A Nutritional Journey: Dietary Needs Vary On
Passage From Treatment Through Recovery
For some cancer patients, a diet that includes healthy food choices
such as broccoli or whole grains may be part of the overall plan to
help fight cancer. Other patients may focus on extra doses of nutritional
supplements as part of their cancer-fighting arsenal.
Yet these methods may not be as beneficial as they first appear,
says Debra DeMille, MS, RD, LDN, nutrition counselor at the Joan Karnell
Cancer Center. Nutritional needs of patients are different, depending
on whether they are in treatment or recovery. Patients undergoing
chemotherapy and radiation therapy may have obstacles to eating a
well-rounded diet. And some vitamin and mineral supplements can negatively
interact with drugs taken for cancer treatment. That's why DeMille
works individually with patients during treatment and provides ongoing
services afterwards to tailor nutrition to specific needs.
During treatment, nutritional therapy can help patients obtain their
nutritional needs to better tolerate treatment and prevent weight
loss. “The priority during treatment is maintaining strength
and minimizing side effects,” she said. “If this means
drinking milkshakes every day, that's okay for now. Lifestyle
and lifelong nutritional changes can be done after treatment is completed.”
“During treatment may not be the time to make major alterations
in eating habits,” adds oncologist Lee
Hartner, MD. “My goal is to make sure patients are not
losing weight and are able to tolerate treatment.” In general,
he tells patients to eat what they like and supplement it with high
protein/high calorie nutritional shakes. “The time to focus
on healthier eating is after treatment is completed. There may be
individual exceptions, however, since chemotherapy lowers blood counts,” he
says. These patients should eat foods rich in protein, iron, folate
and B12, which may help stimulate red blood cell production. Meat
also needs to be thoroughly cooked and produce washed well to avoid
Working with Patients during Treatment
Initially, DeMille sits down with patients and
presents an overview of what can be expected from their specific
treatment. “Everyone experiences side effects differently,” she
said, “but we want to make sure patients have the information
they need to be proactive about combating problems. Then we develop
a list of beneficial foods for each patient.” If side effects
occur, dietary adjustment (such as chicken rice soup for diarrhea
or ginger tea for nausea) may help control them.
She also discusses alternative therapies such as herbal and nutritional
supplements and asks patients about current usage. “Certain
supplements can interact with drugs used in chemotherapy. For example,
some cancer therapies work through the process of oxidation. Theoretically,
they can be hindered by the use of high-dose antioxidants such as
beta-carotene, vitamins C, E and selenium.” St. John's
Wort, available over-the-counter and frequently used for mild depression,
also can interact with many medications.
For many people, a diagnosis of cancer is the
time to take stock of their physical well being, including the foods
they consume. DeMille helps patients analyze their nutritional intake
and learn ways to enjoy a healthy diet. But the complexity of nutritional
choices can be overwhelming, she cautions, especially when patients
are beginning treatment.
“Patients want to make healthy changes in their diet, but they
need to temper this with how they will be feeling during therapy.
What is most important is for them to get the best results they can
from treatment and to control side effects,” she says. Nutritional
therapy can be used to improve food intake in patients who have no
desire to eat, or who are too fatigued to prepare meals. DeMille suggests
strategies to help:
- Spread meals throughout the day.
- Eat smaller amounts of food more frequently.
- Eat what appeals to you.
- Make every bite count: choose foods high in protein and calories.
Families and friends are also key to helping cancer patients get
the benefit of healthy foods. “When someone asks ‘how
can I help?' be specific,” says DeMille. “People
prefer guidance. Let them know they can grocery shop or prepare dishes
for you.” DeMille also educates family members on appropriate
foods and the psychology of eating during treatment. It's important
that family members understand patients often find it difficult to
eat. This should not be a point of conflict. “Gentle offering
of food and encouragement is best,” she says.
Ongoing Nutritional Services
When treatment is completed, Joan Karnell Cancer
Center nutritional services continue. “Cancer is a life altering
experience,” says DeMille. “Our services don't
end with your last doctor's visit.”
“Nutrition can be empowering–an important part of the
journey to improve our patients' lives. That's why we
provide ongoing educational programs for cancer survivors.” She
conducts guided grocery tours at the Whole Foods Market at 9th and
South Sts., and provides programs such as “10 Foods to Consider:
Incorporating Cancer Fighting Foods into Your Diet,” and “Eat
One of the most popular programs takes place at a demonstration kitchen
in the Cancer Center. Philadelphia restaurateur Chef Joseph Poon donated
his time to help design a table to fit the space, which was obtained
through a donation from the Kathleen Maurer Memorial Fund. In the
kitchen, DeMille demonstrates simple, tasty dishes with seasonal ingredients. “I
like to fight the myth that if it's good for you, it can't
taste good,” she says. Along with learning how to prepare dishes
to maximize nutrition, the group learns how to shop, read labels,
and make food tasty for kids. The next program, “Summer Time
Fun,” will take place July 20 and 21.
“Healthy Balance” is a program for women who have been
treated for breast cancer. Four sessions explore the mindfulness of
eating and help women create a healthy balance in their lives through
food, exercise and body awareness. This multidisciplinary approach
includes Michele Hyman, PsyD, who discusses the mindfulness of eating,
and Rob Fritch, PT, who discusses how women can overcome obstacles
to increasing physical activity.
“Take advantage of these programs and the services of the nutritionist,” says
Howard,* who received treatment for head and
neck cancer. “There
are things you may think you know a lot about,
but in the context of cancer – it's a whole new experience.”
*Name changed to protect the patient's privacy.