How Do Psychological Factors Impact Diet During Cancer Treatment?

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How can diet be impacted by psychological factors during cancer treatment? PEN Program Manager Joelys Gonzalez and Communication Manager Nicole Normandin Rueda, LMSW discuss common psychosocial factors, various impacts to diet and nutrition, and strategies to help mitigate negative impacts to patient health. 

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How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

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What Role Does Exercise Play in Cancer Treatment?

Transcript:

Lisa Hatfield:

Have you ever wondered how psychological factors could influence your dietary intake during cancer treatment? Understanding this connection is more crucial than you might think. In this segment, we’ll dive into the complex interplay between mental health and nutrition on this Patient Empowerment Network RESTORE program. 

So, Joelys, what psychological factors most commonly affect a cancer patient’s ability to maintain proper nutrition during treatment? 

Joelys Gonzalez:

There are many psychological factors here in hand, but some most important ones will be like anxiety, depression, and stress are the most common ones in cancer patients and can significantly affect their ability to maintain the proper nutrition during and after treatment. For example, anxiety can lead to reduce their appetite or cause a patient to skip a meal altogether, because they’re super anxious about their treatment and sometimes they can actually forget to get their meal of day. Depression might also make it difficult for patients to find motivation into prepping a meal themselves, or even buying a meal.

Sometimes they could, specifically if they live alone, sometimes it’s hard to just think yourself, what can I eat? What should I eat? And that can cause stress. That’s where the stress comes, whether from the diagnosis itself, or it could be financial concern or worries about a family member. That can lead to a patient to have erratic eating patterns. And sometimes they can also, they might overeat as a coping mechanism, while there are others that might lose their appetite completely and not even recognize that they have lost their appetite or if they had a meal of the day. Additionally, this can also cause cognitive changes like chemo brain. We have all heard about chemo brain, we forget, or foggy brain.

This can also affect the meal planning or prepping. This can make it very challenging as many patients can lead to unhealthy eating habits. It’s also worth noting that taste can also change during treatment, which can also be a really huge side effect that many patients go through. As we can know, previously maybe a person, a patient enjoyed certain foods. Now they might not be able to taste that food, and they might find it unappealing. And making the patient’s ability to eat well, super complicated.

And I feel like to help address these issues, I have been working with patients closely to identify these psychological barriers and creating some coping skills or some coping strategies that can make it easier for them to eat or to make some easy to prep meals more enjoyable such as small meal prepping, like, just involving your family or friends overall to make something that you used to, that you used to like, or that you used to enjoy. That can help also a patient kind of overcome that barrier by having also the emotional support that many can gain from counseling or support groups or their family members or their neighbors. It could be anyone. Also, like for example, a puppy. You could have a puppy providing you emotional support.

I am a huge fan of puppies, and just recognizing and addressing these psychological factors is very crucial in helping a patient maintain their nutrition and overall health during and after treatment. And not just patients but also the care partners. Care partners also go through those challenges, especially wanting to make sure that the patient is eating well or that the patient is getting the correct nutrition.

Lisa Hatfield:

Okay. Thank you so much. 

Lisa Hatfield:

So for both you, Nicole and Joelys. We’ll start with Nicole. first. What strategies can be employed to help cancer patients overcome psychological barriers to healthy eating, such as anxiety, depression, or changes in taste and appetite? 

Nicole Normandin Rueda, LMSW:

So piggybacking off of what Joelys just offered, I think that really utilizing your health care team and all the resources available is going to be critical. So we want to make sure there’s nutritional counseling available.

So a lot of times, for example, a lot of times getting enough protein is difficult because, I mean, if you’re not eating a whole bunch of chicken all day, I mean, it’s hard to get enough protein in all three meals. So, things like Ensure or Boost or whatever, whatever it is that your health care team recommends, not only can they recommend it, but usually there are social workers that can help you get, either coupons or discount codes or whatever, because the cost can also add up. So that’s a huge strategy, right? Utilizing your network, your health care team, to really make sure that you’re helping alleviate any of those issues that you may be having is first and foremost.

Next, I would say, if you needed it, there are cognitive behavioral therapy techniques, as well as like behavior change techniques that you can use, and you can go through with a counselor to figure out how you can change your thought process and help set goals, monitor, food journals, all these little things that for some people super helpful, other people, maybe not so much. Other people might just be like, hey, I just need to remember to eat something today. I need to be able to keep my food down in order to take my medicine. So that’s where we’re going to prioritize our efforts, right?

And then also, as far as the taste and texture thing. There are texture things that some people either can no longer handle or have never been able to handle really. And so we want to make sure that we are encouraging or offering suggestions that are helpful. But also, there are things that happen with side effects when it comes to your mouth, your salivary glands, your taste buds, all of that, your throat.

There are side effects that so many different patients with cancer experience that are not really talked about. And so we have to make sure that we are just on top of it. So we’re making sure that if you’re not eating something, if you’re not, if you don’t go near a certain food, what’s the reason there? And then we can offer suggestions if we need to. Another thing that is difficult to do is mindful eating. And what does that mean, right? Promoting like slow eating. So there are chemicals in your brain that whenever you are eating too fast, your body doesn’t understand, like it takes a while to catch up and say, oh wait, I’m full or oh you know what, this is not what I needed right now.

So we want patients to just slow down. Make sure you are listening to your hunger, like, if you don’t really think about it, sometimes you’re like, oh my goodness, it’s gone eight hours, and I haven’t had anything but an apple. That’s not going to be helpful long term.  So we want to make sure we’re having patients understand the consumption process, what it looks like, how often should I be eating, and what are the meals, what should they look like? Are berries enough, or do we need to add like a protein, some walnuts in there to eat the berries with the walnuts?

What is it that I need to do in order to make sure that I am meeting these nutritional recommendations? 

Lisa Hatfield:

Okay, thank you, Nicole 

Lisa Hatfield:

And, Joelys, do you have anything to add to that? Different strategies that can be employed by cancer patients to help overcome those barriers to eating healthy? 

Joelys Gonzalez:

Honestly, I want to piggyback on what Nicole said. She mentioned most of the strategies that I can possibly think of at the moment, but making sure you work closely with your healthcare team. It’s very important. That could be either the dietitian or your mental health professional making sure that you are having a unique personal plan for you. That’s very important, not just for the nutritional needs of a patient but also for the psychological needs.

For example, like I mentioned before, anxiety and depression, if you’re feeling anxiety and depression, psychological support might be like counseling or therapy can be super beneficial, because they can help you manage those emotions and find motivation and for eating again. Also, for example, you mentioned the changes of taste, you can also continue to try small spices or different spices or different texture until you’re able to get to that comfortable space that you’re looking for. And not just trying to give up at the first hand, I know it can be tough.

t is tough to be focusing on whether your mental health or your nutrition, but also being able to focus on having to celebrate that little small step. It’s very important to continue motivating yourself. And also, I encourage having small meals. Don’t think about it as a full meal perspective when you’re looking at your nutrition, because starting small is better than starting big and being disappointed and having that disappointment or overwhelming feeling.

Lisa Hatfield:

You heard it here directly from our experts. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

What Role Does Exercise Play in Cancer Treatment?

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How can exercise benefit cancer patients? PEN Program Manager Joelys Gonzalez and Communication Manager Nicole Normandin Rueda, LMSW discuss the benefits of exercise to cancer health and recovery, recommended exercise types, and tips for patient support and maintaining some level of activity. 

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 How Do Psychological Factors Impact Diet During Cancer Treatment?

How Do Psychological Factors Impact Diet During Cancer Treatment?

Transcript:

Lisa Hatfield:

How can staying active during cancer treatment benefit your overall health and recovery? In this Patient Empowerment Network RESTORE program, we’ll explore the vital role of exercise in cancer care and uncover how incorporating physical activity into your treatment plan may enhance your well-being and support a better outcome. 

Joelys, how can physical activity be safely incorporated into a cancer treatment plan? And what types of exercises are most beneficial for patients? 

Joelys Gonzalez:

Well, incorporating physical activity into a cancer treatment plan requires more of a personalized approach, considering the type of cancer or the treatment being received or the overall health. I often start this discussion with patients by letting them know the importance of exercising during and after treatment, explaining how it can help manage side effects such as fatigue, stress, and depression. I usually recommend starting with low impact activities such as swimming, walking, or gentle yoga, as long as, of course, the patient is able to move around, whatever you’re capable of, which can be just adjusted based on the patient’s energy levels and how they’re feeling on day by day. Of course, if they’re feeling low, they can start doing small activities, light activities, such as moving your fingers or moving your head around. 

I also stress the importance of listening to your body, making sure you know how your body works, and making sure that you’re not overstressing your body. It’s very important. Resting as much as needed. It’s very important to be able to stay active. To ensure safety, I encourage them to check in regularly with their healthcare team just to make sure that they are having a tailored, a personalized plan, a personalized exercise plan with them. That could be involving physical therapists or their dietician to make sure that they have a unique plan. And by making physical activity as flexible as possible and adaptable to their part of their daily routine, patients can enjoy its benefits without feeling overwhelmed and alone.

Lisa Hatfield:

Thank you for that. And I really appreciate your comments. And I know Nicole and I have talked before, even small movements like moving your fingers and your toes or any movement is better than no movement, because sometimes we are just flat out too exhausted or in too much pain to do much more. So I appreciate you saying that for patients that you can do any little movement and that’s beneficial. So thank you. And, Joelys, what are the potential benefits of maintaining an active lifestyle during cancer treatment, particularly regarding treatment outcomes and overall well-being? 

Joelys Gonzalez:

Maintaining an active lifestyle during cancer treatment can have some profound effects on both treatment outcomes and the patient’s overall well-being. And when I mentioned that physically, physically staying active helps fight the treatment-related side effects, such as fatigue or muscle loss or weight changes. It could also support the cardiovascular health, which is very important since most cancer treatments can affect your heart. For instance, if you do such light exercise like walking or cycling, that can help you improve your blood circulation, helping you reduce the risk of blood clots or other complications from the treatment.

