Helping Patients to Navigate Dietary Choices

February 11, 2009

As difficult as treatments are for many cancer patients, another difficult time awaits them at the conclusion of therapy. Until that point, patients have become accustomed to the fleeting comfort of regularly scheduled appointments for diagnostic testing, chemotherapy and/or radiation treatments, and ongoing contact with health care professionals. Conclusion of treatment can seem abrupt and the absence of attention can be unsettling for many. It is at this point that patients often ask, “What can I do now to help myself?”

This article reviews the following: Nutrition During and After Cancer Therapy

 

 

As difficult as treatments are for many cancer patients, another difficult time awaits them at the conclusion of therapy. Until that point, patients have become accustomed to the fleeting comfort of regularly scheduled appointments for diagnostic testing, chemotherapy and/or radiation treatments, and ongoing contact with health care professionals. Conclusion of treatment can seem abrupt and the absence of attention can be unsettling for many. It is at this point that patients often ask, “What can I do now to help myself?” This may represent, as the authors eloquently put it, the “teachable moment” at which diet and exercise are two options within patients’ control that may offer protection against recurrences of their cancers, or comorbid conditions such as heart disease. The article by Barrera and Demark-Wahnefried provides a valuable framework for understanding what diet, exercise, and behavioral modification can offer.

During treatment, the goal may be as basic as maintaining one’s weight during the rigors of chemotherapy and/or radiation. Poor appetite is common with certain cancers and their treatment regimens. The pursuit of an ideal plant-based diet may not be possible owing to the side effects of chemotherapy or radiation, or post-surgical concerns. As the authors note, advising patients to take smaller meals more often and eat calorie-rich foods is a helpful recommendation.

Add to that simple menu suggestions such as soups, stews, and casseroles with added plant fats such as olive or canola oil and you can enhance calories and deliver them in meals that connote comfort. Memorial Sloan-Kettering Cancer Center employs a staff of clinical dietitians who offer diet counseling for poor appetite and other side effects that impact diet. For health care settings without clinical dietitians on staff, referral to the American Dietetic Association is an excellent recommendation from the authors.

The effects of overweight and obesity on the risk for certain cancers and on disease-specific and overall survival are becoming more established. That certain cancers and their treatment regimens can lead to weight gain for certain patients makes weight management a critical post-treatment concern. The problem that presents itself is what diet method to employ; this is exacerbated by the sheer volume of diet books available to the consumer and the seeming inconsistencies between dietary recommendations, even in the scientific literature.[1] Calorie restriction and increased energy expenditure are clearly desirable, but from the perspective of diet the feasibility and efficacy of calorie counting are debatable.

A specifically tailored calorie-restricted diet will produce weight loss, but in this reviewer’s experience it is rarely adhered to in the long run. Portion control with an emphasis on high-fiber plant-based foods, with known disease-preventing components, combined with a limiting of refined carbohydrates, alcohol, and sources of animal fat may offer a more reasonable and doable approach. Fortunately the plethora of recent research documenting the benefits of the Mediterranean diet for weight management and disease prevention offers a viable and more enjoyable alternative.[1–3] The role of fat in cancer prevention is debatable but as the Mediterranean diet demonstrates, it may be more a matter of what type of fat is ingested-animal or plant-that is important. As for supplements, and antioxidants in particular, their concurrent use with chemotherapy and/or radiation raises concerns of interference with treatment, tumor protection, and decreased survival, but is still a matter of continuing debate and research.[4]

Overall this article is a valuable review of some of the options available for patients after their treatment has concluded and as they enter survivorship. Tables 1, 2, and 3 provide very useful general guidelines and sources of further information. Ideally, diet, exercise, and behavioral modification should be intertwined, and nurses are an important starting point for appropriate recommendations and/or referrals.

 

References:

1. Shai I, Schwarzfuchs D, Henkin Y, et al: Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359(3):229–241, 2008.
2. Benetou V, Trichopoulou A, Orfanos P, et al: Conformity to traditional Mediterranean diet and cancer incidence: The Greek EPIC cohort. Br J Cancer 99(1):191–195, 2008.
3. Sofi F, Cesari F, Abbate R, et al: Adherence to Mediterranean diet and health status: Meta-analysis. BMJ 337:a1344. doi: 10.1136/bmj.a134. Sep 11, 2008.
4. Lawenda BD, Kelly KM, Ladas EJ, et al: Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? J Natl Cancer Inst 100(11):773–783, 2008.