Dos and Don’ts of Supplement Intake During Cancer Treatment

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What are the dos and don’ts of supplement intake during cancer treatment? Registered dietitian and oncology nutritionist Julie Lanford discusses potential issues and strategies to help ensure the best care if taking nutritional supplements during cancer treatment. 

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How Do Nutritional Deficiencies Impact Cancer Treatment?

Transcript:

Lisa Hatfield:

Navigating supplement intake during cancer treatment could be complex. Knowing what to include and what to avoid is crucial for supporting your health and enhancing treatment outcomes. As part of the Patient Empowerment Network RESTORE program, we’re exploring the best practices for supplement use during treatment. 

Julie, what are the key dos and don’ts when it comes to taking supplements during cancer treatment, and how can patients ensure that they’re choosing the right supplements without interfering with their treatment? 

Julie Lanford:

Yeah, well, I guess the number one do is to make sure your medical team knows what you’re taking. And the number one don’t would be, don’t hide what you’re taking from your medical team. Maybe the number two do is follow their advice. A lot of us in oncology care are very cautious about supplements, and the reason we’re cautious is kind of twofold. One, there’s not a lot of great data suggesting that taking nutrients in pill form is beneficial.  

When you have a nutrient deficiency, that’s when you need to take a supplement, and you take it for a period of time and monitor that clinical outcome to see is it helping? And do I need to stay on it or not? The things that I don’t want people to do are to just take supplements because someone told them it would be good for them, and they just take it, and they don’t even really know what they’re taking. Those are, to me the situations where we’re like, eh, let’s not do that.

The supplement industry is not regulated in the same way that food and pharmaceuticals are, so they’re sort of free-range industry. They don’t have to show the same kind of data that pharmaceuticals do. They don’t go through the same quality standards that food does. So my biggest concern is actually that a supplement would be contaminated with something harmful, which we have seen happen many times. But you won’t know necessarily that what they say is on the bottle is what’s actually in it.

So what I want to do with people is to make sure that they’re only taking, nobody wants to take extra pills. Especially people who are already taking lots of medication, they don’t want to take extra pills. So let’s not take extra pills if we don’t have to. So a lot of times, we’ll actually take people off any regular supplements that they’re taking if we don’t think that they’re necessary, or if we think they might be harmful. So really pairing it down can be helpful. And then always showing the bottle to your treatment team, so they can find, look, and just see if there’s anything questionable in it that you want to be concerned about.

Lisa Hatfield:

All right, thank you. Are there any specific supplements that should definitely be avoided or carefully monitored? We hear a lot of cancer patients, and I hear a lot of suggestions. Take turmeric or tauroursodeoxycholic acid (Tudca). Are there any that you would say not to take in general? 

Julie Lanford:

Yeah, antioxidant supplements are generally things we don’t want people to take. And then things like St. John’s wort can commonly interact with a lot of different oncology medications. So those are kind of two major ones that we often tell people not to take. I don’t think that it’s necessary to take anything more than just a regular multivitamin if you want to be taking something. And most treatment centers will kind of have that as their policy that during treatment they don’t want you to take anything except a multivitamin.

And then after active treatment is over, then you can have a discussion about what might be safe to sort of restart if you feel like you really need them. So those are the ones that we would want to be cautious with. But then again, if somebody is deficient, so if you’re low in iron or low in vitamin D, you do need to take a nutritional supplement. Sometimes you can get pharmaceutical versions of those, which I think is nice because then it guarantees a safety standard but sometimes, then the price is off the roof. So definitely, in partnership with your medical team is what you really need for those supplement and sort of herbal strategies. 

Lisa Hatfield:

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

How Do Nutritional Deficiencies Impact Cancer Treatment?

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Registered dietitian and oncology nutritionist Julie Lanford discusses nutritional deficiencies for cancer patients, monitoring of deficiencies, and advice to help address nutritional deficiencies for optimal patient wellness. 

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Dos and Don’ts of Supplement Intake During Cancer Treatment

Dos and Don’ts of Supplement Intake During Cancer Treatment

Transcript:

Lisa Hatfield:

Nutritional deficiencies can significantly impact your health and treatment outcomes, but identifying them early and managing them effectively is key. As part of the Patient Empowerment Network RESTORE program, we’re exploring how to recognize these deficiencies and the role of regular follow-up with a dietician.

Julie, how can patients identify if they are experiencing a nutritional deficiency, and what tests or assessments are typically used? 

Julie Lanford:

Yeah, so it really depends on what type of cancer, what type of treatment and sort of each person’s medical history in terms of what we might monitor. In general, first of all, we want people to maintain their weight. We want them to get enough calorie and protein needs.

So, that’s one sort of major thing that we look at. But when it comes to nutritional deficiencies, most people think of sort of micronutrients, so vitamins and minerals that their body needs to function. If they don’t have enough of it, your body just doesn’t function as well. And there are some common deficiencies that we do see with various types of treatments.