And this can also help you mentally. Maintaining that regular physical activity can significantly reduce your stress and improve your mood, especially when it comes to anxiety and depression, which are the most common among patients living with cancer. I’ve seen patients who incorporate daily movements into their routine, which has made them stronger than they have been before in the sense of control over their overall health, which boosts their confidence and their resilience during their cancer treatment.

Additionally, exercise has been shown to improve sleep, which is often disturbed during their treatment. And from a social work perspective, engaging in group activities or even walking with a friend or a family member can reduce your feelings of isolation, the feelings of being alone, and it can actually help you in building that support network that you need through your cancer journey, which is very very important. I really reiterate that having someone next to you not just to talk and just to make small exercise that can help you a lot during your cancer treatment, and the overall maintaining an active lifestyle helps patients manage their treatment better and contribute to a higher quality of life during and after cancer treatment.

Lisa Hatfield:

Nicole, how can healthcare providers effectively support and motivate cancer patients to stay active despite the challenges posed by their treatment? 

Nicole Normandin Rueda, LMSW:

Great question. So healthcare providers are often the first line of defense, right? And so they have this unique opportunity to really invest in getting to know their patients, which will then in turn…it will be the strategy that they use whenever it comes to tailoring the actual like exercise plan, for each patient. What that means really is that we get to know the patient’s needs, their abilities, knowing a little bit more about their diagnosis or their treatment, the side effects, or potential barriers. The more, the better you can tailor the actual personalized plan for each patient.

That also means not just the oncology team, but all the ancillary services. So your physical therapist, your exercise specialists, there are movement specialists. I mean, there’s a whole, a plethora of resources that can be brought in to help make sure that a patient…their treatment stage, their overall health, any secondary or other diagnoses that they may be managing as well as their just physical capabilities are all things that we want to make sure are very…we’re thinking about those at all times. We want to make sure whatever it is that we’re asking them to do is safe and achievable and aligned with their needs.

The encouragement from your oncology team and hearing that you know what you’re doing great, your small steps are baby steps, but they are steps and we are proud of that. Kind of that affirmation is huge. The next thing I would say would be setting the realistic goals and being on top of the potential barriers. So we all know how great it feels to check something off a box or cross something off a list, right? So we want to give patients that sense of pride and the sense that they are able to do whatever it is that we’re asking them to do, even if it’s very small and manageable.

Our goal is to help alleviate any potential future issues or current issues, secondary to their diagnosis. So if that means it’s fatigue, if it’s pain, if it’s the circulation, all of these things that we want to alleviate or inhibit from happening or getting worse, that’s important that patients know why we’re asking them to do something and setting the goals that are small enough and achievable that they can feel that sense of accomplishment is a big deal. Again, I mean, I can’t say this enough, I want every patient to know they are not alone. There are fantastic resources online to get, even if it’s stretching exercises.

I mean, there are things that are tailored to people with cancer that are absolutely incredible and free, that patients should be able to have the support that they need. Not just emotionally, but also physically, if that’s in-person or virtual, there are resources available that can help get whatever it is that patients need under their belt and so that they have the tools they need to go and accomplish whatever it is that they are being asked to accomplish. And that gives them that sense of pride that also makes it usually a success story, right? At least for that small piece of their treatment, they can say, I was able to do what it is that you asked me to do. That’s great.

And healthcare providers, like I said, are the first line of defense. They’re the ones that are checking in and asking the questions and so making sure that we’re always asking, but also listening to what it is that patients are saying. So if they’re saying, no, I didn’t really get around much today. Maybe we need to tailor what it is that your homework is going to be for the next week or whatever, to make sure that you are getting what it is that you need from us. 

Lisa Hatfield:

Okay. Thank you. And I appreciate that you talked about even celebrating the smaller, what seems to be smaller accomplishments. Like, sometimes if you can walk even five feet a day, you’re trying to walk again, even that, Yay, that’s exciting. Instead of thinking, well, before I used to be able to walk a half a mile or whatever. I think celebrating those small, those smaller steps are just as important. So thank you for bringing that up. It does give patients a sense of pride. You’re right.

Nicole Normandin Rueda, LMSW:

Absolutely.

Lisa Hatfield:

Well, you heard it here directly from the experts. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

Navigating Supplements in Cancer Treatment: Insights from a Harvard Expert

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What should cancer patients know about supplement intake during treatment? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses advice about taking supplements during cancer treatment, communicating with healthcare providers, interactions with cancer medications, and improving the gut microbiome for optimal absorption. 

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

It’s essential to understand which supplements can support your health and which ones to avoid to maximize treatment effectiveness and overall well-being. With so much misinformation, are there evidence-based studies that can provide clarity? Find out next on this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, what are the essential guidelines for taking supplements during cancer treatment, and how can patients and their care partners select the right supplements without affecting treatment?

Dr. Jennifer Ligibel:

This is such a great question, Lisa, and one that my patients are asking me all the time. There is so much information and misinformation out there about supplements that it can make it really hard for people to know what they should be doing, to worry that they might be missing out on something important. And so, I think it’s really important to talk about supplements and how they factor into cancer treatment.

The first thing I will say is that if you are considering taking a supplement, please talk to your medical oncology providers about this. I think there have been studies that have shown that a lot of people who take supplements don’t talk to their oncology team about the supplements they’re taking. And this is so important, because there can be interactions that occur. I think it’s just so important that as an oncologist that I know the medicines that my patients are taking, whether they’re over-the-counter medicines or medicines that I or another physician prescribe.

I will be honest that most guidelines from groups like the American Cancer Society, the Oncology Nursing, the Oncology Nutrition Society really recommend that people get their nutrients from food. And the reason for this is that your body absorbs nutrition much better from food than it does from supplements. And it can be difficult to get to a dangerous level of a nutrient from food as opposed to from a supplement. Now this is for the average patient who has good nutrition and is able to eat.

The situation is quite different if people are not able to eat a balanced diet because of their cancer treatment or because of some kind of mechanical issue that’s related to the cancer or the surgery they’ve had. And in that situation, it is so critical that patients work with an oncology nutrition specialist, someone who really understands oncology treatment to make sure that they’re getting the nutrients that they need, because nutrition during cancer is such an important thing.

I think sometimes it is very tempting to want to take supplements as an alternative to treatment or an enhancement. And I think what’s very tricky about this is that supplements are not regulated as medicines in the United States. And so, that means that people can say things about supplements on their advertisements that may not be supported by the same kind of clinical trials that lead to the approval of a medicine, for example.

And so, that can make it really complicated for people to know what is really based on kind of fact and what may not be. I think another piece that’s so important is making sure if you’re somebody who’s actively receiving a cancer treatment, and this is especially true with a lot of the new targeted treatments, many of which are oral that if you are going to take a supplement that you make sure that it’s not going to interact with the cancer treatment that you’re taking.

A lot of supplements use the same cellular machinery to metabolize or break down the supplements that are used to metabolize cancer medicines. And so, what can happen is if you have two things that use some of the same machinery, sometimes you can end up with really high levels of a medication in your system or really low levels. So if you are interested in taking a supplement, it’s critical that you talk to your oncology team about it, so they can just make sure that it’s not going to impact the effectiveness of the cancer treatment.

There are also supplements that may have hormonal properties, things like an estrogen-like effect, and that can be of concern if you have breast cancer. So again, just really important to review all supplements with your oncology team. A lot of my patients take supplements and, you know, my perspective on all of this is that people are going to make their choices and do the things that feel best for them. My role as an oncologist is just making sure that things are safe and that I really want to have an open dialogue with my patients and just make sure they feel comfortable telling me about the medicines they’re taking so that I can make sure that they wouldn’t have any effect on the treatments that I was prescribing to the patient.

Lisa Hatfield:

Okay. Thank you. So, are there any supplements in particular that cancer patients should avoid or that they really need to be closely monitored?

Dr. Jennifer Ligibel:

So I am not an expert in different supplements, and this is a place where there is a growing workforce in oncology that focuses on integrative medicine. There are many places that have integrated medicine services or pharmacists within their cancer center where they could really answer that question much more concretely, because sometimes it depends on what medicines the patients are receiving. A lot of this is about interactions and changing the effectiveness of cancer treatment. For people that are not on therapy, I think that the concerns are generally much lower.

The other thing though that sometimes can happen, and that it really can be difficult, is that supplements and these more alternative treatments are not supported by insurance. And cancer itself has such financial toxicity that I do think that sometimes when people are worried about their outcome and their health, they can be more susceptible to, unfortunately, ending up spending thousands and thousands of dollars on these products.

And I do think, again, it’s just important to really look at the level of evidence when people are saying that this, whatever the supplement is, would maybe treat your cancer, to kind of think about sometimes if things sound too good to be true, they can be. So I just really also just want to make sure that people are aware of what the level of evidence is and the cost of many of these products.

Lisa Hatfield:

I appreciate you pointing that out, because I think sometimes us cancer patients feel desperate to take care of this cancer, and so we’ll go to great lengths to do that. So thank you for mentioning that. Always, always talk to your healthcare team for advice on supplements. 

Dr. Jennifer Ligibel:

There is a group called the Society for Integrative Oncology which is an international group that does a lot of research and work focused on integrative therapies and supplements in cancer. And that’s also a really nice resource for people looking for more information about supplements in cancer that’s evidence-informed. But I think really nicely balanced and recognizing the importance for people to feel autonomy in their health balanced with the safety and the financial pieces, so that’s a good resource for people.

Lisa Hatfield:

And I do have one last question. Hopefully, there’ll be a quick one for you. It’s regarding probiotics, because sometimes the chemotherapy or any medications we’re taking can wreak havoc on our system. I did consult with a local dietician she recommended, similar to you. She said, use whole foods to get those pro- and prebiotics, that was her suggestion. Unless she said, unless you have a vitamin D deficiency, then that’s an okay supplement.

