NUTRITION IN CANCER

Nutrition plays a vital role in maintaining the health of cancer patients, especially those undergoing treatment and those in recovery. Yet despite advances in cancer treatment, the healthcare industry continues to see malnutrition compromising patient outcomes, impacting the efficacy of treatment, and affecting quality of life.

An informative webinar titled Nutrition During Cancer Treatment: Evidence and Impact of Intervention, presented by Board Certified Specialist in Oncology and Adult Nutrition, Dr. Kathryn Allen, delved into evidence linking nutrition to the outcome of cancer treatment. It then unpacked some practical intervention strategies that healthcare professionals (HCPs) can employ when working with cancer treatment and management in patients.

The Challenge of Malnutrition: Then and Now

A landmark article published by Dr. Charles Butterworth in 1974 brought to light some of the basic causes of malnutrition in cancer patients. These included elements like failure to record patient weight and height during hospitalisation and withholding meals for diagnostic procedures.

Decades later, and the healthcare industry still finds itself faced with some of these challenges. A 2014 study estimated that disease-related malnutrition affected 25–60% of hospitalised patients upon admission, with oncology patients having the highest prevalence at 65%.

Weight Loss and Clinical Outcomes

Unplanned weight loss (also known as Involuntary Weight Loss or IWL) is regularly associated with cancer patients, leading to detrimental effects on their health and quality of life, going so far as reducing survival rates across cancer types.

An ECOG study on IWL, published by the Journal of Clinical Oncology in 2000, revealed that across 3 047 patients undergoing chemotherapy for advanced cancer, weight loss greater than 5% in the six months prior to starting chemotherapy was a strong indicator that individuals wouldn’t respond as well to the therapy due to an already-compromised immune system. Effects included:

• Shorter survival
• Decreased response to treatment
• Increased toxicity
• Lower quality of life

Studies on adult patients undergoing radiation therapy also saw lower tolerance to the therapy when individuals did not follow an adequately nutritional diet.

The Functional Consequences of Lean Tissue Loss

One of the most significant effects of involuntary weight loss is losing lean muscle tissue, which happens in both skeletal and smooth muscle loss. This can cause a cascade of systemic failures in the patient’s body, from functional decline and impaired organ function to a weakened immune system. It also directly impacts a patient’s ability to tolerate and respond to cancer treatment.

Managing Nutrition Impact Symptoms

One of the biggest issues we are seeing is a big gap in nutrition counselling. Cancer patients are simply not getting the information they need to understand nutrition and cancer. This includes how to manage their nutritional health in relation to side effects of both the disease and its treatment, and the role of nutrition for cancer recovery.

Patients can experience anything from a decrease in appetite, to nausea and vomiting; changes in their sense of taste (dysgeusia), to dry mouth syndrome (xerostomia). Trying to bring the right mix of, and enough, nutrients into the body to keep it functioning well can see the patient losing weight unintentionally which can be detrimental to their health and wellbeing.

HCPs can support patients by crafting a chemo nutrition diet, which prioritises calorie and protein intake and incorporates protective, anti-inflammatory foods. It’s also important that patients are aware of safety in food after chemotherapy – ensuring foods are washed thoroughly, and are not raw or undercooked.

Strategies to Manage Nutrition: Diet and Cancer

There are various strategies that HCPs can use to ensure that patients are getting enough nutrition. These include enteral nutrition (tube feeding), sufficient electrolyte and prebiotic levels during diarrhoea, and adequate hydration.

Healthy cancer fighting foods

While no single food can prevent or cure cancer, a dietary pattern rich in certain foods can significantly reduce the risk of developing cancer and supporting health during treatment. This diet can include:

• Cruciferous, leafy green, and allium vegetables
• Berries and dark-skinned fruits
• Tomatoes
• Turmeric
• Wholegrains, legumes, nuts and seeds

There are many other foods to eat during cancer, treatment, but a patient may not always be able to include all of them. Incorporating dietary supplements in the diet can support areas where a patient isn’t getting sufficient nutrients.

Mental and Emotional Factors Also Impact Nutrition

Anxiety, depression, memory impairment, and losing the desire to continue living can all impact a cancer patient’s food and beverage consumption. Some strategies to aid cancer patients include:

•    Integrate mental health support with nutritional counselling
•    Implement a structured eating schedule that’s easy to follow
•    Reframe nutritional goals to be orientated around comfort and pleasure

Nutrition and Immune Function

Nutrition is vital to support immune function, if cancer patients aren’t following an optimal diet, they could face issues in the gut, impaired neutrophil function, impaired immune and inflammatory response, and a lack of nucleotides that are important for DNA repair.

To support immunonutrition, cancer patients need to consume sufficient calories, protein, amino acids, fatty acids, and nucleotides. This is how HCPs can support patients:

• Advise patients on foods they can eat if they have cancer, as well as food fortification techniques. These can include adding protein powders and healthy fats to meals, and incorporating omega-3-rich foods like fatty fish. These are some of the top cancer fighting foods.
• Prescribe specialised nutrition supplements formulated for immunonutrition to deliver a concentrated dose of key nutrients efficiently.