Cachexia and anorexia in malignancy.

The cancer cachexia syndrome may be present in up to 80% of patients with cancer. Malnutrition resulting from cancer cachexia is a significant cause of morbidity and mortality. Anorexia, tissue wasting, and weight loss appear to be the result of metabolic abnormalities caused by host cytokine production in response to the tumor. The host cytokines include TNF-alpha, IL-1, IL-6, IFN-gamma, and D-factor. Nutritional support in the patient with cancer has been controversial, with the belief that tumor growth may be augmented; however, human studies fail to confirm that tumor growth occurs in excess of normal tissue growth. The efficacy of nutritional support in the cancer has not been adequately studied. Considerable interest exists in providing nutritional support pharmacologically to modify the response to malignancy.

Nutritional support: pharmacists' influence on the prescribing process.

A commitment was made at a 1,025-bed county teaching facility to increase staff pharmacists' involvement in nutritional support and physician prescribing. The plan was to utilize the Nutritional Support Clinical Pharmacy Specialist (NSCPS) to train the staff pharmacists to provide direct patient care for patients receiving parenteral nutrition. The implementation included specialized training for staff pharmacists, staff pharmacists monitoring all parenteral nutrition patients, pharmacists' attendance at nutritional support rounds, documentation of all pharmacist interventions, and pharmacists' involvement in the drug-usage evaluation (DUE) process. The results of the increased influence of pharmacists on the prescribing process included more appropriate parenteral nutrition therapy, earlier transitioning from parenteral to enteral nutrition, recognition of staff pharmacists as resources by the physicians, and increased job satisfaction for pharmacists.

Documentation of clinical interventions in nutritional support.

The implementation of this documentation system has been a success. The SPF pharmacists' participation has been excellent. All of the original objectives have been met. The results collected have been responsible for more than validating the clinical functions of the pharmacists. They have been used to create CQI indicators, improve the work flow in the IV room, and enhance the evaluation process. The pharmacists work as a team to ensure that all interventions are documented. The results obtained, including numbers and trends, are reported on a monthly basis to the NSCPS, the sterile product formulation manager, and the director of Pharmacy Services. Although the documentation is considered to be a requirement for the pharmacists, they are continually encouraged through constant feedback from the managers. This feedback included individual recognition for exceptional interventions and reports of the impact of the interventions on pharmacy service. The biggest problem with the present system was the time-consuming task of entering the data into the Paradox computer database. This will soon be resolved by the implementation of a bar code system to automate this process. The pharmacists will be able to document the information from the interventions with a hand-held bar code wand. At the end of each day, the information can be automatically downloaded into the Paradox computer database.