But what are your thoughts on that, if a patient wants to take a probiotic or wants to improve their gut microbiome because of the side effects of treatment?

Dr. Jennifer Ligibel:

That is such a good question. And the microbiome is such a hot topic, and there’s just so much we don’t understand about the microbiome. You know, it’s interesting, there were studies, there have been studies that have actually shown that the composition and health of the microbiome is directly related to how well patients with some kinds of cancers respond to immunotherapy, which is kind of fascinating when you think about that connection with gut health and effectiveness of treatment.

But in that situation, people who took antibiotics and probiotics actually had less diversity of their gut microbiome, and that was related to not having as good of an outcome. Now that is a very small study, and I think there’s a lot that we don’t know, but I think what the dietician had suggested that your food is a better way to populate your microbiome, I think is important. And there are some foods that are very, very, very rich in active bacterial species. I mean, simple things like yogurt and then more complicated foods, things like kimchi really have some interesting impacts on your microbiome.

And consuming those types of foods I think really contribute to having a diverse bacterial kind of the…a lot of different species seems to be related to better outcomes in some cancers. And so, again, this is like really, really early. Some of it feels like science fiction where they’re taking someone’s gut microbiome and transplanting it into someone else. But I think this is a really interesting area. But again, as much as you can get your nutrition from food, I think the better for people’s overall health and their gut health. 

Lisa Hatfield:

You’ve heard it here straight from the expert. Thanks for joining us on this RESTORE program. I’m your host, Lisa Hatfield.

Lifestyle Interventions and Cancer Care Outcomes Research

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What’s important to know about lifestyle interventions and cancer care outcomes? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses lifestyle interventions of physical activity and weight loss on cancer outcomes, controversy about body weight, and exercise levels during cancer treatment that show cancer outcome benefits. 

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

How can lifestyle changes impact cancer care outcomes? The answer may be more crucial than you think. In this Patient Empowerment Network RESTORE program, we’ll connect with a respected expert on the ground floor of this research. 

Dr. Ligibel, your research highlights the impact of physical activity and body weight on cancer risk and outcomes. Can you explain how exercise and weight loss interventions influence biomarkers associated with cancer risk and outcomes?

Dr. Jennifer Ligibel:

Absolutely. So this research is, I think, both really, really exciting and empowering for patients, because exercise and nutritional change are things that people can do themselves that don’t involve a prescription. But they can also be kind of confusing and leave people sometimes feeling like they’re not sure what the right thing to be doing is to support their long-term cancer outcomes. The truth is we do know that there are patterns that we see in society.

Like if you ask a lot of cancer patients, how much do you exercise and you track their weight. We see that people who exercise tend to have better cancer outcomes. So they tend to have a lower risk of cancer returning and a higher likelihood of surviving their cancer. For common cancers like breast cancer, colon cancer, prostate cancer, not as much evidence in some other cancers. We also know that people who keep their weight in a healthy range are less likely to develop cancer in the first place, and they’re less likely in some cancers, mostly the ones we talked about, breast, prostate, and colon to have their cancer return or die from cancer.

But what we don’t know is what aspect of lifestyle really drives these relationships, because the thing that’s complicated is that somebody who exercises more tends to have a little bit of a different dietary pattern than somebody who doesn’t. It’s not true for every single person. I’ve known marathon runners that live on Twinkies. But for the most part, people that exercise more are thinking more about their diets. They tend to weigh a little bit less, they smoke less. They may be going to do their screening mammograms and colonoscopies more often.

So it can be really tricky when you look at a large group of people and you just ask them what they’re doing and following them to make direct cause and effect relationships between one particular thing, like exercise or eating a particular food and their cancer outcomes. And this is one reason why my group at Dana-Farber, the research that we do really seeks to put people into interventions where we take a group of people that maybe aren’t exercising or they have a body weight that’s kind of above the ideal, and we help them to lose weight or to exercise more.

And we compare two groups of people that were the same at the beginning. One group took part in our program, the other didn’t. And then we’re able to kind of look more directly at whether these types of things affect their cancer outcomes, kind of what happens after their cancer is diagnosed. So we have some ongoing studies that are testing the effect of weight loss programs on cancer recurrence and breast cancer. We have some smaller studies looking at exercise and how that affects cancer. But the truth is we don’t a hundred percent know yet.

If we take a patient who’s not exercising or has weight in a certain range and we change that, is that going to have a direct effect on their cancer? We hope so, but that’s still something that we’re really studying. At this point, what we do know is that healthy lifestyle seems to be linked to lower cancer risk and better outcomes for people who’ve had cancer.

And I think the other thing that is really promising and hopeful is that there’s evidence that shows that even people that maybe didn’t have the healthiest lifestyle before being diagnosed with cancer, if they make some changes, they may have better long-term outcomes. So it kind of shows us that it’s not too late after cancer is diagnosed, but I think we’re still trying to really learn what are the particular factors for an individual person that are going to be most impactful to improve their cancer outcomes?

Lisa Hatfield:

Okay. Thank you. That gives cancer patients a lot of hope too, to know that going forward I can make some changes. In your randomized trials, how have you measured the effects of exercise and weight loss on cardio, respiratory fitness, and body composition in cancer patients? And what have been the key findings in their implications for patient care?

Dr. Jennifer Ligibel:

Absolutely. So we’ve done a lot of work in taking people who’ve been diagnosed with cancer and perhaps aren’t exercising regularly, or their diet is not as healthy as it could be, or their body weight is higher than the kind of there’s…a lot of controversy about the best body weight. But we, we kind of look at different levels of overweight and obesity and how they relate to health outcomes.

So we’ve looked at many different studies where we take people who might not have the healthiest lifestyle, and then we help them exercise more. We work, have them work with a coach or take part in a structured program. The first studies that we did really looked at, just how do you get people to make these changes when they’re going through cancer treatment or afterwards? Because there are a lot of extra barriers. We all know it’s not so easy to eat well or to lose weight or to exercise regularly at any point, but then you add cancer treatment to that, and it becomes more complicated.

So our first studies really just looked at how do you get people to do it? Is it safe? And we found indeed it was safe and that we could get large groups of people to engage in these programs. Not just people we enrolled at Dana-Farber, but people from all over the country. And that was really good to see that we could scale things that way.

Then we were interested in looking at some of the biomarkers you talked about, like what happens when somebody who hasn’t been exercising starts to exercise, or somebody whose body mass index is 27 or 30 or kind of in the higher levels showing that they have excess adiposity. What if they lose weight? What changes? So we’ve been able to show that people who exercise or lose weight have favorable changes in their metabolic hormones, favorable in changes in inflammation, which we know is something that relates to cancer risk.

And most recently, we’ve been able to show that exercise in particular has an effect on the immune system, both throughout the whole body and at the level where breast tumors form. So that’s been really interesting and helps to perhaps show us how is it that exercise could lower someone’s risk of cancer and really seeing how it activates the immune system. We’re also doing studies that then look at really big long-term outcomes, like whose cancer comes back and whose doesn’t. Those studies are really, really complicated to do. They involve enrolling thousands of patients, and they take 10 years to get the results.

And so, we’re still waiting for some of the outcomes of those studies. But the work that we’ve done so far shows that it’s safe for people to exercise and lose weight throughout their whole cancer journey, that it is also very scalable, not just to small groups of patients, but we can do this more broadly across thousands of patients. We’ve shown that when you make these types of changes, your metabolism improves, your risk of cardiovascular disease potentially decreases, then people feel better. We’ve done a lot of work with quality of life and fatigue and other side effects, and showing that when you make these types of changes the side effects of cancer therapy are often lessened.

Lisa Hatfield:

Okay, thank you. One quick follow-up question also as a patient. If you were telling me about exercise and how it might reduce inflammation, is that cardio or strength training or a combination of both? Do you have a recommendation on that for patients?

Dr. Jennifer Ligibel:

So, that is a great question and something that has been studied looking at different kinds of exercise. So there’s definitely value to both cardiovascular exercise, things like walking and running or swimming and to strength training. And that can be done using body weight. Things like squats and lunges, using weights, using machines. Strength training exercise is really important for maintaining muscle, and we know that a lot of cancer patients lose muscle, and that losing muscle is associated with losing function. So, doing strength training exercise is so important for maintaining your muscles.

A lot of the studies that have looked at how exercise relates to long-term cancer outcomes have primarily studied aerobic exercise, and that literature is really strong, that as little as walking three times a week can have benefits, long-term benefits in terms of cardiorespiratory health and perhaps even cancer-related outcomes. There’s an important place for both cardiovascular and aerobic exercise.

here’s a group, the American College of Sports Medicine, who tried to bring together all of the research from intervention studies. So studies where they took people and they put them on exercise programs to look at, well, what changes when you’re on an exercise program? And they looked at all these studies and tried to develop what’s called a fit prescription. So frequency, intensity, time, and type of exercise.

So to be able to tell people, “All right, what you need to do is 30 minutes of cardio three times a week, and that’s what’s going to help you feel better from a fatigue standpoint.” And so, they’ve worked out a couple of prescriptions for things like anxiety and fatigue that really are helpful in thinking about, well, how much do you really need to do to start to see a benefit? And in most of these studies, it was at least 90 minutes of aerobic exercise and a couple of strength training each week were kind of the minimal level of exercise where people really started to have benefit.

Lisa Hatfield:

Okay. That’s really helpful. Thank you.

Dr. Jennifer Ligibel:

Sure.

Lisa Hatfield:

Dr. Libel, how do you integrate quality of life assessments into your research on energy balance factors? And what role do these assessments play in evaluating the effectiveness of lifestyle interventions for cancer patients and survivors?

