Therapies                             74
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