Malnutrition Among Cancer Patients

Today article referenced. Good nutrition is important - especially if you are battling cancer. Cancer itself, and cancer treatment, can affect the appetite and how the body digests, absorbs, and uses food. When the body is depleted of essential nutrients, it becomes malnourished. Malnutrition is an epidemic affecting many cancer patients, and is the cause for nearly one in five cancer related deaths in the United States. MALNUTRITION

"Malnutrition is one of the most common - and most serious - side effects of cancer and its treatment. This condition affects up to 80% of patients depending on tumor type and stage, according to NCI, and is responsible for nearly one in five cancer-related deaths." HemOnc Today

David Jennings II, MSN, RN, oncology nurse practitioner at Levine Cancer Institute at Carolinas HealthCare System said, "Malnutrition is very widespread - almost epidemic. Almost everyone I see is either malnourished or at a very high risk for being malnourished. We in the oncology community should be more proactive in identifying and managing at-risk patients." Many oncologists overlook weight loss as an early indicator for malnutrition, which occurs when individuals do not get enough calories or consume the appropriate amount of key nutrients.

"There is a certain level of tolerance," Declan Walsh, MD, Mac, chair of the department of supportive oncology at Levine Cancer Institute, told HemOnc Today. "Clinicials willl say, 'Well, of course you're not eating properly, you have cancer.' In other words it is just accepted as being part of the cancer experience."

Several cancer-related factors contribute to weight loss among patients with cancer: chemotherapy, radiation, tumor location, and stress. Many of these treatments include side effects "such as nausea, vomiting, diarrhea, anorexia, mouth sores, difficulty swallowing, taste changes and poor appetite." These factors can play a huge role in malnutrition.

"Depending upon tumor type, up to 80% of patients with cancer experience significant involuntary weight loss, defined as at least 10% of total body weight lost within 6 months. This often is associated with treatment interruption, infections, hospital readmission and early mortality." Journal of Oral and Maxillofacial Pathology.

Dr. Rachael Lopez, MPH, RD, clinical research dietician for surgical oncology and cancer immunotherapy at the NIH Clinical Center said, "Malnourished patients are often unable to withstand the rigorous and aggressive treatments that best treat the cancer, and that may mean they have to reduce doses or take breaks from treatment. This ultimately leads to a suboptimal treatment plan, which translates to poor cancer outcomes.” Dr. Lopez goes on to say that "many patients are malnourished because they refuse to eat foods with carbohydrates." LOSS OF MUSCLE TISSUE Lead research in oncology at the University of Alberta, Dr. Vickie Baracos stated that Sarcopenia (loss of muscle tissue as a natural part of the aging process) can occur 10 to 25 times faster among patients who receive chemotherapy or radiation. Patients who require bone marrow transplants can experience even greater losses of muscle mass.

“It’s like aging 10 years in 1 ... one of the big issues is that no action is being taken until the malnutrition gets very bad. Leaving it until then is completely missing the opportunity for effective intervention.” Dr. Vickie Baracos

Before 2007, clinicians often determined malnutrition by a patient’s weight in relation to his or her height. Over the past decade, cancer centers have taken further steps to identify malnutrition by observing caloric intake, body fat, muscle mass, fluid accumulation and grip strength. Patients who undergo stem cell transplants who are at risk for graft-versus-host disease, or those with gastric or esophageal cancer, sometimes require additional interventions. Overall, oncologists, nutritionists and dieticians agree on the need for earlier intervention by nutritionists, as well as the need for increased research funding to study the nutritional needs of patients with cancer.

“We know that patients who have better nutrition tolerate chemotherapy more easily, which leads to improved outcomes,” Dr. David Jennings, Oncology Nurse Practitioner at the Levine Cancer Institute said. “That’s why we frequently collaborate with our dieticians and nutritionists. The first remedy for malnutrition is prevention, and it is too great a task to tackle on our own. It takes a multidisciplinary approach.”

Dietary recommendations and studies often provide inconsistent and conflicting guidance about how to stay nourished during cancer treatments.

“There is so much misinformation out there,” Dr. Rachael Lopez said. “A simple internet search of ‘diet and cancer’ will bring you pages and pages of fad diets that claim to cure cancer or diets recommending expensive supplements that have not been tested. For people searching for their cure [who] want to do everything they possibly can, it is really heartbreaking to see them spend their money on these unresearched supplements or to follow these very restrictive diets that end up making them malnourished.”

While every myeloma patient is different, here are some helpful tips to improve nutrition and maintain a healthy diet. When To Eat: Many patients may find it easier to eat a few small meals throughout the day instead of eating two or three large ones. By doing so, you can keep up your energy and feel less nauseated. Also, keep snacks on hand for when you are hungry. Food You Should Eat: It's important to eat food that will provide your body with the best nutrients.

• Fruits and vegetables - These are full of antioxidants that will help your body rebuild itself (many doctors recommend consuming cooked fruits and veggies).
• Fiber - If you have constipation, add more fiber to your diet. It will help break down food and clear your bowels. (apples, pears, dried fruits, whole grains, oatmeal, broccoli, carrots, nuts and beans)
• Bland Foods - If you're dealing with diarrhea, many doctors recommend eating a low-fiber diet known as BRAT (banana, rice, applesauce, and toast). It's important to also stay hydrated.
• Iron - The cancer cells that build up in the bone marrow may crowd out the health blood cells (possibly causing a shortage of red blood cells, called anemia). If this happens, eat more iron-rich foods like lean meats, beans, and dark leafy greens.
• Vitamins and Minerals - At times, doctor or dietitians may suggest taking a daily supplement to make sure you get enough nutrients. Don't start taking supplements without asking your doctor first.

Multiple myeloma makes your immune system weaker, so it's important to avoid the following foods that may make you sick.

• Raw meat or fish
• Runny eggs
• Unpasteurized drinks
• Sushi
• Unwashed fruits and vegetables

The definition of healthy eating changes throughout a patient’s treatment course. It can be affected by their tolerance of treatments and other chronic conditions, such as high blood pressure, high cholesterol or diabetes. A study by Martin and colleagues — published in 2015 in the Journal of Clinical Oncology — showed that weight-stable patients with a BMI at or above 28 survived nearly five times longer (20.5 months; 95% CI, 17.9-23.9) than those who lost 15% or more of their body weight and recorded a BMI of 22 or less (4.3 months; 95% CI, 4.1-4.6). (Information referenced here) “That paper shows that — regardless of whether your starting body weight is large, medium or small — weight loss is still highly associated with mortality,” Vickie  Baracos, PhD, lead researcher in oncology at the University of Alberta, said. Additionally, Dr. Colin Champ, MD, emphasized the importance of researching how diet impacts survival.

“There are no good randomized studies and there absolutely should be. We should know more about how diet impacts survival. We do not have the answers, but if we are not pushing research in that direction, how are we supposed to get closer to providing answers? If we want to give doctors the right things to say to patients, we have to come up with those answers.” Dr. Colin Champ

Malnutrition is an epidemic in the cancer community. It's a battle worth fighting, and as patients eat right and stay well-nourished, it may help increase their chances of survival.