So, that’s a great question for your nurse, your chemo teaching nurse, or your nurse navigator or your physician team is to ask, hey, are there any things I need to know about risk for nutritional deficiency with this particular type of treatment or this particular type of cancer? The general things that I would be watching for, iron is a big one.

And I recently read a study that a lot of people are sort of underdiagnosed in the oncology population regarding iron deficiency. So, that can be picked up on with regular lab work. Just hemoglobin often can give that picture. But if there are some physical signs of iron deficiency and hemoglobin is normal, you can still ask for an iron panel if it’s warranted.

So you can always mention that to your doctor. The signs I would be looking for is, if you have a lot of fatigue, which…that’s always another thing. How do you know if you have more fatigue than the normal person getting cancer treatment? But you should kind of know yourself and if you’re adequately getting enough calories and enough protein and hydrated, but you still really feel like something is off with your energy, I think it’s a valid reason to at least check into an iron panel and see if that’s contributing to it.

So that’s one thing. A lot of the other labs are being checked pretty regularly for most people who are currently under treatment. Now, if you’re somebody who’s on like an active sort of maintenance treatment or you’re done with treatments or on a treatment break, you may not be getting lab work nearly as often.

And so really paying attention to whether if something off, you can always ask for lab work and typically it’s paid for if there’s a good reason to do it. So oh, I’m having a lot of fatigue or I’m feeling muscle soreness or things like that where it might trigger a thought that, hey, is your potassium low? Is your magnesium low? They’re pretty easy to check for though.

So most of the time, what I find with oncology active treatment people is that they are getting lab work done regularly, and they can look over their labs if they don’t see some of the things they want to see. They can always have a conversation with their medical team to say, hey should I have an iron panel checked? Should I have vitamin D checked? How is my just general lab work? And they can go through it with you, so that you have an idea. Usually it’s, people are pretty on top of it, but I also say that asking is always a good idea.

Lisa Hatfield:

Okay. Thank you. Julie, what role does regular follow-up with a dietician play in managing and preventing nutritional deficiencies? And if I did want to see a dietician and my oncologist has not recommended that, can I just ask for a referral to the dietician at our cancer center? 

Julie Lanford:

Yeah, so it really is going to be cancer center-specific. A lot of the larger cancer centers tend to have full-time dietitians, more than one available. A lot of times, they specialize in certain types of cancer. But if you are at a smaller cancer center, they don’t always have the resources to pay for a full-time dietician. They may have dieticians in other parts of the hospital that they can sort of pull on when they need it. So it can be challenging just depending, but I always tell people to start with their treatment center. 

Even in my area, there are two treatment centers here, and I work at a local nonprofit, so I’m not even part of any of the treatment centers. And both of our treatment centers here have two or three dieticians on staff for their treatment center. So whenever somebody local to my area comes to me, I always point them back say, have you asked at your treatment center? Because they may not even know they have a dietician available.

So definitely asking even if the doctor has not recommended it, you can still ask if nutrition consults with a dietician are available, and they should be able to answer that question. And then if you don’t have access to one at your treatment center, you can look for a local dietician. There are a lot of dietitians in private practice. They may or may not have oncology experience, but they probably can help troubleshoot some things.

Like all dietitians should be able to help you meet calorie needs with some various food ideas. So those are also, I think, good options. And eatright.org is also a national organization of all types of dieticians, and they have a find an expert search as well. So I would start with your local treatment team, and if they can’t find you somebody there, then you may have to kind of dig around a little bit.

Lisa Hatfield:

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

How Can I Stimulate My Appetite During Cancer Treatment?

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Registered dietitian and oncology nutritionist Julie Lanford discusses ways for cancer patients to stimulate appetite and strategies for improving calorie intake to help maintain wellness. 

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Transcript:

Lisa Hatfield:

Managing appetite loss during cancer treatment can be a significant challenge, but are there strategies that can help? In this Patient Empowerment Network RESTORE program, we’ll explore practical tips and techniques to help stimulate appetite and hopefully make mealtimes more enjoyable.

Julie, what are some effective ways to stimulate appetite during cancer treatment? And are there specific foods or meal strategies that can help make eating a little bit more appealing? 

Julie Lanford:

Yeah, so I think the most effective way is to allow yourself the freedom to eat what sounds good to you, no matter the time of day or whether it’s a food that typically goes at that time of day. So for people who are facing appetite challenges, remembering that any food is better than no food lowers the bar on your expectations. I think a lot of people get caught up in like, well, I should only eat “healthy foods.”

Well, at this point, if you are in a position where you don’t have much appetite, I just want to remind you that any food is better than no food. So things like milkshakes are okay. If that’s all that sounds good to you, go ahead and eat them. All the things that maybe you historically might not have let yourself or your children consume at breakfast, you could just go ahead and, like, throw the rules out and give yourself the freedom to eat anything that sounds good to you, which can be kind of fun, I think, in a way. It’s not fun to not feel like eating, so I think that is a significant issue.

And then, so I would say don’t eat your favorite foods, thinking that you might not tolerate them so well. But anything that sounds like you could get it down would be my first thing to think of. And then there are some strategies around meals that can help.

