Tag Archive for: balanced diet

Navigating Supplements in Cancer Treatment: Insights from a Harvard Expert

/in , /by

 

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.

How Does Nutritional Screening and Assessment Impact Cancer Care?

/in , /by

 

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. 

How Can Wellness Interventions Aid Patients During and After Treatment?

/in , /by

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.

Download Resource Guide

See More from RESTORE

Related Resources:

How Do Wellness Practices Impact Cancer Care Outcomes?

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 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?

/in , /by

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

Related Resources:

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

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.