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56 today's Veterinary Practice July/August 2014 tvpjournal.com r ead Practical Approaches to Feeding the Cancer Patient, page 51, for further information on feeding dogs and cats with cancer. Visit tvpjournal.com/resources.asp#resources for the table, Feeding Guidelines Based on Nutritional Status for Dogs & Cats with Cancer, which provides detailed information on: • Clinical assessment (step 1) • specific feeding guidelines (steps 2–4, 6, 7) • suggested feeding approaches (step 5) • Practical recommendations (step 7). in-CliniC FOrM Korinn E. Saker, MS, DVM, PhD, Diplomate ACVN North Carolina State University Step by Step: Feeding the Pet with Cancer 1. Assess the pet to determine nutritional status: Well-nour- ished, borderline malnourished, or significantly malnour- ished. 2. Determine current caloric intake and daily calorie needs of pet based on nutritional status: • Assess current daily calorie intake: using the reported caloric density (kcal/can, kcal/8-ounce cup, kcal/gram of diet) of the commercial diet being offered, calculate the actual daily calorie intake based on amount (cans, cups, grams) of diet consumed each day. • Calculate resting energy requirement (rer) based on pet's current or optimal body weight (BW): rer (kcal Me/day) = (bwkg) 0.75 × 70 • Calculate daily energy requirement (Der, a mathemati- cal equation with variables based on nutritional status): der (kcal Me/day) = rer × predetermined numerical factor (Table). • Compare actual daily caloric intake to daily calories required (Der). 3. Determine dietary fat and protein levels (low, moderate, high; see Table 4, page 54) based on current or planned treatment regime and comorbidities, such as renal, hepatic, or pancreatic disease. 4. Determine required supplemental nutrients based on anticancer therapy. • No treatment: Consider immediate dietary supple- mentation of omega-3 fatty acids and antioxidants (AoX). • Surgery: if intestinal surgery, consider immediate glu- tamine supplementation; following any surgery, delay omega-3 fatty acid supplementation for 3 to 4 days. 1,2 • Chemotherapy: Prior to therapy, consider probiotic supplementation; during therapy, appetite stimulants and omega-3 fatty acid supplementation. Do not supplement with AoX until chemotherapy regime is completed. • Radiation: same as chemotherapy. 5. Identify appropriate feeding method to ensure ade- quate rer/Der intake: • Voluntary only • Voluntary + enteric assisted • enteric assisted only • Parenteral ± enteric assisted. 6. Choose appropriate diet based on appropriate nutri- ent levels, supplemental nutrients, and feeding method. 7. Discuss feeding plan with pet caregiver: • identify food choices or options. • Calculate daily feeding dose based on daily caloric goal (rer to Der at current or optimal BW). • Determine feeding frequency. • set monitoring parameters and follow-up schedule. AoX = antioxidants; BCs = body condition score; BW = body weight; BWkg = body weight in kilograms; Der = daily energy requirement; Me = metabolizable energy; rer = resting energy requirement References 1. Mooney Ma, vaughn dM, reinhart Ga, et al. evaluation of the effects of omega-3 fatty acid-containing diets on the inflammatory stage of wound healing in dogs. Am J Vet Res 1998; 59(7):859-863. 2. harris wS. expert opinion: Omega-3 fatty acids and bleeding—cause for concern? Am J Cardiol 2007; 99:44C-46C. tABle. Predetermined Numerical Factors for Calculating Der NUTRITIONAL STATUS NUMERICAL FACTOR a Canine Feline Well Nourished BCs 4–6 (current BW) b BCs > 6 (ideal BW) c 1.6 1–1.2 1.2 0.8–1 Borderline Malnourished 1.6–2.5 1.2–2 Significantly Malnourished 1.6–3 1.3–2.5 a. numerical factor varies depending on nutritional status and signalment (adult life stage) b. Calculate based on current bw c. Calculate based on ideal bw