If you notice that you tend to be able to eat soft foods better than foods you have to chew a lot, then we might suggest more of a soft food or liquid diet. If you notice that hot foods don’t go so well for you or cold foods don’t, then finding either room temperature foods or hot foods or cold foods, depending on what it is. I think so those are kind of sensory-type things. And then the other thing is just that we know that yellow and red colors can help stimulate the appetite. McDonald’s and Burger King aren’t stupid. They have chosen colors for a reason.

So we will also recommend, like, do you have plates or cups or table, table, I say tablecloths, if you have placemats in that color, so yellow or red, that can sometimes help just, like, give one little extra boost that your appetite needs to get to get that down. There are some medications that can help with appetite. Of course, there are always side effects. And for a lot of people in cancer treatment, it’s like you’re already on so many medications. Do you want to spend one more? 

So I do like trying out all these other strategies first to see if we can sort of put together some kind of formula that works for you, that just gets you enough motivation or your body enough receptivity to the food to get it down and meet your needs. But if those aren’t working, definitely talk to your medical team about what types of pharmaceutical options might be available to help get that food down. 

Lisa Hatfield:

Okay, thank you. And just a side tip that I learned from an occupational therapist, she told me if I either have a bread maker or can borrow a bread maker that the smell of fresh baked bread can sometimes stimulate appetite. So I didn’t have a problem with appetite on my high dose steroid days, but otherwise I did and it did seem to help and maybe just feeling like I was productive and made a loaf of bread helped too.

But anyway, that’s just a tip for patients, they might want to try it also for stimulating appetite.

Julie Lanford:

Yeah. And then you have fresh bread, and that’s amazing. 

Lisa Hatfield:

Great, yeah.

Julie Lanford:

Fresh food itself that can really be much more appetizing than something that’s maybe not so fresh.

Lisa Hatfield:

Right. Yeah. Thank you. Julie, are there specific types of foods or meal patterns that might help make eating more appealing and manageable? 

Julie Lanford:

Yeah, I think that, again giving yourself freedom on the food choice, but also give yourself freedom on the portion sizes of food. So what you might be used to is larger portions on your plate, but maybe you can’t tolerate a lot at a time. Your stomach is just not settling so well, and you need to eat smaller amounts more frequently.

So often setting a timer for every two to three hours and eating a small amount each of those times might be more effective at meeting your calorie needs without causing too much overfullness for your appetite. And then making sure that the foods you consume are as high-calorie as possible. So choosing the higher fat versions of things, choosing the things that don’t have artificial sweeteners in them, because we are going to want all the calories possible in the food choices that you eat, especially if you’re not able to eat as much volume as you have been before.

And then using beverages to get extra calories in is also important. So it can hydrate you, but also provide extra calories. So juices, milk, even some of like Gatorade will give you a little bit of calories in with those electrolytes. So those are types of things. And then, of course, protein shakes or any types of smoothies you can make yourself will help get extra calories in.

Lisa Hatfield:

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

How Is Hydration Managed During Cancer Treatment?

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Registered dietitian and oncology nutritionist Julie Lanford discusses general hydration needs, how needs may vary during cancer treatment, and tips for maintaining hydration levels. 

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How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

Hydration is a crucial aspect of supporting your body during cancer treatment. But what should patients know? Can side effects like vomiting and diarrhea make you lose too much fluid? I’ve connected with a leading voice on this topic, and we will get some answers right now on this Patient Empowerment Network RESTORE program.

Julie, it may seem like a silly question, but how much water should patients be drinking each day while undergoing cancer treatment? And can too much or too little trigger side effects? 

Julie Lanford:

Yeah, so we talk in general about water intake. And we often, the guideline is eight to 10 cups per day, which is somewhere between 64 and 80 ounces, if you do your math. And that’s the general good guide.

Now, if you have a treatment regimen, where the doctors are like, Make sure you hydrate really well for the next two days, somesome chemos are pretty toxic to the kidneys. And so they want you to take in lots and lots of extra water to kind of flush that out, then you would want to be doing 10 cups and maybe a little bit more. You know, technically people can consume too much water, it would take a lot, and it would take you consuming a lot at one time in order for you to cause a lot of problems.

The other sort of risk in terms of taking in too much water is if you’re not eating very well, and you’re not getting your electrolytes, and you’re just drinking plain water, sometimes that can cause a balance issue with the electrolytes in your blood. So if you are somebody who’s nauseated, having lots of diarrhea, and you’re just drinking water, I would suggest you have some type of oral rehydration beverage, you can make some yourself. But the easiest thing is something like Gatorade or Pedialyte, or even just diluting juice and adding a little bit of salt to it, something that helps get your body those electrolytes in addition to the water, because that’ll just help everything function better.

But let’s assume that you can eat okay, then generally eight to 10 cups of a beverage a day should meet your needs. You definitely can get too little water, that is always a challenge. And usually a sign of not enough water is when you get lightheaded standing up, or you have lost weight really quick, like, I don’t know, two pounds over a day, or five pounds over a day. That to me is a sign of fluid loss without being replaced, which can happen if you are having a lot of vomiting and diarrhea, which just pulls a lot of water out of your body.

