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Pneumonitis

Rosemarie Biancardi

Breast Cancer Statistics


Second leading cause of death among women
1 in 8 women will develop breast cancer in their
lifetime
Breast cancer mortality has decreased by 36%
from 1989 -2012

Breast Cancer Types


21 histologic subtypes
4 molecular subtypes
o HR+/ HR
o HER2+/HER2 HR+ / HER2 is the most common diagnosed
breast cancer
HR-/ HER2- accounts for 12% of all breast cancer
diagnoses

Breast Cancer Statistics in


African American women
Black women have a lower incidence of
breast cancer compared to non-Hispanic
white women
Non-Hispanic Black women have the
highest mortality
Have higher rates of triple negative (HR-/
HER2-)
More likely to be diagnosed at a later
stage

Breast Cancer Statistics in


African American women
Incidence rates are increasing in African
American women
Increase in ER+ breast cancer
o Obesity

Mortality is higher among African American


women
o
o
o
o
o
o

Mammogram quality
Delayed follow up
Insurance coverage
Cancer subtype
Stage of cancer
Access quality treatments

Pneumonitis
Taxanes: Taxal or parlitaxel
o Microtubule stabilizing agents
Mechanism is cancer cells: destabilizing
of microtubule lattice during cell
division

Radiation Recall
Pneumonitis
A reaction that can occur when irradiated
pulmonary tissue has a reaction to a triggering
agent (chemo).
Common symptoms
o
o
o
o
o
o

Dyspnea
Shortness of breath
Low grade fever
Cough
ground glass opacity
Infiltrates in lungs

Radiation Recall
Pneumonitis
Mechanism behind chemotherapy induced
pneumonitis is unknown
No relationship between duration of chemotherapy
and occurrence
Reactions are usually more sever if time between
radiation and the beginning of chemotherapy are short

31 cases using Taxanes


o 35% needed intubation with ventilation support
o 82% of the cases on a vent died.

Meet the patient


The patient is a 48 year old African
American Female being treated for
Taxol induced Pneumonitis

Patient History
Stage IV ER/PR positive breast cancer with bone
mets.
Palliative radiation for bone mets.
Endocrine therapy (Faslodex and Ibrance)
Chemotherapy (Taxol) since February 2016
Compression fracture to spine (kyphoplasty)
Hyperglycemia
Right mastectomy
Hypertension
Hypercholesterolemia

Anthropometrics
163.56cm or 5 feet 4 inches
Initial weight 75.8kg or 166.8lbs
BMI 28
Adjusted body weight 62.3kg or 131.7lbs
Patents weight range: 66.8kg (146lbs) - 85.7kg
(188lbs)

Labs

Nutrition Related
Medications

IV Vancomycin, zosyn, ceftriaxone


Lyrica
Solumedrol
Lantus/ Humalog
Propofol
Nimbex

Reglan
Fentanyl
Levophed (Norepinephrine)
Acyclovir

Tests and Procedures

Intubation/ Extubation
X-rays
Chest CT
Bronchoscopy
Tracheotomy
Blood transfusion
Video swallow study

Nutrition Diagnosis
Inadequate oral intake related to inability to take
PO and increased metabolic needs as evidenced
by NPO/ need for nutrition support and metastatic
breast cancer.
Altered nutrition related lab values (glucose)
related to endocrine dysfunction as evidenced by
elevated blood glucose with no diabetes history.

Complications
Sedation and vent needed due to respiratory
distress
Health care associated pneumonia
Herpes Zoster on right leg
High Blood glucose levels
Iatrogenic right pneumothorax
Tracheostomy
C-Diff
Sinusitis

Estimated Energy Needs


1,558-1744 kcals (25-28kcal/kg )
75-87g protein (1.2-1.4g/kg)
1558-1700ml fluid

Nutrition Intervention
Nutrition support
o Jevity 1.5
o Vital HP
o Promod
o Glucerna 1.5
o Clinimix 5%/15% and 150ml lipids

Monitor and Evaluation


Blood Glucose levels
Propofol rate
Enteral feeding tolerance

Day to day Medical plans that would effect


nutrition

References
http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid= 507554
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statistics, 2015: Convergence of incidence rates between black and white women:
Breast Cancer Statistics, 2015. CA: A Cancer Journal for Clinicians. 2016;66:31-42.
2. CamachoRivera M, Kalwar T, Sanmugarajah J, Shapira I, Taioli E. Heterogeneity of
Breast Cancer Clinical Characteristics and Outcome in US Black WomenEffect of Place
of Birth. The Breast Journal. 2014;20:489-495.
3. Alushin GM, Lander GC, Kellogg EH, Zhang R, Baker D, Nogales E. High-resolution
microtubule structures reveal the structural transitions in -tubulin upon GTP
hydrolysis. Cell. 2014;157:1117-1129.
4. Ding X, Ji W, Li J, Zhang X, Wang L. Radiation recall pneumonitis induced by
chemotherapy after thoracic radiotherapy for lung cancer. Radiation oncology (London,
England). 2011;6:24-24.
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2012;18:311-315.
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