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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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.