And so those oral rehydration solutions, which have the electrolytes mixed in with the water really can help you from sort of getting overly dehydrated, because the last thing you want to have to do is go over to that hospital. But if you have lost fluids really, really fast, and you are nauseated, you can’t keep anything down, or you cannot stop the diarrhea, you will feel better if you go over there and get hydrated.

That’s what I always tell people, especially if it’s a Friday. Nobody wants to have to deal with the hospital, but you can feel pretty awful if you’re dehydrated, it’s very risky. So it can be challenging. But unlikely to get overhydrated, probably more likely to get dehydrated.

Lisa Hatfield:

Okay, thank you. Julie, are there specific hydration strategies or recommendations to follow? And how can patients address common hydration challenges and ensure they’re meeting their fluid needs effectively? 

Julie Lanford:

Yeah, so I think the challenge often is that you don’t realize how much time has gone by since you’ve had something to drink. So a couple things, monitoring your weight, if this is a significant risk for you, you want to pay attention to if your weight is staying stable. And then the other thing is to go ahead and fill up a big jug.

 So if it’s 64 ounces, or you want to do two jugs a day, and drinking from that, so you know how much you’re having, it is also perfectly fine to get your water from juice, from different beverages, even coffee and tea. I know some people like to say, well, if it has caffeine, it’s dehydrating you. It’s not really that much anyway.

And if that’s all that tastes good to you, it’s better off to get that. So I think spreading your beverages throughout the day. So setting a timer, have four ounces or eight ounces every hour or two, and allow yourself the freedom to choose whatever beverage you think will taste good to you.

If you’re tired of the sweet stuff, let’s say you’ve kind of existed on like Ensure and Gatorade for days, and you’re so sick of the sweet taste. Broths are something that can help hydrate you. Milk is a great option to give you nutrition and hydration. You can get lactose-free if you don’t tolerate lactose, but those also give you  that water along with the nutrition. So those are kind of my basic guidelines for doing that. And then just making sure that you’re letting yourself have things that taste good to you so that you’re more motivated to get it down.

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. 

Enhancing Cancer Survivorship Through Wellness Strategies

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How can wellness strategies enhance cancer survivorship? Expert Dr. Amy Comander from Massachusetts General Hospital discusses research on lifestyle interventions, the role of nutrition and gut microbiome, and other impactful lifestyle interventions.

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Transcript:

Lisa Hatfield:

Ensuring overall well-being during cancer treatment involves more than just addressing the illness itself. Wellness strategies are key but do they really optimize the health of cancer survivors? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program. 

Dr. Comander, what are some of the most effective wellness strategies you recommend for patients to incorporate during cancer treatment to support their overall well-being?

Dr. Amy Comander:

I’m really excited that over the past few years, we’re seeing more and more research demonstrating the important role of lifestyle interventions in terms of improving our patient’s outcome after a diagnosis of cancer. So I’m a breast oncologist, and of course there’s so much data in the field of breast oncology. But now we’re seeing so much data emerging with regard to individuals with prostate cancer or gynecologic cancers or hematologic malignancies, such as multiple myeloma.

So this is really an exciting time to be paying close attention to this field. So when you say, what are some of the most effective strategies? I have to pick my favorite exercise. This field of exercise oncology is really exciting, demonstrating that individuals who are able to engage in physical activity after their cancer diagnosis have improved quality of life, reduce cancer-related fatigue, and in many cases, improve outcome. And a lot of this data has certainly come from the field of breast oncology, but again, we are seeing it more and more in other types of cancers as well.

In terms of other wellness strategies, we’ve talked a lot about the important role of nutrition and thinking about some of those key concepts of what we consider an overall healthy diet, a predominance of fruits and vegetables, whole grains, limiting red meat, avoiding processed foods, and avoiding sugar-sweetened beverages and alcohol. So that’s kind of all part of a healthy diet that we think about. But more and more research is also demonstrating that diet can actually potentially influence outcome as well. And there’s a lot of research trying to understand the mechanisms of this.

And I think if your listeners are wondering, what’s an area where I can read more about this? I feel like the gut microbiome, learning more about that is really interesting. We know, for example, in the field of multiple myeloma research, or in the field of looking at immunotherapy drugs, a healthy, diverse gut microbiome, meaning those bacteria in your GI tract have favorable characteristics, and they’re very diverse and healthy, that is a reflection of the diet. Lots of healthy fruits and vegetables, fiber in the diet helps result in a healthy, diverse gut microbiome, which in emerging studies is showing that that is associated with an improved microbiome responsiveness to certain drugs, particularly immunotherapy.

So this is an exciting time. The field is evolving, but I’m excited to learn more as we continue to see these studies emerge.

Lisa Hatfield:

Thank you. And, Dr. Comander, how do you see lifestyle medicine contributing to optimizing the health of cancer survivors, particularly in reducing late effects and improving overall well-being?

