Use of Pro-Cal shot in Upper GI Cancer | Case Study

Medical: Cerebrovascular accident, hypertension, hiatus hernia & atrial fibrillation.

Surgical: Transhiatal oesophagectomy (2014) without adjuvant chemotherapy, bypass for recurrent small bowel disease (2015).

Results of tests/investigations: CT scan following 4 cycles of palliative chemotherapy – no evidence of bowel obstruction or peritoneal disease for a further 2 cycles.

Medications: Unknown.

Reason for referral: Dietetic referral as standard for UGI cancer undergoing oncological treatment.

Anthropometry:

🟥 Pre-Assessment

🟩 Initial Assessment

🟪 Follow Up

% Weight loss:

29% between Nov 2014 and Nov 2015

Biochemistry:

Bloods: ↓Hb but Na⁺, K⁺, PO_4- Urea, Creatinine, Corrected Calcium all within normal range. Checked in November 2015, February and March 2016.

Clinical:

Unplanned weight loss of 29% over 1 year, due to oesophagectomy-related dietary restrictions:

• Difficulty eating high fat food
• Early satiety
• Feels as if food is getting stuck in chest

In addition to poor appetite and occasional nausea due to chemotherapy.

Dietary:

Patient had minimal concern over weight loss as now a healthy BMI (previously obese). Appetite and oral intake significantly reduced following surgery and due to side effects of chemotherapy. Estimated oral intake: 1000kcals & 40g protein.

Estimated Requirements:

Energy: (10.2 x 53.1kg + 572) x (PAL 1.4) + (0-20% SF) = 1559kcals-1782kcals (Henry, 2005).

Protein: (0.17-0.2g) x 53.1kg x 6.25 = 56-66g (ASPEN, 2002).

Fluid: 30 x 53.1kg = 1593mls

Initial assessment (Nov 2015):

Neutral powdered supplement made up with whole milk od + low volume lipid emulsion mixed in glass of milk tds was recommended to improve nutritional status and prevent further weight loss.

Patient tried but disliked ready-to-drink milkshake-style oral nutritional supplement (ONS) following surgery.

Outpatient clinic (end of Nov 2015):

Pre-1st chemotherapy cycle: patient disliked neutral powdered supplements and preferred to take lipid emulsion mixed with lemon curd tds.

Inpatient (Dec 2015):

During 1st chemotherapy cycle: lipid emulsion poorly tolerated (taken od only).

Outpatient clinic (Feb 2016):

Pre-cycle 4: prescribed strawberry Procal shot^® 40ml tds.

Outpatient clinic (March 2016):

Pre-cycle 6: increased Pro-Cal shot to 6 x 40ml shots/day.

Follow up (April 2016):

Dietary difficulties continue but following advice and taking Pro-Cal shot 40ml tds.

Patient completed 6 cycles of chemotherapy and showed no evidence of peritoneal disease.

Compliance & tolerance: Complied with recommended amount of Pro-Cal shot (6 x 40ml) and tolerated well throughout chemotherapy.

Ongoing monitoring: Nutritional status and weight maintained with current advice.

• Flavour and texture well-tolerated
• Helped aid weight maintenance through improved compliance

• High energy, low volume ONS are beneficial for patients with side effects of oesophagectomy.

Manufacturers typical dose (4 x 30ml/day) not the maximum dose all patients' can manage/tolerate.

1. ASPEN Board of Directors and the Clinical Guidelines Task Force. (2002). Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients. Journal of Parenteral and Enteral Nutrition 26 (11).
2. Henry, C.J. (2005). Basal metabolic rate studies in humans: measurement and development of new equations. Public Health Nutrition, 8(7A) 1133-1152.