Tag Archive for: RESTORE Program

How Do Psychological Factors Impact Diet During Cancer Treatment?

 

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

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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 Role Does Exercise Play in Cancer Treatment?

Transcript:

Lisa Hatfield:

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

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

Joelys Gonzalez:

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

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

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

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

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

Lisa Hatfield:

Okay. Thank you so much. 

Lisa Hatfield:

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

Nicole Normandin Rueda, LMSW:

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

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

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

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

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

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

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

Lisa Hatfield:

Okay, thank you, Nicole 

Lisa Hatfield:

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

Joelys Gonzalez:

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

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

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

Lisa Hatfield:

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

What Role Does Exercise Play in Cancer Treatment?

 

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

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

How Do Psychological Factors Impact Diet During Cancer Treatment?

How Do Psychological Factors Impact Diet During Cancer Treatment?

Transcript:

Lisa Hatfield:

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

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

Joelys Gonzalez:

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

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

Lisa Hatfield:

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

Joelys Gonzalez:

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

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

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

Lisa Hatfield:

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

Nicole Normandin Rueda, LMSW:

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

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

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

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

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

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

Lisa Hatfield:

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

Nicole Normandin Rueda, LMSW:

Absolutely.

Lisa Hatfield:

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

Navigating Supplements in Cancer Treatment: Insights from a Harvard Expert

 

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

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

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

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

Dr. Jennifer Ligibel:

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

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

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

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

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

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

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

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

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

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

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

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

Lisa Hatfield:

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

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

Dr. Jennifer Ligibel:

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

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

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

Lisa Hatfield:

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

Lifestyle Interventions and Cancer Care Outcomes Research

 

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

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

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

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

Dr. Jennifer Ligibel:

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

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

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

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

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

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

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

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

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

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

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

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

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

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

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

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

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

Lisa Hatfield:

Okay. That’s really helpful. Thank you.

Dr. Jennifer Ligibel:

Sure.

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

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

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

Lisa Hatfield:

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

How Does Nutritional Screening and Assessment Impact Cancer Care?

 

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

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Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

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

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

Dr. Jennifer Ligibel:

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

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

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

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

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

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

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

Absolutely.

Lisa Hatfield:  

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

What Supportive Care Treatments Are Available to Patients?

 

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

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See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

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

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

Dr. Jennifer Ligibel:

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

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

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

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

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

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel: 

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

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

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

Lisa Hatfield:

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

What Is Supportive Care Therapy in Cancer Care?

 

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

Download Resource Guide

See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

Transcript:

Lisa Hatfield:

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

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

Dr. Jennifer Ligibel:

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

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

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

Lisa Hatfield:

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

Dr. Jennifer Ligibel:

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

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

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

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

Lisa Hatfield:

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

Dos and Don’ts of Supplement Intake During Cancer Treatment

 

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 Is Hydration Managed During Cancer Treatment?

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How Do Nutritional Deficiencies Impact Cancer Treatment?

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?

 

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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How Much Protein Should I Consume While Undergoing Treatment?

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

Dos and Don’ts of Supplement Intake During Cancer Treatment

Dos and Don’ts of Supplement Intake During Cancer Treatment

Transcript:

Lisa Hatfield:

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. 

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

 

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

Download Resource Guide

See More from RESTORE

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How Can I Stimulate My Appetite During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

How Do Nutritional Deficiencies Impact Cancer Treatment?

How Do Nutritional Deficiencies Impact Cancer Treatment?

Dos and Don’ts of Supplement Intake During Cancer Treatment

Dos and Don’ts of Supplement Intake During Cancer Treatment

Transcript:

Lisa Hatfield:

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

Julie Lanford:

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

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

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

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

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

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

Lisa Hatfield:

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

How Can I Stimulate My Appetite During Cancer Treatment?

 

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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Related Resources:

How Important Is Calorie Intake During Cancer Treatment?

How Important Is Calorie Intake During Cancer Treatment?

How Is Hydration Managed During Cancer Treatment?

How Is Hydration Managed During Cancer Treatment?

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?

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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Related Resources:

How Important Is Calorie Intake During Cancer Treatment?

How Important Is Calorie Intake During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

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. 

How Much Protein Should I Consume While Undergoing Treatment?

 

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

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Related Resources:

How Important Is Calorie Intake During Cancer Treatment?

How Important Is Calorie Intake During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

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

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

Julie Lanford:

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

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

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

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

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

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

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

Lisa Hatfield:

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

Julie Lanford:

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

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

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

Lisa Hatfield:

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

How Important Is Calorie Intake During Cancer Treatment?

 

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

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Related Resources:

How Much Protein Should I Consume While Undergoing Treatment?

How Much Protein Should I Consume While Undergoing Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

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

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

Julie Lanford:

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

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

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

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

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

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

Lisa Hatfield:

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

Julie Lanford:

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

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

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

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

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

Lisa Hatfield:

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

Julie Lanford:

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

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

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

Lisa Hatfield:

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

Julie Lanford:

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

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

Lisa Hatfield:

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

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

 

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

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Related Resources:

Does Diet Adjustment Impact Cancer Care?

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

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

Transcript:

Lisa Hatfield:

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

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

Dr. Cynthia Thomson:

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

Lisa Hatfield:

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

Dr. Cynthia Thomson:

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

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

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

Lisa Hatfield:

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

Dr. Cynthia Thomson:

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

Lisa Hatfield:

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

Dr. Cynthia Thomson:

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

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

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

Lisa Hatfield:

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