Dr. Amy Comander:

I’m a strong advocate that these tools from lifestyle medicine should be a part of every patient’s cancer treatment. And these are pretty basic things when we think about, again, physical activity, encouraging exercise, following a healthy diet pattern, getting adequate sleep, social connection. Actually, let’s talk about social connection. I feel like that’s one when I first started getting to this field, I’m kind of like, yeah, social connection, that’s important.

But I will tell you, as I’ve been doing this more and more and working with groups of patients, focusing on providing education about diet and exercise and stress management and sleep and all of these important things that we’ve been talking about, I’ve noticed that the support from other individuals who truly get it, if you bring a group of patients together who are all going through treatment for multiple myeloma, or prostate cancer, or breast cancer, or whatever it may be, that support piece, talking to another person who’s facing the same challenge, who might want to meet you at the YMCA and go to that exercise class, or might be willing to text you, “Hey, how are you doing with those salads you’re trying to have for lunch each day?”

That accountability and support is such an important component of health. And I think we really learned during the pandemic how much social connection and support is so integral to our health. So I think in the field of oncology, the work this organization does, and so many others, that building up community, social connection, social support is really something we should invest more in to help improve the health and well-being of our patients with cancer.

Lisa Hatfield:

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

How Can I Maintain a Healthy Diet During Ongoing Cancer Treatment?

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How can cancer patients maintain a healthy diet during and after cancer treatment? Expert Dr. Amy Comander from Massachusetts General Hospital discusses common side effects of cancer treatment and advice for boosting nutrition during and after cancer treatment.

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Transcript:

Lisa Hatfield:

As a patient living with cancer where there’s no cure and treatment is ongoing, I’m constantly navigating the challenges of maintaining my health during treatment and avoiding unwanted side effects. Nutrition is a big part of that, but it’s not the whole picture. I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program.

Dr. Comander, how can patients manage treatment side effects that affect their appetite or ability to eat? And what role does hydration play in supporting cancer treatment and recovery?

Dr. Amy Comander:

We know that many individuals going through cancer treatment really have a poor appetite, often don’t feel like eating, and this can be due to a multitude of factors. Maybe it’s due to nausea from the medication, or other side effects from the chemotherapy agents or other medications that a patient’s taking. So this can really be a challenge. And I encourage a patient to really talk to his or her doctor about these concerns if really poor appetite is a major problem because, yeah, actually sometimes there’s strategies we can think about, sometimes there’s medications that can be helpful to boost the appetite, or sometimes it’s really thinking about introducing certain foods that may perhaps be appealing, such as making a smoothie.

Sometimes maybe you weren’t a smoothie person before going through cancer treatment, but now that might be a great way to get in some calories. Obviously you can put a lot of healthy things into a smoothie. So this is one strategy that some of my patients employ. But I certainly encourage someone listening to this to kind of talk to their doctor about this, if it’s a real problem like not being able to eat.

In terms of hydration, we know that is so important. Many of our treatments get metabolized by the liver or cleared by the kidneys. So it’s really important to stay well hydrated, especially in the summer months, if it’s really hot outside. So I always encourage my patients to have a trusty water bottle by their side at all times.

There’s so many fun water bottles out there, so I’m like, “Get one that you like. If it has to be pink, that’s great, whatever it is,” but have a water bottle with you at all times. Certainly think about water, other drinks with electrolytes, some people like Gatorade, whatever that might be, but it’s really important to be drinking throughout the day to stay hydrated, to keep yourself healthy as you’re going through cancer treatment.

Lisa Hatfield:

Okay, thank you. Dr. Comander, what strategies do you recommend for cancer patients to maintain adequate nutrition when experiencing treatment side effects such as nausea or taste changes? And additionally, are there specific foods or supplements that can help alleviate these side effects?

Dr. Amy Comander:

Right, so many patients when they’re going through chemotherapy, or receiving other treatments for their cancer, really note nausea, changes in taste, and have a really tough time finding what they want to eat during this time. And I will say, obviously, sometimes it’s playing around with the diet to find what things work and what things don’t work. And often that’s the first thing we might try. But if nausea is the primary issue, I will say we now have such an amazing array of anti-nausea medications that we can use for our patients going through chemotherapy.

And these are really game changers in the field of oncology. I can just see it even over my career how some of the newer medications we have, such as olanzapine(Zyprexa), to use for nausea, are really beneficial. So I think if you’re going through chemo and having a real hard time with nausea and that’s preventing you from eating, talk to your doctor. “What other anti-nausea medication can I consider taking so I can get nutrition into my body?”

Taste changes, it really is something that can evolve often during active chemotherapy treatment. Patients may experience that. It tends to get much better when you’re done with some of these drugs, such as cisplatin, for example, that can cause a lot of changes in taste. So that’s usually something that’s hopefully more of a short-term thing and will get better with time. In terms of specific foods or supplements, I really very much advocate that my patients get nutrition from whole foods with a focus on fruits and vegetables and whole grains. I’m not a big supplement person.