Dr. Jennifer Ligibel:

This is really important, because supportive care is designed to help people feel better. And if we are making people more active or changing their lifestyle in a way that doesn’t help them feel better, then we’re really not satisfying kind of the primary goal of supportive care interventions. And so, this is why we really make sure that we measure what are called patient-reported outcomes. So how does the patient feel as an integral part of the work that we do.

And so, most of the time these types of measurements are done through questionnaires where you ask people, how do you feel? How much does this side effect affect you? How much does fatigue impact your daily life? What about nerve-induced, what’s called chemotherapy-induced peripheral neuropathy? How much does that affect you? How much does that stop you from doing the things that you want to do? So we generally evaluate like, is the symptom present? And if it is, how much does it impact your ability to do the things you want to do? And I think that, when we see that people feel better that these side effects lessen as a result of interventions, that’s really what leads us to want to take things from being part of a research study to part of the standard care that we provide to our patients.

Lisa Hatfield:

That’s great. Thank you. You heard it here from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

How Does Nutritional Screening and Assessment Impact Cancer Care?

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What impact can nutritional screening have on cancer care? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses key pieces of the nutrition puzzle for cancer patients and advice for boosting calorie intake and nutrition during the cancer journey. 

Download Resource Guide

See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

How can nutrition help during the cancer journey? So many questions, and fortunately I’ve connected with a respected Harvard expert to get some answers on this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, what are the key components of nutrition that patients should be thinking of during their cancer treatment?

Dr. Jennifer Ligibel:

This is such a good question and honestly, something I get asked every day that I’m in clinic, “What should I eat?” I think it’s such an important part of our health more broadly. What we eat is related to our weight. It’s related to often, our mood. It has such an impact on so many elements of our lives. And for a cancer patient, there is I think a really complicated relationship often with food for people as they’re going through treatment, things that they once really loved to eat are no longer palatable.

Sometimes people also really feel worried about will what I eat make my cancer worse or make it come back? And I think there’s a lot of myths out there about the relationship between food and cancer. We do know that, historically, if you look across large groups of people, that people who eat healthier diets have a lower risk of developing many kinds of cancer.

But I think what’s confusing sometimes is what healthy is. Sometimes changes, and you only have to look back in history to see, there was a time when we thought all fat was bad, and low fat products were the way that everybody should be eating. And then people realized, “Oh wait, if we take all the fat out, that means we added a lot of sugar.” And so I think that there can be a lot of confusion about diet at times.

One of the things that we do know though, that eating whole foods, so things that come from a plant or from an animal that are not ultra-processed generally tend to be healthier for people. Balanced diets are really important, although there’s a lot of interest in sort of these extreme diets where you cut out all the fat or all the carbs really for long-term health. Most studies suggest a balanced diet is more healthful, that really relies on fruits and vegetables and lean meats and more complicated grains.

So these are kind of really healthful eating patterns more broadly. But what about for somebody with cancer? And the reality is that we don’t have perfect evidence about what the best diet for someone to be eating is. And that can be really frustrating, because I know people often want to be told, “What you need to do is eat a lot of broccoli, or as long as you never have X food again, you’re going to be fine”.

Unfortunately, the research that we have doesn’t give us such clear-cut guidance about what the best diet is or if there are foods that people should avoid at all costs or something that you should eat every day. We do know as well that there are kinds of different dietary considerations for different phases of the cancer journey as well. One thing that is important when you’re getting treatment, especially chemotherapy treatment, is to make sure that you have enough protein in your diet. We know that people tend to lose muscle mass during chemotherapy treatment, and not having adequate protein is one of the factors that contributes to that, as well as not exercising as much.

We know that after cancer treatment, making sure that your diet is balanced, that it keeps your weight in a good range, is really important. But there’s a lot that we don’t know about diet, and I think this is something that’s really important to acknowledge and to study. But I think it also means that people shouldn’t beat themselves up if they’re not able to adhere to a very strict or a particular dietary plan. There’s a lot we need to still learn about food. But I think that people can really be aware that trying to eat a healthy balanced diet is something that is a long-term goal and not something that if you have one bad day that it’s going to have an impact on you or your cancer.

Lisa Hatfield:

Okay. Thank you. I appreciate that. And I know we hear a lot as cancer patients, there’s a lot of information thrown at us to not eat sugar, cut out all sugar, sugar feeds cancer. I know that we could have a two-hour-long discussion, at least, about that. But it’s nice to hear that we don’t need to beat it, if we have one little piece of dark chocolate, because it just feels good after our chemo, that’s probably okay. If we want to do that. So that’s nice to hear. So thank you.

Dr. Jennifer Ligibel:

Absolutely.

Lisa Hatfield:  

You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

What Supportive Care Treatments Are Available to Patients?

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What options do cancer patients have for supportive care treatments? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses side effect management, exercise, nutrition, and integrative therapy for patient care. 

Download Resource Guide

See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

 How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

Managing the side effects of cancer treatment can be just as crucial as the treatment itself. But how does supportive care fit into the equation? I’m getting some clear answers from a respected expert in this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, could you speak to some available supportive care options, and how can patients work with their healthcare team to effectively incorporate supportive care into their treatment plans to manage side effects?

Dr. Jennifer Ligibel:

Absolutely. And this is such an important topic. I think sometimes people want to downplay the symptoms that they’re experiencing. And so, they don’t tell their healthcare team when they’re experiencing nausea or fatigue, or they’re just feeling really down because of the effects of their cancer treatment. And these are all areas that supportive care treatment modalities can really help people feel better during their cancer treatment if they talk to their oncology teams about the symptoms they’re experiencing, because there are so many supportive care options that are available now.

These options really run the gamut. So there are supportive care medications. We know that there are really effective medicines for nausea, for example, and sometimes people need different nausea medicines than what was initially prescribed. So really important if you’re experiencing nausea despite the medicines that you’re taking to talk to your care team about that.

here are medications additionally for pain when people develop nerve damage from treatment. Those are other things that there are supportive care medicines that can be really important and really help people feel better. Then there are other types of modalities that people may seek out themselves, things like exercise or changes in nutrition. I always recommend that people talk to their healthcare teams before incorporating any kind of supportive care into their treatment protocol, especially if they’re currently receiving treatment for cancer.

But there are many different ways that people can help themselves feel better by being more active and by making sure that they’re consuming enough calories, making sure that they have enough protein in their diets to really support themselves through treatment. Then there are supportive care modalities that are directed toward particular symptoms. And there are what are often called integrative therapies.

And integrative therapy is a type of treatment modality that really takes the best of both Western medicine and Eastern medicine to try to help support people during their cancer treatment. Integrative modalities often include things like yoga and acupuncture and massage, and there’s a growing literature showing that these types of interventions can also really help support patients during cancer treatment.

There’s also meditation and mindfulness, because we know that cancer and cancer treatment has such an effect, not just physically on people, but also emotionally, and really managing the emotional effects of cancer treatment is incredibly important to feeling better. And so, this is an area where there’s a lot of active research, so many more ways that we know now can help people feel better during treatment than even five years ago. And so, it’s important to talk to your care team about the side effects that you’re experiencing and really to be open to different types of supportive care options to help you feel better.

Lisa Hatfield:

Okay. Thank you. Dr. Ligibel, what factors should patients consider when discussing supportive care options with their providers? And how can these therapies help enhance their overall treatment experience?

Dr. Jennifer Ligibel: 

Absolutely. And I think one of the things that we’ve come to recognize is that it’s often easier to prevent side effects than it is to treat them once they’ve already occurred. And so, I think it’s really important for people to be proactive and talk to their oncology care providers from the very beginning about what kinds of side effects they may experience as a result of treatment. And thinking about preventative strategies as early as possible.

We were reviewing all of the evidence, looking at exercise, nutrition, and weight management programs for people currently receiving chemotherapy as part of a project through the American Society of Clinical Oncology and saw really consistent evidence that for people who started exercising even before their cancer treatment started, they were much less likely to experience things like fatigue. They were much less likely to lose strength or mobility. They were less likely to suffer from anxiety or depression, and they had a better quality of life.

So really starting that type of program as early as possible is definitely something that we recommend, but it doesn’t mean that those types of changes couldn’t have value no matter where you are in your cancer trajectory. And there have also been studies that have shown that exercise can help treat fatigue once it’s developed, can help people regain strength. So it’s never too late. But I think that for many supportive care options, the earlier that you start them, the more benefit you may derive.

Lisa Hatfield:

Okay. Thank you. You heard it here directly from Dr. Jennifer Ligibel. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

What Is Supportive Care Therapy in Cancer Care?

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In cancer care, what is supportive care therapy exactly? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses the concept of supportive care and a variety of supportive care methods of nutrition, exercise, behavioral therapy, and side effect management.

Download Resource Guide

See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

 How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

Transcript:

Lisa Hatfield:

The term supportive care may be an unfamiliar term to many patients. So what is it and what are the key components of supportive care? I’m diving deep into this topic, with the Harvard expert on this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, there are so many variations of this term, and it may mean different things for different patients. Can you give us a baseline by explaining what supportive care in today’s cancer care landscape is?

Dr. Jennifer Ligibel:

Absolutely. So when we think about supportive care, we think about all of the things that we do to help our patients feel better after a cancer diagnosis through their cancer treatment, and beyond that can be things that help support people’s quality of life, decrease their side effects, support their mood. There are many, many different aspects of supportive care, but it’s all about trying to help people feel as good as they can throughout the cancer journey.

Lisa Hatfield:

Okay, thank you. Dr. Ligibel, how can patients maximize the benefits of supportive care, such as nutritional counseling and psycho-oncology to manage side effects and maintain their overall well-being during treatment?

