Together We Can -- Newsletter of the Joan Karnell Cancer Center
 

Summer 2005

A Nutritional Journey
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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 consuming bacteria.

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.

Taking Stock
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 Your Herbs.”

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.

 


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