In fact, organizations such as the American Institute of Cancer Research really counsel patients not to focus on supplements as a major way to get nutrition into their body. Of course, there are some instances where supplements are needed. For example, a patient with anemia could have deficiency in iron or vitamin B12. Those are supplements that may be necessary to help boost those red blood cells. Or one of my patients, for example, a diagnosis of breast cancer, an aromatase inhibitor, where she may be experiencing a decline in bone density, she may need a vitamin D supplement because she lives in New England and doesn’t get enough sun exposure, which is how we get vitamin D.

So vitamin D, iron, B12, things like that sometimes are necessary, but there are a lot of supplements out there that people are encouraged to buy and spend a lot of money on, and I really would encourage you to shy away from that. That would be my recommendation.

Lisa Hatfield:

Okay, thank you. And a quick question for those patients who are on the flip side of the decrease in appetite. Sometimes patients going through cancer treatment are on high dose steroids, and they have the increase in appetite and they have certain cravings. Do you have any suggestions or recommendations for those patients?

Dr. Amy Comander:

Yes, we know that we use steroids a lot in oncology to help our patients manage nausea or other side effects related to their treatment. And you’re absolutely right, being on steroids can sometimes really rev up the appetite, make it hard to sleep at night, cause a whole wide array of other side effects. So certainly with my patients who have this problem, sometimes I try to cut down the steroids a little bit, see if we can get away with that to kind of minimize those adverse side effects from the steroids themselves.

But if someone really is having cravings, usually the steroids are used around chemo for just a few days. So I usually encourage them like, again, if you’re craving carbs, try to focus on some healthy carbs, again, focus on whole grains, try to avoid some of the potato chips and other stuff, which we know are not so good for us, but usually it’s a short-term thing, but maybe cutting down the steroids a little bit might be the first step if possible in collaboration with your oncology team.

 

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.

RESTORE Wellness Kitchen | Tomato Salad Sandwich

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In this RESTORE video featuring a tomato salad sandwich recipe, explore the potential health benefits of ingredients such as tomatoes, olive oil, basil and how they may help support immune function, reduce inflammation, and contribute to overall well-being.

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Transcript:

Lisa Hatfield:

Welcome to our RESTORE kitchen! Today, we’re making a delicious and refreshing tomato salad sandwich.

Start by slicing vibrant orange and red tomatoes. Tomatoes are rich in vitamins A and C, which support immune function and overall health. Arrange the slices on a plate and drizzle with your favorite olive oil based Italian dressing (and maybe a little balsamic vinegar). The healthy fats from olive oil help absorb fat-soluble vitamins and antioxidants from the tomatoes.

Add freshly chopped basil for that perfect burst of flavor. Basil has antioxidants and anti-inflammatory compounds, which can help reduce oxidative stress and support the immune system.

Next, sprinkle Parmesan cheese over the tomatoes. Parmesan is high in calcium and protein, essential for maintaining bone health and muscle mass.

Lastly, take two slices of toasted whole wheat bread, which is a source of fiber and can help aid in digestion. Place the dressed tomatoes on one slice and top it with the other slice of bread, and there you have it – a simple yet nutrient-packed tomato salad sandwich. Enjoy!

How Can Wellness Interventions Aid Patients During and After Treatment?

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How can wellness interventions aid cancer patients during and after treatment? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss benefits of different wellness practices, practical wellness strategies, and support resources.

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Transcript:

Lisa Hatfield:

How can wellness interventions help patients during and after cancer treatment? And what specific practices might help? I have many questions. I’m getting to the bottom of it in this Patient Empowerment Network RESTORE program.

Dr. Comander, how can wellness interventions help folks like myself during and after treatment? And while there seems to be only pros here, can you also speak to any risks of certain wellness practices during cancer treatment? And how can patients mitigate these risks?

Dr. Amy Comander:

Such an excellent question. And I do think it’s really important for us to focus on things that a patient can do after his or her diagnosis to take control of one’s health. We know there’s nothing scarier than getting a diagnosis of cancer and going through treatment for cancer. So we want to think about practical strategies that people can employ to feel better, tolerate their treatments better, and ultimately improve their health.

So let’s pick one of my favorites, which is exercise. I know for some people that word exercise sounds intimidating, scary. Maybe they’re not someone who ever really practiced exercise on a regular basis and so when their doctor or nurse practitioner or social worker is talking to them about this, they feel kind of intimidated. Well, I will say a new field emerging is actually called exercise oncology. It’s really fascinating. And we’re really learning about what is actually happening in the body when an individual exercises, what is going on at the cellular level that may actually be fighting the cancer.

And this is really interesting and exciting. And I love reading these scientific papers. But we’re not going to get into that right now. Let’s just talk about, when you talk about practical strategies, if you’re someone who really has not been active, just walking to the mailbox to get the mail. Try to do that each day. Maybe taking a walk in your dining room, a few laps around the dining room table, if you have one, just something basic like that, walking your dog, walking a friend’s dog. Like everyone has to start somewhere.