Dr. Jennifer Ligibel:

This is a great question and this really does vary by the patient, by the stage of their disease, by the type of treatment that they’re getting. So there are a lot of different elements of supportive care, and some of them may be more useful at some points during the cancer trajectory than others. I think that speaking with their oncology team is a good first step, really being clear about the side effects they’re experiencing as a result of their treatment or after their treatment has been completed. Because there’s a lot of research that’s going on now, trying to figure out what type of supportive care can be the most beneficial for a particular side effect.

For example, there are studies that have gone on looking at treatment of things like nausea, and we know that there are a lot of anti-nausea medications that are in a really important part of the supportive care for patients receiving therapy that help mitigate nausea. But there are other strategies that may also be beneficial, things like acupuncture or altering diet. And so, I think the first step really is talking to the oncology care team about the side effects that are present to start thinking about what types of supportive care modalities can be most beneficial.

Lisa Hatfield:

Okay, thank you. And two of the things that seem to come up a lot with cancer patients, myself included, during treatment and ongoing treatment, are fatigue and then just the mental gymnastics of dealing with cancer. Do you have any suggestions on types of supportive care for those two symptoms or side effects in particular?

Dr. Jennifer Ligibel:

Absolutely. And honestly, we could talk for hours about the best ways of managing those types of issues, because they’re so common for people, and the causes of fatigue in particular can really be multifactorial. Some patients may have a low red blood cell count or be anemic. Other patients, it may be a direct effect of the treatment itself, or the treatment may be causing them to not have an appetite, and so their nutrition is not sufficient during treatment.

So I think the first step in really helping to minimize a side effect like fatigue is trying to look at, well, what are the causes? Is there something else going on that may be contributing to fatigue? Most of the time, honestly, it’s the effect of the cancer or the cancer treatment itself. And in that case, there’s been a lot of work that’s been done to look at, well, what types of supportive care modalities are beneficial, actually, and this often is counterintuitive to many people, the best medicine for fatigue is exercise.

I know it seems crazy in some ways that when you’re already feeling tired, the thought of getting out there and exercising may seem insurmountable. But there have been hundreds of studies that have looked at exercise programs as a way of mitigating fatigue. Most of the time, these programs start really slowly. They involve things like walking, doing kind of low intensity strength training, but the evidence is really consistent that exercise is incredibly beneficial to both prevent fatigue and to treat it once it develops. Another really effective strategy for both preventing and treating fatigue is cognitive behavioral therapy.

And so, this involves really thinking about your energy levels and when your energy levels are higher and matching your activity to the times of day when you have the most energy. There are many other strategies for fatigue that have been explored. Things like mindfulness and meditation. The thing that hasn’t been shown to be that beneficial in most settings for fatigue is medications, unfortunately. And I think that’s something that many of us reach when we’re experiencing any kind of a side effect is for a medication, and in this time period, unfortunately, medications haven’t been shown to be as effective.

Lisa Hatfield:

You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

What Are Practical Tips for Managing Taste Changes During Cancer Treatment?

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Registered dietitian and oncology nutritionist Julie Lanford discusses common taste changes that may occur during cancer treatment and practical strategies and resources for managing taste changes for patients. 

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Related Resources:

How Can I Stimulate My Appetite During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

 How Do Nutritional Deficiencies Impact Cancer Treatment?

How Do Nutritional Deficiencies Impact Cancer Treatment?

Dos and Don’ts of Supplement Intake During Cancer Treatment

Dos and Don’ts of Supplement Intake During Cancer Treatment

Transcript:

Lisa Hatfield:

Dealing with changes in taste perception can make mealtime challenging. What are ways to make food more enjoyable? As part of the Patient Empowerment Network RESTORE program, we’re diving into practical tips for managing taste and appetite changes. Julie, what are some practical tips for dealing with changes in taste perception that can make food more palatable? And do you have any recommendations for flavor combinations or cooking methods that might help enhance the taste of food for those of us experiencing a metallic or altered taste from our treatment? 

Julie Lanford:

Yeah. So there are some different strategies for affecting taste. And different people tend to have different challenges with the taste changes. So like you mentioned, the metallic taste. Some people don’t tolerate really sweet food where they used to. So it all depends on the type of taste change. Some of the common tips that we give people is to sort of clear your palate before you eat by drinking some water with fresh lemon squeezed into it. That tends to somehow sort of reset your taste buds. And then if you notice you don’t like the taste, sweet taste or that sweet tastes off or coffee tastes off, of course, avoiding those foods.

And then doing if sweet is bothering you, you can do things like having more of a sour type of marinade. For people who have to drink the nutrition supplement drinks, they tend to be very sweet. And if you’re not tolerating that taste so well, you can get bitters, drops of bitters, and add those just to help tone that sweetness down a little bit. And then for some people, it’s adding a different flavor to the food. So if something is really bland, and you don’t have much of a taste, the taste receptors aren’t working very well, can you add like an acid, like the lemon juice or tomato sauce? Can you add spices to it that make it a little bit of a stronger flavor so that your muted taste buds can maybe pick it up? 

Or if you have mouth sores or things that are making those types like spicy foods not tolerable, how can you make it more like creamy and bland? So it sort of depends on the taste change. There are some great tips from Rebecca Katz, who’s a chef. So I will say, I find that the chefs tend to have a little bit more expertise around the taste change issue, because that their expertise is like tasting of food.

Like as dietitians, our expertise is the nutritional value of food and how you meet your needs, whereas the chefs look at the taste piece. So Rebecca Katz is sort of a specialized chef for oncology. And she has a whole system that works around fat, acid, salt, and sweet in terms of how you can tweak things in order to meet those needs. So that’s if you need more sort of troubleshooting, I think her resources are really helpful. And she’s got great, very fancy foodie-type recipes for cancer patients, which is fun.

The other thing, though, with metallic, I mentioned squeezing lemon into water is avoiding metal silverware sometimes helps as well. So I think all of us have at some point tasted like a fork that you can just taste the metal in your mouth. And for a lot of cancer patients, that’s just magnified.

So using plastic silverware, or there’s some bamboo silverware or things that don’t involve metal can help with that in terms of trying to avoid that. And then red meats tend to have more a stronger metallic flavor. So probably staying away from having your favorite steak at this moment might be another wise thing to do.

Lisa Hatfield:

You heard it here from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

How Much Protein Should I Consume While Undergoing Treatment?

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Registered dietitian and oncology nutritionist Julie Lanford discusses protein needs during cancer treatment and advice for boosting protein levels for optimal wellness during treatment. 

Download Resource Guide

See More from RESTORE

Related Resources:

How Important Is Calorie Intake During Cancer Treatment?

How Important Is Calorie Intake During Cancer Treatment?

How Is Hydration Managed During Cancer Treatment?

How Is Hydration Managed During Cancer Treatment?

 How Can I Stimulate My Appetite During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

How can patients undergoing cancer treatment ensure they are meeting their protein needs when facing taste changes or digestive issues? Are there certain meats or protein drinks that should be avoided altogether? I’m getting some clear answers from a respected expert in this Patient Empowerment Network RESTORE program. 

Julie, what are some practical tips for those of us actively undergoing treatment when it comes to protein needs? And can you share some of the best practices that have been successful, particularly for those of us who have experienced taste changes or digestive issues? 

Julie Lanford:

Yeah, so protein needs can be challenging to meet, because a lot of our favorite sort of comfort foods that we usually go to when we’re sick are not necessarily high in protein. So the first thing to, I think, do is to kind of speak with your medical team to see how much protein you might be needing. Or if you think you’re having enough, they can usually do a simple calculation, or you yourself can actually calculate. And we do this in kilograms, for whatever reason, us dieticians work in kilograms. So if you take your body weight and divide it by 2.2, that will get your kilograms.

And then generally, we would say for people during treatment, aiming for 1 to 1.5 grams of protein per kilogram body weight is something that I think can give an easy range. The typical person, we would actually put more at 0.8 grams per kilogram body weight, but because when people are under treatment or have active treatment going on, that often uses more of our stores, then we sort of bump that suggested range up a little bit. So once you kind of have an idea what that is, then you need to know, well, what are the foods that I’m eating that have protein? So you mentioned meats, you mentioned some protein drinks, so those are pretty easy ways to get quick protein.

There are plant proteins as well, nuts, seeds, and beans. But when you’re talking about digestive issues, sometimes those higher fiber forms of protein are not the easiest to digest. And I know a lot of treatments do cause people digestive issues where they are just not able to sort of break down some of those more complicated foods.

So meats and protein drinks tend to be the easiest to digest, as well as the dairy-based protein, which you can find in milk, yogurt, cheese. Those are ways, as long as you tolerate lactose in the milk, but even if you don’t tolerate lactose, it’s pretty easy to get lactose-free options. Milk is a really simple thing to throw in smoothies that helps to add more. And I think any types of meat are fine, as long as you tolerate them and they taste good to you.

Some of the ones that are just easier to eat will be some of the softer meats, things you don’t have to chew as much, so more like chicken or like shredded meats or anything that might be in a soup where it kind of just goes down with the liquid. Protein drinks are great. I would pay attention to how much protein you can get per, usually they’re in 8-ounce containers, so finding like the plus version, so things like BOOST Plus or Ensure Plus will have higher levels of calories and higher levels of protein, so per 8 ounces, you get better bang for your buck.

And then you can make your own sort of protein drinks at home, like I mentioned, using milk, or you can buy protein powders. The actually most affordable protein powder you could get would be like a dry milk powder that you can just toss in with extra things. So I think those are really simple, easy ways, but the most important thing is that you make sure you’re eating regularly and you’re including protein regularly throughout the day.

So if you’re not eating much, then having something every two to three hours, like with an alarm, and making sure that when you have something, it does include protein, it’s much easier to meet your needs when you’re doing that several times a day than if you’re relying on like one or two sort of eating sessions a day to get them all in.

Lisa Hatfield:

Okay, thank you. Julie, how can patients safely incorporate protein powders or shakes into our diet without disrupting treatment? And is there any risk of getting too much protein? 

