Nutrition Therapy on Cutaneous Lymphoma Patient with Anemia and Hypoalbuminemia: A Case Report


Fitri Tyas
Suryani As'ad
Asrini Safitri
Aryanti Bamahry


Nutrition is a part of cancer management during therapy, recovery, remission, and recurrence prevention. Malnutrition and cachexia often occur in cancer patients and influence morbidity, mortality, and quality of life, especially in the advanced stage of malignancy. We reported a case of cutaneous lymphoma with anemia and hypoalbuminemia in the terminal condition. This case report focuses on nutritional therapy and palliative care on nutrition. We reported a case of a 40-year-old-man with Cutaneous Lymphoma (CL) and moderate protein-energy malnutrition that was developed to severe protein-energy malnutrition due to difficulty in dietary access. He had an eating problem because of multiple tumors and ulcers on his mouth. We provided access for parenteral nutrition from Central Venous Catheter (CVC) and orogastric tube (OGT) for enteral feeding. Even though the dietary target was never accomplished, there was a slight recovery on hypoalbuminemia and renal function during hospitalization. This case showed a considerable challenge in nutritional therapy due to limited dietary access. Since death was inevitable, we have tried different dietary access to provide adequate intake.



1. Wilcox, R. A. Cutaneous T-cell lymphoma: 2017 update on diagnosis, risk-stratification, and management. Am. J. Hematol. 92, 1085–1102 (2017).
2. Bagherani, N. & Smoller, B. R. An overview of cutaneous T cell lymphomas [version 1; referees: 2 approved]. F1000Research 5, (2016).
3. Ardinal, A. P., Wiramihardja, S. & Wijaya, I. Malnutrition in Non-Hodgkin Lymphoma Patients at Dr. Hasan Sadikin General Hospital Bandung. Althea Med. J. 6, 7–12 (2019).
4. Wiegert, E. V. M., Padilha, P. D. C. & Peres, W. A. F. Performance of Patient-Generated Subjective Global Assessment (PG-SGA) in Patients with Advanced Cancer in Palliative Care. Nutr. Clin. Pract. 32, 675–681 (2017).
5. Arends, J. et al. ESPEN guidelines on nutrition in cancer patients. Clin. Nutr. 36, 11–48 (2017).
6. Marischa, dkk. Malnutrisi Pada Pasien Kanker. J. Medula 7, 107–111 (2017).
7. Prawira, Y. Pedoman Nasional Pelayanan Kedokteran : Tata Laksana Malnutrisi Dewasa - Perhimpunan Dokter Spesialis Gizi Klinik Indonesia. SSRN Electron. J. 5, 1–19 (2019).
8. Komite Penanggulangan Kanker Nasional. Panduan Penatalaksanaan LIMFOMA non Hodgkin’s. Kementrian Kesehat. Republik Indones. 1–38 (2016) doi:Artn 72080s\rDoi 10.1117/12.809886.
9. Glaspy, J. Update on Safety of ESAs in Cancer-Induced Anemia. JNCCN J. Natl. Compr. Cancer Netw. 10, 659–667 (2012).
10. Madeddu, C. et al. Pathogenesis and treatment options of cancer related anemia: Perspective for a targeted mechanism-based approach. Front. Physiol. 9, 1–20 (2018).
11. Wiciński, M. et al. Anemia of Chronic Diseases: Wider Diagnostics-Better Treatment? Nutrients 12, 1–17 (2020).
12. Liu, C. M. et al. Research progress on the relationship between zinc deficiency, related microRNAs, and esophageal carcinoma. Thorac. Cancer 8, 549–557 (2017).
13. Mikirova, N. A., Casciari, J. J., Hunninghake, R. E. & Riordan, N. H. Intravenous ascorbic acid protocol for cancer patients: scientific rationale, pharmacology, and clinical experience. Funct. Foods Heal. Dis. 3, 344 (2013).
14. Klimant, E., Wright, H., Rubin, D., Seely, D. & Markman, M. Intravenous vitamin C in the supportive care of cancer patients: A review and rational approach. Curr. Oncol. 25, 139–148 (2018).
15. Abdelhaleim, A. F., Amer, A. Y. & Abdo Soliman, J. S. Association of Zinc Deficiency with Iron Deficiency Anemia and its Symptoms: Results from a Case-control Study. Cureus (2019) doi:10.7759/cureus.3811.
16. Skrajnowska, D. & Bobrowska-Korczak, B. Role of zinc in immune system and anti-cancer defense mechanisms. Nutrients 11, (2019).
17. Doldo, E. et al. Vitamin A, cancer treatment and prevention: The new role of cellular retinol binding proteins. Biomed Res. Int. 2015, (2015).
18. Zinder, R., Cooley, R., Vlad, L. G. & Molnar, J. A. Vitamin A and Wound Healing. Nutr. Clin. Pract. 34, 839–849 (2019).
19. Polcz, M. E. & Barbul, A. The Role of Vitamin A in Wound Healing. Nutr. Clin. Pract. 34, 695–700 (2019).
20. Moores, J. Vitamin C: a wound healing perspective. (2013).
21. Susanti, M., Widjaja, S. S. & Siregar, D. R. Pengaruh Vitamin D terhadap Indeks Apoptosis pada Penderita Kanker Payudara. J. Kesehat. Andalas 7, 182 (2018).
22. Mahmood, A. Tuberculosis and vitamin D deficiency. Pakistan J. Med. Heal. Sci. 7, 16–17 (2013).
23. Resistance, D., Ayelign, B., Workneh, M., Molla, M. D. & Dessie, G. Role Of Vitamin-D Supplementation In TB / HIV Co-Infected Patients. (2020).