So when we talk to our patients about exercise, we just meet them where they are and help them get started with something. And I know this sounds very intimidating, but organizations such as the American Cancer Society, American College of Sports Medicine, and my organization, American Society of Clinical Oncology, strongly recommend that individuals going through cancer treatment engage in exercise. And so you just have to start somewhere. So why is this important? Exercise has been shown to help patients tolerate their treatment better, reduce side effects, reduce the need for dose reductions, improve the fatigue that is often associated with cancer, and in many cases, reduce risk of recurrence and improve the outcome. So there are so many reasons to do it.

You also ask about risks. And I can understand that many people are fearful of starting an exercise program if this is not something they’ve been doing on a regular basis. So I would encourage patients to talk to their doctor just to address any particular concerns. Certainly, let’s say an individual has cancer involving their bone and they’re worried that they might be at risk for a fall and a fracture. That’s something they should certainly talk about with their doctor.

As a breast oncologist, I care for many women who are concerned about risk for lymphedema. Lymphedema is swelling of the arm, perhaps on the side of the surgery. And my patients are often worried, will that get worse if she starts a strength training program? Actually, it will not, but that’s a good question for her doctor or her physical therapist. So I think it’s really important to think about exercise as the number one wellness intervention that we want to address. 

Lisa Hatfield:

Okay, thank you. And over to you, Nicole, what are some common wellness practices that cancer patients can adopt during treatment? And how can patients be empowered to take an active role in their wellness during and after cancer treatments?

Nicole Normandin Rueda:

Great question. So just like Dr. Comander said, so physical activity, starting somewhere is going to be of the utmost importance. Nutrition, balanced diet, making sure you’re hydrated, you are following all the recommendations from your medical team regarding what you consume, avoiding anything that you probably shouldn’t be consuming. Stress reduction techniques are all, mindfulness, meditation, deep breathing, the things that help you kind of get back to calm is really critical. We want to make sure patients are aware of their sleep. So the sleep cycle is one of those things that people often complain about, but aren’t really informed on how important it is to your actual overall well-being.

And so if that is an issue, we want to make sure that we are referring them to the appropriate specialist in order to help get that resolved. Social connections, again, huge. We want to make sure people understand that there are organizations and people out there that are here to just serve and help as much as we can. Maintaining the relationships, not just with their immediate family and friends, but also making new connections and new relationships with people that are going to support them throughout this journey is important.

For me as a social worker, empowering patients is what I do…it’s why I’m here. We want patients to have an active role in their wellness, both during and after treatment, because we know, as trained individuals, we know that that is going to overall have a positive impact in their quality of life, in their family’s experience throughout the cancer journey. And that’s important. This is a stressful time for a lot of people. So in order to do that, we always want to make sure we’re providing education and that is first and foremost going to come from the medical providers. Follow up to that would then be everything else, all the ancillary services.

So you have organizations, Patient Empowerment Network. We are very focused on providing evidence-based information in an easy to understand way. And so that is one of those organizations that, as a social worker, I would refer everybody to. But there are others that are doing fantastic things providing education on all sorts of topics, anything that you could possibly want. There are organizations that are doing it well. Now that’s the thing, we want to make sure that we are referring patients to get evidence-based, research-backed information for them to consume and digest at their own pace. Next would be advocacy. If you don’t have a strong advocate in your corner, or if you are not comfortable speaking up or asking questions, this is one of those things that is so incredibly important when it comes to empowering patients to really be involved in their care.

And I can tell you firsthand, my mom was my dad’s biggest advocate. It was kind of embarrassing at times, but in hindsight, thank goodness, because had she not been so ferocious and asked so many questions, there’s a lot of things that we wouldn’t have known as a family going through a cancer diagnosis. So that’s really important. And I know working with medical teams, they want somebody to ask questions, they want to be able to provide as much information as they can. That’s a good backbone for people to understand, that their medical teams are going to want to make sure that they walk out of the room feeling like they have the information they need. 

And so we want to make sure that we are providing as much information, as many resources as we can. And then it is up to the patient and their care partners or their family members to then take that and run with it. But we want to be able to make sure that we’re giving them what they need in order to ask the right questions at the right time to the right people. And if they have the resources that they need to go and make it happen.

Lisa Hatfield:

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

How Do Wellness Practices Impact Cancer Care Outcomes?

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What are the impacts of wellness practices on cancer care outcomes? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss the field of lifestyle medicine, the six pillars of lifestyle medicine, research results, and wellness resources for cancer patients. 

Download Resource Guide

See More from RESTORE

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How Art’s Healing Abilities Can Help Those Touched by Cancer

What Is Whole Person Care Exactly?

 Why Is It Important to Address Whole Person Care?

Why Is It Important to Address Whole Person Care?

Transcript:

Lisa Hatfield:

How do wellness practices impact cancer care outcomes? I’m getting to the bottom of it in this RESTORE Program. Dr. Comander, you have a strong interest in cancer survivorship, lifestyle medicine, and improving outcomes of patients facing cancer. Can you speak to the impact of wellness practices on cancer treatment outcomes and what are we learning?