Julie Lanford:

Well, you can get too much protein. I don’t see that very often, unless somebody is using a ton of those protein powders, which I just don’t really find feasible for people who are having digestive challenges or appetite issues. So it seems unlikely. I would be cautious with protein powders that you get from like a health food store, because they’re not regulated in the same way that food is regulated. I wouldn’t take that risk if it were me or my family member. If I were going to use a protein powder, I would purchase one, either from the grocery store, like the dry milk powder is regulated and controlled in terms of there’s not going to be contamination. The other challenge with some of the protein powders at the health food stores is that they’re typically not designed for the sort of typical oncology patient.

They’re really more designed for people who want to be like bodybuilders. And so they’ll throw in lots of this other stuff, creatine or different things that they claim are boosting performance that I wouldn’t be comfortable throwing into the mix of my oncology treatment regimen. So I tend to be pretty basic. I just, if I want protein, I want to include things that only have protein. I don’t want to add a lot of extra other stuff. If I’m going to add fiber to my day and I need to use a fiber supplement, I actually don’t want any extra stuff. And I don’t want the flavorings with it. I just want it plain.

And so I feel that way about protein as well. Ideally, you will get it from food sources. If you can’t meet your need from food sources, protein powders from legitimate sort of food-based sources, even if they are, in shake form at the grocery store sold on the shelf, they should be pretty well-checked and monitored. And so that’s what I tend to tell people to look for when they’re trying to make sure to get enough protein. 

Lisa Hatfield:

Okay, that’s great information for patients. You heard it here directly from our expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

How Important Is Calorie Intake During Cancer Treatment?

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Registered dietitian and oncology nutritionist Julie Lanford discusses the impact of calorie intake during cancer treatment, a simple calculation to use for caloric intake, and nutrition advice for common dietary needs for boosting during treatment.

Download Resource Guide

See More from RESTORE

Related Resources:

How Much Protein Should I Consume While Undergoing Treatment?

How Much Protein Should I Consume While Undergoing Treatment?

How Is Hydration Managed During Cancer Treatment?

How Is Hydration Managed During Cancer Treatment?

 How Can I Stimulate My Appetite During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

Nutrition plays a crucial role in supporting the body during cancer treatment. Proper nutrition can help manage side effects and maintain strength and energy. What should my caloric intake look like? I’m diving deep into this topic as part of the Patient Empowerment Network RESTORE program to uncover how best patients can best support our bodies through nutrition during treatment.

Julie, how can patients accurately determine their specific caloric needs during cancer treatment considering the increased energy demands and perhaps the patient’s existing treatment plan?  

Julie Lanford:

Well, calculating caloric needs is not an exact science. So as a dietitian, we were trained in this, but even being trained, each person is very different. Treatment regimens are different, and the foods they like are different. So, we often don’t actually calculate someone’s needs, unless there is some kind of problem going on.

So typically the sign to that would be unintentional weight loss either before a diagnosis or after diagnosis and because of treatment. So if people start with losing weight and feeling like they can’t quite keep it stable, that’s when we will go through these calculations.

And someone’s medical team can do this for them, but it’s also a pretty simple sort of range that you can come up with for yourself just to see how you’re doing. So we always calculate things for whatever reason in kilograms, per calorie per kilogram. So if anybody in the audience is wanting to try to figure out some kind of range for what would help them maintain their current weight, they can take their pounds, their body weight in pounds divided by 2.2, and that will give them kilograms. And then what we use for calculations, it can be pretty broad.

So, but let’s just say in general, I might calculate for somebody a range between 25 and 35 calories per kilogram. And that is, it might seem like a lot for some people. Some people might not be familiar with how many calories are in different things. It’s really mostly meaningful if you’re somebody who’s not eating well, and you’re taking a lot of supplement drinks or things like that, that have the calories listed on them. Of course, it’s easier to figure it out that way.

I often use a calorie range to help people like that figure out, well, how many, supplement drinks like Ensure or BOOST or Carnation Instant Breakfast might you need to drink in a day if you’re not able to eat in order to help maintain your weight. So it can be helpful to have that range, but it’s not always easy for patients to figure out how many calories they’re taking in. And that’s just a general guide.

Some people’s treatment regimens or types of cancer will actually put them in more of a hypermetabolic state. And we may even estimate up to 40 calories per kilogram. And then if somebody is a small individual, not very active, and they’re not in a hypermetabolic state, even down to 20 might be something we work with. So it is quite a range, but I do think for some people it’s helpful to really compare those numbers.

Lisa Hatfield:

Julie, what are some practical tips for incorporating high-calorie, nutrient-dense foods into my diet, especially when I’m experiencing a lack of appetite or nausea? 

Julie Lanford:

I’m always encouraging people to just make sure if they are nauseated to the point where it’s affecting their intake of food, then they need to be sure they’re taking nausea medicine. Whatever it is, if it’s a once a day, or the sort of quick-acting nausea medicine, or both, and making sure to take those 30 minutes before they plan to eat. And that way, once they approach the table, the nausea’s sort of settled down, and it’s easier to take those foods in.

The last thing we want is for somebody to not take their nausea medicine, then get to the table, then the smells or the looks of the foods make, they feel nauseated, they can’t eat it, then they take their nausea medicine, but then it’s like another 30 to 45 minutes before it’s kicked in, and now you’ve missed a window of opportunity to put those calories in.

So that’s your first, and I think most important when it comes to nausea. And then the second thing actually ties in very well with the poor appetite challenges, is that you just want to maximize the volume of the food you’re eating. So you may not be able to eat as much as you normally do, but if you can make those meals or snacks as calorie-dense as possible, then that way even if you eat less foods, you’re getting as many calories. And the most dense version of calories is actually fat. So as long as you’ve got  your nausea under control, and your digestive system is basically kind of working okay, you can get more calories per volume by having higher fat foods. So that’s why we’re always telling people choose whole milk, choose the highest fat cheeses, peanut butter, which is a good source of healthy types of fats, heart-healthy fats, avocados.

Anytime you can include those types of things into the foods that you know you like, you’re going to be able to boost their calorie content. Other people find that actually drinking foods or calories is easier than eating them. If you don’t have much appetite, it somehow just feels like you’re eating less if you’re drinking it through a straw.  So making things like smoothies, or cream soups or anything that you can think that you’ll be able to swallow.So even if it’s that you’re drinking chocolate milkshakes all day long, that is going to be better for you than not having enough to eat. Because if your body does not have the calories and the protein to sort of recover from the treatments and the challenges that you’re facing, there’s really not much no tools your body has to help with that. So I always say eating something is better than eating nothing. So don’t take any foods off the table. If you have a wide variety of choices, given your appetite challenges, of course, we want people to consume lots of nutritious, healthy, or traditionally healthy foods.

But if you can’t do that, any food is better than no food. And that’s kind of the bottom line. And remembering that the higher fat versions of things are likely to have higher calories. If you’re choosing a supplement drink, I would look at the calories and the protein to make sure and, it’s going to be higher calorie if it’s using things like real sugar rather than artificial sweeteners. So some of those drinks are kind of tailoring to the people who want to do more keto-type diet for people who are in cancer treatment and just need more calories. You need the drinks with the highest calorie content. So I would not be using those. We want the sugar that will help to add more calories into it. 

Lisa Hatfield:

Okay, thank you. Julie, how often should patients reassess their caloric and protein intake with their healthcare team? And what signs should prompt them to seek adjustments to their nutritional plan? And are there any tools that patients might be able to use for screening and monitoring nutritional intake during cancer treatment? 

Julie Lanford:

So there are some screening tools that treatment centers will often be using. There’s like a three question malnutrition screening tool that a lot of cancer centers have integrated, and they would be using that pretty regularly, maybe not every week, but a few times throughout treatment. But generally, the things that they’re asking on that are things that any patient should, I think, be monitoring for self-monitoring or caregivers monitoring for them, which is just what is your weight status compared to what your usual weight is. And I like to compare to someone’s usual weight, as an adult and before any inkling of cancer came around. So if somebody lost weight, significant amounts of weight before diagnosis, I’m not looking at their usual weight as at diagnosis, I’m looking at their usual weight going back. And so that’s one thing is just change in weight.

If your weight is changing, that is a sign that your nutrition strategy might need a little tweaking. If your intake is not very good, that’s another sign. So those are kind of the key things is just are you able to eat? And are you maintaining your weight? Usually people are getting weighed once a week if they’re coming in for treatments regularly. Now, if somebody is not coming in very often, you probably will need to monitor your weight at home. And yes, you need to advocate for yourself in the doctor’s office, because sometimes they just don’t pick up on those changes or they don’t see them as particularly important.

So I would say that you are somebody as a patient or a caregiver that needs to kind of bring up that conversation. If you have noted a drop, and then it some drops some more, if you’re going down and up and down and up and generally staying the same, that’s okay. But if we’re seeing drops and drops and drops, even if it’s just two pounds here, two pounds there, but you’re not rebounding, then that to me is a sign you need to make a change with your nutrition strategy.

Lisa Hatfield:

Okay, thank you. And are there any tools that patients can use to monitor that? Or do you recommend just basically using the scale and identifying if there’s weight loss and notifying their health care team? Is that the best way to monitor?  

Julie Lanford:

Mainly yes, the scale is the easiest. You can do fancy things like body composition analysis, which honestly, some of those that they’ll sell to you at home probably aren’t very accurate. Perhaps they might be accurate, if you’re always comparing to yourself or if you do any workouts in the gym, and you notice that you’re just not able to do as much, but there’s so many things that impact your strength, given that you’re under cancer treatment, it’s really hard to tell. So weight is kind of the key thing. If your clothes fit differently, sometimes that can also be a sign of body composition changes, or you may notice that your body composition is changing. I would say if your body composition is changing, that also may tip you to think that your sort of exercise approach may need to be adjusted as well.

