Nutrition in Cancer Care

Cancer and cancer treatments may cause nutrition-related side effects. Diet is an important part of cancer treatment. Eating the right kinds of foods before, during, and after treatment can help the patient feel better and stay stronger. To ensure proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients (vitamins, minerals, protein, carbohydrates, fat, and water). Symptoms that interfere with eating include anorexia, nausea, vomiting, diarrhoea, constipation, mouth sores, trouble with swallowing, and pain. Appetite, taste, smell, and the ability to eat enough food or absorb the nutrients from food may be affected. Malnutrition (lack of key nutrients) can result, causing the patient to be weak, tired, and unable to resist infections or withstand cancer therapies. Eating too little protein and calories is the most common nutrition problem facing many cancer patients. Protein and calories are important for healing, fighting infection, and providing energy.

Common causes of malnutrition in cancer patients.

Anorexia – Some patients may have anorexia when they are diagnosed with cancer. Almost all patients who have widespread cancer will develop anorexia.

Cachexia – is a wasting syndrome that causes weakness and a loss of weight, fat, and muscle. It commonly occurs in patients with tumours of the lung, pancreas, and upper gastrointestinal tract.

Effect of Cancer on Nutrition

Cancer can change the way the body uses food.

Tumours may produce chemicals that change the way the body uses certain nutrients. The body’s use of protein, carbohydrates, and fat may be affected, especially by tumours of the stomach or intestines.

Drugs may help relieve cancer symptoms and side effects that cause weight loss.

Early treatment of cancer symptoms and side effects that affect eating and cause weight loss is important. Both nutrition therapy and drugs can help the patient maintain a healthy weight.

Effect of Cancer Treatment on Nutrition

Effect of Surgery on Nutrition

Surgery increases the body’s need for nutrients and energy. The body needs extra energy and nutrients to heal wounds, fight infection, and recover from surgery. If the patient is malnourished before surgery, there may be complications during recovery, such as poor healing or infection.

Effect of Chemotherapy on Nutrition

Chemotherapy may affect the whole body.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Because chemotherapy targets rapidly dividing cells, healthy cells that normally grow and divide rapidly may also be affected by the cancer treatments. These include cells in the mouth and digestive tract.

Effect of Bone Marrow and Stem Cell Transplantation on Nutrition

Bone marrow and stem cell transplant patients have special nutritional needs. Bone marrow and stem cell transplantation are methods of replacing blood-forming cells destroyed by cancer treatment with high doses of chemotherapy or radiation therapy. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen for storage. After the chemotherapy and radiation therapy are completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the body’s blood cells. Chemotherapy, radiation therapy, and medications used in the transplant process may cause side effects that prevent a patient from eating and digesting food as usual.

The benefits and risks of nutrition support vary for each patient.

Decisions about using nutrition support should be made with the following considerations:

• Will quality of life be improved?
• Do the possible benefits outweigh the risks and costs?
• Is there an advanced directive? An advanced directive is a written instruction about the provision of health care or power of attorney in the event an individual can no longer make his or her wishes known.
• What are the wishes and needs of the family?

Cancer patients and their caregivers have the right to make informed decisions. The healthcare team, with guidance from a registered dietitian, should inform patients and their caregivers about the benefits and risks of using nutrition support in advanced disease. In most cases, the risks outweigh the benefits. However, for someone who still has good quality of life but also physical barriers to achieving adequate food and water by mouth, enteral feedings may be appropriate. Parenteral support is not usually appropriate. Advantages and disadvantages of enteral nutrition include the following:

Current guidelines for promoting general health and well-being include the following:

• Eat nutrient-rich foods within calorie limits.
• Maintain a healthy body weight.
• Exercise regularly.
• Eat a variety of fruits, vegetables, whole grains, and low-fat dairy products each day.
• Eat less fat and avoid trans fatty acid (trans fats).
• Choose fiber-rich fruits, vegetables, and whole grains often.
• Eat fewer foods high in salt. Choose more foods high in potassium (like bananas, spinach and potatoes).
• Those who choose to drink alcoholic beverages should do so in moderation. Certain individuals should avoid alcohol entirely.
• Keep food safety in mind when preparing, storing, and serving foods.

Cancer Prevention

Healthy food choices and physical activity may help reduce the risk of cancer. The American Cancer Society and the American Institute for Cancer Research have both developed cancer prevention guidelines that are similar.

The following diet and fitness guidelines may help reduce the risk of cancer:

• Eat a plant-based diet. Eat at least 5 servings of fruit and vegetables daily. Include beans in the diet and eat grain products (such as cereals, breads, and pasta) several times daily.
• Choose foods low in fat.
• Choose foods low in salt.
• Get to and stay at a healthy weight.
• Be at least moderately active for 30 minutes on most days of the week.
• Limit alcoholic drinks.
• Prepare and store food safely.
• Do not use tobacco in any form.

What is the support available?

CanHOPE a ParkwayHealth initiative together with the multi-disciplinary team of doctors tries to bring about a holistic approach to cancer care at no extra cost. Counsellors manned its cancer counseling service through a hotline and email to provide emotional and psychosocial support to all patients and caregivers to assist them to cope effectively with cancer. A ‘meet and greet’ service with face-to-face counselling can also be arranged.

Patients, health care professionals & the general public can also receive up-to-date cancer information, its related screening tests, treatment and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies, diet and nutrition.

CALL our CanHOPE counsellors: +65 67389333 or e-mail: enquiry@canhope.org