Dr. Amy Comander:

So I’ve gotten very interested in the field of lifestyle medicine over the past few years. And I think it’s really important to define what that is to those who are just learning about that term for the first time. So lifestyle medicine refers to the therapeutic use of evidence-based lifestyle interventions to prevent and treat chronic diseases. In addition, those who are trained in lifestyle medicine work to empower the patient to adopt these tools and make effective behavior changes. 

The six pillars of lifestyle medicine include physical activity, attention to diet, social connection, avoidance of risky substances, stress management, and adequate sleep. These are so important for the care of our patients with cancer from the time of diagnosis and beyond. And at our hospital we’ve developed a program where we provide individualized consultations to counsel our patients on each of these pillars to help them optimize their health and well-being, and in many cases, outcome from cancer. There are emerging studies demonstrating the important role of these lifestyle behaviors for improving outcome for our patients.

As a breast oncologist, I can tell you that there are significant studies demonstrating that individuals with a diagnosis of breast cancer who are able to exercise, whether that’s during treatment or after completion of primary treatment, actually have a lower risk of recurrence and improved outcome from their breast cancer. This is very powerful data, and we’re actually seeing this in other cancer types as well. So it’s very important that we in the oncology field provide our patients with these tools so they can engage in these six pillars of lifestyle medicine to improve their health and well-being.

Lisa Hatfield:

Okay, thank you for that. One quick follow-up question, and then I have a question for Nicole. So if a patient does not have a lifestyle medicine specialist, I guess that’s how I think of you, who, what is the resource, like at a local community center, could they ask the social worker there to help me out with these additional aspects of my cancer treatment? Who would they go to for those questions?

Dr. Amy Comander:  

Such an excellent question, and I know I’m fortunate that we have this wonderful program that we started. I would say that in terms of exercise, if you have access to a YMCA, many YMCAs have a program called the  LIVESTRONG Program, which is a free exercise program for cancer survivors, and many individuals take advantage of that, and that’s a great resource. If you can’t access a YMCA, thankfully, due to technology like this, we now have the opportunity to offer all kinds of exercise programs on YouTube or through an entity called the Maple Tree Cancer Alliance. There’s so many options potentially available online for somebody who wants to take on an exercise program. I’ll pick another important pillar of lifestyle medicine, nutrition.

One, we know there’s so much information out there on the internet, but one organization that does a very good job on conveying important evidence-based nutrition information is the American Institute of Cancer Research, AICR. So I often refer my patients to that site where they can read articles about nutrition, check out recipes, and, again, it’s very evidence-based and based on research that I trust, and so I think that’s a great resource for individuals who might not have access to an oncology-registered dietician at their hospital.

Lisa Hatfield:

Okay, thank you. And Nicole, are there specific wellness practices that have been shown to improve treatment outcomes for patients facing a cancer diagnosis?

Nicole Normandin Rueda:

Yeah, absolutely. So research has shown that adopting certain wellness practices can significantly improve your quality of life and potentially enhance treatment outcomes. Patients that have physical activity, and what that looks like is different for every patient. So regular exercise can mean a lot of different things. At the end of the day, from my perspective, the importance is that you’re moving your body. So if you start with just stretching, yoga, things to get your body start to start moving, it’s better than absolutely nothing, and then you work your way up to as much as you can endure. That’s key, I think, just like Dr. Comander just said.

Second, we have nutrition. So the balanced diet is difficult for everybody, but whenever it comes to a cancer diagnosis, you really want to take into consideration whatever your doctor’s recommending, and that’s specific to your treatment potentially. But as well as just making sure that you are nourishing your body, getting enough water, staying hydrated, all of the basics.

Next, I know that mindfulness and stress reduction techniques are huge. These practices, including like meditation, yoga, just deep breathing exercises to help kind of reduce that stress level, improve your overall clarity and mental health is really important. We want patients to stay as cool, calm, and collected as they can be. And so even just taking some deep breaths in through your nose, out through your mouth, these things are critical. And then I think another big one is the psychological side of things.

So psychosocial is one of those words that doesn’t mean anything to a lot of people, but to those of us who are trained, we understand that psychosocial means everything around you, everything that interacts with you is impacted by this cancer diagnosis. So we want to make sure we are connecting patients with all of the support groups that we can possibly think of. If that’s what they’re looking for. We also want to take into consideration the cultural situation. So if that means that you really don’t want to sit in a room with others, but you want to just read a blog from somebody like an empowerment lead or something like that, that can also be helpful.

And that is what patients are looking for now is easy access to information that is evidence-based, of course, but also that is just testimonial, somebody that’s been there and can guide them through what it’s like to, yeah, it is okay to talk to others, and it is okay to ask for help when you need it. So we really want to encourage that as much as possible. And obviously we want to foster a sense of community. We want everybody to understand you’re not alone. And there’s organizations out there doing fantastic things. Patient Empowerment Network is one of them, but there’s also so many others that are just doing fantastic things to support patients in every aspect of their cancer diagnosis.

Lisa Hatfield:

Thank you, Nicole. You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.