That’s the pairing of nutrition and exercise is that if your weight staying stable, but your body composition is changing, or you’ve noticed muscle loss, either through strength, or just by looking at how your body looks, you can eat enough protein, but that’s not going to build muscle, what builds muscle is using your muscles. So it needs that combination of both being physically active and perhaps using a trainer or somebody who can help you focus on different areas where you’ve noticed muscle loss, and also making sure to provide your body with those nutrients that need to build the muscles.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the experts. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

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How can diet and lifestyle changes impact cancer care and recovery? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses diet and exercise, comorbidities, self-regulation methods, and oncology dietitian support. 

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Transcript:

Lisa Hatfield:

How do patients optimize nutrition during cancer treatment? What are some actionable steps towards supporting behavior change during this critical time? I’m connecting with a respected expert to learn more on this Patient Empowerment Network RESTORE program. 

Dr. Thomson, how can changes in daily habits like diet and exercise really impact cancer care and recovery, and why is this something that patients and care partners should pay attention to? 

Dr. Cynthia Thomson:

Well, importantly, we move every day and we eat every day. And we can make decisions about what we eat and how we move that really can optimize not just our response to cancer treatment, but also our longer-term health, right? And keep that cancer at bay as well as reduce comorbidities, things like diabetes or hypertension that might sneak up on us as we age. And so it really is important to make healthy decisions about what we’re eating and how active we are as cancer patients, but also in general, everyone needs to think about these things.

Lisa Hatfield:

Okay, thank you. And Dr. Thomson, in your study, self-regulation was strongly associated with meeting nutritional and physical activity recommendations. What strategies could be employed to enhance self-regulation in cancer survivors, particularly through mobile app interventions? 

Dr. Cynthia Thomson:

Yeah, so, self-regulation is always a bit of a challenge for each of us, but it’s so important, right? And it starts really with mindfulness and really thinking about the connection between what we eat, how active we are, and how it affects our health. And believe it or not, a lot of people really haven’t given a lot of thought to that. And it’s amazing to me because as I work with patients, what I realize is when they make that connection, when they realize how much better they feel, it makes them kind of self-motivated to continue to self-regulate.

Now there are a lot of different ways you can self-regulate, and one is self-monitoring. And I think that’s probably the most common. Many of us have our watches, right? We have our little devices on our wrist that we use to monitor our activity and perhaps our sleep and maybe even some health outcomes. But in addition, you can do things like think about how you walk through the grocery store. You start in the produce section, right? Instead of going to the cookie aisle. You can think about where you park your car and are you allowing yourself to park further away so that you can walk. So setting some of those self-regulatory behaviors can really help.

You can, in terms of eating, write down what you eat. There are literally hundreds of apps where you can download information about what’s in the food you eat and guide yourself to make better choices. Most people will get tired of writing down what they eat. And so usually if people want to do kind of the written or the app approach, I’ll recommend that they pick a few days of a week or maybe the first week of the month and not burden themselves with doing this day in and day out because over time it begins to lose its excitement. The feedback that you’re getting is not quite as enticing and you begin to feel burdened and you may even change your habits for a lower quality diet simply because you’ve kind of had it with the app.

Lisa Hatfield:

Okay, thank you. Now for patients who are trying to monitor what their intake is and what their diet looks like and maybe they do have access to an app but maybe they don’t, do most cancer centers have a dietitian that a cancer patient can work with on nutritional information surrounding their cancer diagnosis? 

Dr. Cynthia Thomson:

Well, Lisa, I wish they did. But the data that we have suggests there is one dietitian for about every 1,208 patients, which is just dismal. So I do think it’s really important when you’re in care to ask for that referral and try to get in with an oncology dietitian. There are dietitians who practice outside of oncology that certainly can be helpful, but they’re not going to have the insights that you’re going to get from an oncology dietitian. You may have to go to a larger kind of academic or what we call comprehensive cancer center in order to locate a dietitian with this expertise. But I think it’s important to speak up and maybe we’ll get more dietitians on staff if patients advocate for this important information and support during their care.

Lisa Hatfield:

Okay, thank you. Dr. Thomson, how do you think self-efficacy and self-regulation can be effectively promoted in cancer survivorship programs, especially among populations with lower initial adherence to health behaviors? 

Dr. Cynthia Thomson:

Well, I think there’s a number of different ways that we can help people to self-regulate. I think the important thing is to meet people where they are. I think a lot of times as professionals, we’re really quick on giving advice that comes from our own context and our own set of values and beliefs. And most times when we’re asking people to do things that align with our values and beliefs, it doesn’t always work.

And so many times they say it’s really about listening. It’s about hearing the patient and really having patients share what is it that, why are you coming to see a dietitian or why are you interested in nutrition? What motivated you to come here today? What are you expecting to get out of these counseling sessions? And really focusing on having people understand where the gains are for them. I would say that many times it’s important to think about knowledge, right? Because a lot of times people will not have the foundational knowledge to make the right choices.

And certainly we need to support knowledge, but it really is much bigger than that. We have to support self-efficacy. We have to help them build belief in themselves that they can adapt a whole new dietary plan if that’s what is necessary. And so I think it’s really important for us to reward good behavior, support them in any way with information or advisement when they ask for it. And then also to really make sure that we repeat, repeat, repeat. Because I think a lot of times, especially patients in cancer therapy are dealing with a lot. And if you’re trying to work on changing your diet on top of everything else, sometimes it goes in and out and you have to kind of be there to repeat the messaging and support all along the way.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

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What are nutrition and intervention strategies for age-inclusive cancer survivorship? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses cancer research studies on diet and exercise behaviors, strategies to make studies more age-inclusive, and ways to increase self-determination in cancer survivorship.

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

Navigating cancer treatment is challenging at any age. How can age-specific strategies support better outcomes for cancer patients? I’m getting insightful answers from a leading expert in this edition of the Patient Empowerment Network RESTORE program. 

Dr. Thomson, your study suggests that age at diagnosis was not a significant effect modifier. What implications does this have for designing interventions that address diet and physical activity behaviors across different age groups? 

Dr. Cynthia Thomson:

Yes, I think it’s really important when we think about designing studies that we think about what is best for the individual patient, right? And, unfortunately, when we’re designing trials and we’re trying to evaluate diet and physical activity, we have to keep what’s called treatment fidelity. We have to kind of give everyone the same package, right? Because we want to know if this package works.

On the other hand, we know that patients do best when we individualize that care. And so it’s kind of a dance that we do as researchers to make sure patients get what they need, but also are relatively adherent to a plan that we’re testing with hypotheses. And so I would say that in some of my research, age has not been an effect modifier. In others, it has. And it really comes down to two things, I think. One is in individual studies, the age range may be very narrow, right? A lot of times when we go to do exercise and diet studies, we focus on, oh, we don’t want anyone who has heart disease, or we don’t want anyone who might fall, or we don’t want anyone who’s, we’re going to drive up their blood pressure.

And so in order to keep things safe, we may develop an age range for enrollment in our trial that kind of excludes people at either end. And so that lack of significance as an effect modifier may just reflect that it was a pretty narrow age range. The other thing is I always tell people when I hang up my flyer and say, come join my diet and physical activity study, cancer survivor, we need you. It attracts the people who are already walking, the people who go, well, I’m a vegetarian, I’d be great for this study. And so one of the things that we really need to do in research is to be more inclusive and to get those different age groups into different studies. And we are starting to do that. I think there are more and more studies that are reaching higher and higher age groups, younger age groups, trying to be more inclusive.

Lisa Hatfield:

Okay, thank you. And then considering that health behaviors and beliefs among adolescent and young adults and adults or older cancer survivors were found to be similar, how should this influence the way that we approach the development of age-inclusive survivorship care plans? 

Dr. Cynthia Thomson:

Yeah, so care plans I think are imperative to really help people kind of have that self-determination about where they’re going during and after their cancer journey. And I think it’s important to think about age. I think it’s also important to think about race, ethnicity, resources that individuals have. We need to think about the individual overall and adapt our care plans to meet individual goals and individual needs. Even things like language, preferable language, many times are not addressed during cancer care or survivorship. And so we really have to get back to that and make sure that we’re meeting all of those needs across the spectrum of cancer survivors that we treat.

Lisa Hatfield:

Okay, thank you. And I just want to clarify a little bit the word or the term survivorship care plan. What exactly is that and what would that include for people who are wondering, hmm, I don’t have, I’m a cancer patient, but I don’t have a survivorship care plan. What might you tell them about that? 

Dr. Cynthia Thomson:

Usually it’s the nurses that really take charge of helping patients develop their survivorship care plan. And really, this is a written plan that goes within your medical record that really details, what your current health status is, what your goals are as a cancer survivor. It may even detail different resources, different providers you need to meet with, the frequency that you need to follow up on your survivorship care. And so diet and physical activity should be part of that survivorship care plan, but those plans are much broader. They’re really addressing all of the healthcare needs that a cancer patient will need to tap into both immediately and long-term.

Lisa Hatfield: Okay, thank you for explaining that. You heard it here directly from Dr. Cynthia Thompson. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

Does Diet Adjustment Impact Cancer Care?

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How is cancer care impacted by diet adjustments? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses potential impacts of strategies for symptom management, immune response, nutrient deficiencies, inflammation, and diet patterns. 

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

How can adjusting your diet support you through your cancer journey? I’m excited to connect with a top expert to help us find the answers on this Patient Empowerment Network RESTORE program.  

Dr. Thomson, what are the key components of nutrition that patients should be thinking during their cancer treatment? 

Dr. Cynthia Thomson:

I think to start with, people need to think about what kind of symptoms they might be having during treatment and how can nutrition help them manage symptoms because I think symptom management is probably the most central nutritional issue in terms of making sure people can get through their cancer treatment in a timely manner that aligns with the prescription and optimizes their outcome after treatment. So I think managing those symptoms is one of the key components.

