August 19, 2019 by Peter B. Laird
Cancer and Nutrition: ‘Individualized Approach’ is Key
For people with cancer and cancer survivors, nutrition is a crucial but often underestimated part of treatment and ongoing patient care.
Both the disease and cancer treatments can affect the body’s capacity to tolerate foods and absorb nutrients. However, a basic approach to nutrition cannot address the complex and varied needs of patients experiencing different types of cancer, stages of the disease and treatments. Enter the oncology nutritionist.
These nutrition specialists are trained to assess and provide nutritional interventions, looking at the needs of patients individually, said Claudia Ferri, a registered dietitian specializing in oncology nutrition at Miami Cancer Institute. This evidence-based use of “food as medicine,” she said, is an integral part of treatment and recovery.
“There’s no one type of nutritional approach that fits everybody,” Ms. Ferri said. “The key is an individualized approach. It has to be patient-centered.”
A new study published this month has confirmed the impact of a healthy diet on lower one’s risk of developing some types of cancers. The researchers evaluated seven poor dietary factors: a low intake of vegetables, fruits, whole grains and dairy products and a high intake of processed meats, red meats and sugary beverages, such as soda. They found that an estimated 80,110 new cancer cases in U.S. adults 20 and older in 2015 were linked to eating a poor diet.
Once someone has been diagnosed with cancer and then undergoes treatment, proper nutrition plays a vital role in recovery.
Addressing Challenges of Cancer Treatments
Dietitians certified in oncology nutrition work with specialists to develop a treatment plan for cancer patients. The plan addresses patient challenges during treatment which may be surgical, infusion (chemotherapy), radiation or a combination. The right combination of foods can improve patients’ recovery and help them maintain good health and a sense of well-being.
“If you have a patient who has just been diagnosed with stage four lung cancer, they would have increased calorie needs because they have a hypermetabolic disease where they’re going to be burning more calories than the average person who doesn’t have cancer,” Ms. Ferri said. “Those patients need more calories and protein, because their metabolism works faster.”
Patients undergoing radiation also need more protein, she said, to repair affected tissue. Pancreatic cancer patients may not be able to tolerate fat. A treatment plan would include decreased fat intake or enzymes to help them absorb fat.
Certain Foods for Managing Symptoms
In addition to focusing on helping patients heal, she said, specific foods are used to better manage nausea and vomiting (acidic fruits, such as mandarin oranges and grapes) and many other symptoms that cancer patients experience during the course of treatment.
“Depending on the treatment, we manage symptoms,” Ms. Ferri said. For example, patients who are treated for head and neck cancer with radiation have trouble swallowing. Their production of saliva decreases resulting in dry mouth and difficulty chewing.
Dietitians modify the texture of the diet to puree/liquid for better tolerance Some patients might require a feeding tube. Calories, proteins and liquids are calculated to ensure the patient meets energy needs.
The impact of cancer of the stomach and the treatment may result in gastrectomy, removal of part or all of the stomach. These patients need smaller meals and less fiber, she said.
Balanced Diets with a Focus on Protein
“The majority of patients who have a cancer diagnosis are more prone to lose weight due to the different treatment-related side effects that cause them to eat less,” Ms. Ferri said. “We encourage them to have a balanced diet and focus on animal or plant-based protein to prevent muscle wasting as well as vegetable, fruits, whole grains and healthy fats.”
Dietitians use a malnutrition screening tool to detect the reason for weight loss, which could be poor appetite or due to a functional impairment.
For patients in Miami Cancer Institute’s survivorship program, the focus turns to maintaining good health.
Dietitians also help patients address weight gain following treatment. Some breast cancer patients tend to gain weight during and after treatment. With these patients, dietitians combine motivational counseling and nutritional education.
“We set goals to help them lose weight in a healthy way,” Ms. Ferri said. “That’s why we promote a whole foods (unprocessed), plant-based diet, high in anti-inflammatory foods.”
No Such Thing as ‘Superfoods’
The focus is on healthy eating and exercise that addresses the patient’s needs.
“We don’t give people diets,” Ms. Ferri said. “Some people say ‘You’re a nutritionist, give me a diet.’ It doesn’t work that way.”
And while the concept of “superfoods” has been popularized, Ms. Ferri said, there is no such thing.
“No food will have miracle effects on your body,” she said. “No food will have all of the ingredients that you need. The emphasis is on a balanced diet and having a variety mainly from non-starchy vegetables and fruits. The more colors you see on your plate the better.”
An important part of the dietitian’s role is supporting and motivating the patient, she said.
“The important thing is that they feel they are doing something to improve their health,” Ms. Ferri said. “We are giving them that little push that they need. Some patients come with many goals that may not be very realistic. To motivate them we need to set realistic goals, and we have to help them through this disease. It can be very challenging for some patients. We’re there for them.”