The second is to really do an assessment of what you’re eating and the quality of that diet. Are there nutrient deficiencies that need to be addressed and really honing in on specific nutrients or eating patterns that need to be evaluated and addressed. And then I think the third is really to move towards that long-term cancer survivorship eating plan. Where we’re really promoting a diet that’s more plant-based, a diet that is going to help reduce comorbidities, a diet that’s going to help you have the highest level of vigor and vitality after treatment. And so it’s kind of a continuum from symptom management, address those deficiencies and inadequacies in the diet, and then let’s go after optimization to reduce any risk of cancer recurrence as well as keep us healthy overall.

Lisa Hatfield:

Okay, thank you. And, Dr. Thomson, can you speak to the connection, if there is one, between the immune system and blood type and its impact on diet for cancer patients? And is this a consideration during care for you and your colleagues while supporting patients through their cancer journey? 

Dr. Cynthia Thomson:

Yeah, so I do think there are a number of different, what we call fad diets, like the blood type diet, that are intriguing. Could our blood type actually dictate what diet we should be on and what diet is optimal for our health? I would say that there’s just a total lack of evidence for the blood type specifically. And so will research evolve in the future? I don’t know. I think right now we need a lot more preliminary evidence that this matters, and this is an important factor before we would move forward.

In terms of the immune system, I think this is where diet is critical, as well as physical activity. There is a lot of evidence that when we get active and when we eat certain foods, we can modulate how our immune system responds. And in fact, our immune system is the checkpoint, to make sure cancer does not develop in our bodies or that when it does develop, we can counter it.

I think it’s really important to think about what we eat and our physical activity to enhance our immune system. And I’ll give you, One of the more common examples is adequacy of vitamin C and making sure that we have adequate vitamin C for our immune system to respond. We also know that people who are deficient in vitamin D can have lower immune response. It can happen with other nutrients as well, but on the other side, we have things like inflammation, which is a hallmark of cancer. And so If we can select dietary components that are anti-inflammatory that reduce the inflammatory response within our bodies, then that also can help to modulate our cancer risk. So I think this connection between lifestyle behaviors and the immune system is critical. It is the primary mechanism by which these health behaviors protect us and keep us healthy.

Lisa Hatfield:

Okay, thank you. I do have a follow-up question. As a cancer patient myself, and I know you’re a cancer survivor also, so we hear a lot about different diets, the blood type diet we just talked about, and then things like the keto diet, eat more protein, eat less protein, eat plant-based, importance of the health of the gut microbiome. Is there any evidence that any one type of diet works better than another when it comes to not just cancer prevention, but maintaining where we’re at with our cancer, whether it’s curing it or maintaining, stabilizing the cancer when it’s not curable? Do you have any comments on that? 

Dr. Cynthia Thomson:

Yeah, I mean, I think, first of all, there is a lack of randomized controlled trials, what we consider the gold standard, right? So, in terms of, can I say to you, we have 18 studies that say, the Mediterranean diet is the way to go. We don’t have that. What we do have is a lot of what we call epidemiological data.

So when we look at the diets of individuals who are either prior to their diagnosis of cancer, during their treatment, or after their treatment, we have increasing evidence that people who eat certain diet patterns, like a Mediterranean diet, like an anti-inflammatory diet, or score high on what we call the healthy eating index, where the quality of the diet is very plant-based, lower in fat, lower in processed foods, particularly processed meats. When those patterns are followed, we see better outcomes in terms of survival, but we also see that we can modulate certain inflammatory responses, oxidative stress, et cetera, that lead to cancer. So the mechanisms are there as well.

Lisa Hatfield:

Is there any evidence that there are cancer superfoods that might help stop the cancer or prevent cancer? I hear about blueberries being a superfood. Can you name any superfoods, or is there evidence to support that? 

Dr. Cynthia Thomson:

Well, I think we all have our own superfoods, right? Broccoli, because it’s a cruciferous vegetable, or garlic and onion, which are known to enhance immune response against viral infections, or, on and on and on omega-3 fatty acids. And it could go on and on. So I always hate to say that any one food is going to prevent cancer. That is so unlikely. If there is one, it must be hidden somewhere. I just can’t imagine and so it really and increasingly we know this.

It’s a diet pattern, right? Like if you are, Lisa, putting blueberries on your cereal every morning, but that cereal is Cap’n Crunch or some other sugared cereal versus something that’s higher in fiber, like steel-cut oats or, you know. So I feel like we cannot look at foods in isolation because while one food may have a beneficial effect, we can easily counter that by making other choices that are not so healthy. And so we can eat this anti-inflammatory food and then counter it with a pro-inflammatory food. So it’s really the pattern of eating that we need to think about.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

What Is an Oncology Dietitian vs. a Nutritionist?

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Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses the differences in education levels, training, and continuing education for dietitians versus nutritionists and the meaning of registered dietitians and registered dietitian nutritionists.

Download Resource Guide

See More from RESTORE

Related Resources:

Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 
 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

Dr. Thomson, can you explain the difference between a dietitian and a nutritionist, and why it’s important for patients to seek out the appropriate person, maybe in their cancer center and oncology dietitian when receiving care for cancer? 

Dr. Cynthia Thomson:

Yeah. Definitely. So a registered dietitian, or what we call an RD, similar to a registered nurse, RN, right, they have had a four-year undergraduate degree that is extremely heavy in the sciences, chemistry, biochemistry, physiology. They understand how nutrients are metabolized and how the body processes nutrients to optimize health. In addition, after all of that four-year degree, which is pretty much equivalent to a pre-med degree, they will then go through an internship where they’re supervised by professionals in the field and spend quite a bit of time in the clinics with patients, learning the day-to-day application of all that knowledge that they’ve learned. It’s a five-year commitment for most individuals.

And then they have to pass a registration exam. And then on top of that, they have to stay up-to-date in terms of continuing education, right? They can’t just walk away and then for the next 30 years practice nutrition without being up-to-date. And so it’s a pretty intensive process and a lifelong learning process. In contrast, the nutritionist could be anybody. Lisa, you could decide today, you’re a nutritionist. Technically, in many states, you could hang up a shingle and say, come see me, I’m a nutritionist. And so it gets a little confusing, because people assume that people who say they’re a nutritionist know nutrition.

And, unfortunately, over the years, it has been very difficult to convince people or even educate them on what a registered dietitian is. So about a decade ago, the Academy of Nutrition and Dietetics, which is the professional organization that registered dietitians belong to, decided maybe we should opt to call ourselves registered dietitian nutritionists RDN, because then people would start to put it together that there are different kinds of nutritionists. And so many dietitians have moved to the title of RDN, others who’ve been in the field longer may have chosen to stick with the RD only. And so really look for an RDA or an RD when you’re looking for professional help, because you know you have a highly qualified individual.

When I became an oncology dietitian, my whole day was about taking care of cancer patients. I wasn’t seeing one cancer patient and five heart patients and two pediatric patients. I was seeing oncology patients, inpatient, outpatient, all different cancers at all levels of care. And so I really understood the disease process and how it affected the nutritional status of my patients. And so it’s just a matter of an oncology dietitian is really going to have that certification above and beyond the RDN that says, I know my stuff, and I’ll share it with you. And they also have to go through an exam, a special exam to be an oncology dietitian, and they have to repeat that exam every five years, so very intense. You get what you pay for, and the dietitians who put them through, themselves through all that training do so because they know that’s what’s best to meet the needs of their patients.

Lisa Hatfield:

You’ve heard it straight from Dr. Cynthia Thomson. Thanks for joining us on this RESTORE program. I’m your host, Lisa Hatfield. 

Equity in Cancer Care: Accessing Lifestyle Medicine for All

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How can ethical disparities toward equity in cancer survivorship be addressed? Expert Dr. Amy Comander from Massachusetts General Hospital discusses lifestyle medicine and methods and resources to help close disparities in optimal cancer care. 

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Related Resources:

Enhancing Cancer Survivorship Through Wellness Strategies

Enhancing Cancer Survivorship Through Wellness Strategies

 Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

 What Are the Benefits of Early Integration of Lifestyle Medicine?

What Are the Benefits of Early Integration of Lifestyle Medicine?

Transcript:

Lisa Hatfield:

Addressing ethical disparities in cancer survivorship is crucial for ensuring everyone has access to the best care possible. Is this a much bigger task than experts may realize? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program. 

Dr. Comander, how do you approach the ethical disparities in cancer survivorship interventions, and what steps do you advocate to ensure equitable access to lifestyle medicine and resources?

Dr. Amy Comander:

This is such an excellent question and definitely at top of mind all the time when I’m thinking about our lifestyle medicine program and the various offerings that we have at our hospital. How can we reach out to other communities that may not have access to these tools? For example, two summers ago, I collaborated with a colleague at a hospital in downtown Boston where they don’t really have as many survivorship resources for their patient population.

And we did some group education programs about lifestyle medicine. And I’ll just give you an example. We talked about exercise. And one of the women raised her hand and said, “In my neighborhood, I don’t feel comfortable going outside for a walk. So how am I really going to get this exercise in? I just can’t really walk around in my neighborhood.”

And I think learning from our patients about these concerns is so important. I will say that in that group setting, another woman raised her hand and said, “Well, I went to Target and bought these stretchy bands, and I learned how to do some of these exercises at home. And that’s what I do.” And that led to a really great conversation amongst the participants in the room.

So I do think this is really important. We do need to think about how can we bring these tools from lifestyle medicine to help all individuals facing a diagnosis of cancer. And certainly through the American College of Lifestyle Medicine, the organization that I’m very involved in, we do have an initiative called HEAL. Which is really focused on healthcare disparities and bringing tools from lifestyle medicine to all communities. So thank you so much for asking this important question.

Lisa Hatfield:

Okay. Thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.