Medical Nutrition Therapy For Cancer Patients

  • Ghazala Khan Doctor of Philosophy-PhD, University of Bedfordshire, UK

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Introduction

Definition of medical nutrition therapy (MNT)

Medical nutrition therapy (MNT) aims to help to treat malnutrition in people suffering from disease to eat better so that their symptoms can be managed. Depending on the condition, you can receive personalised meal options to make sure you are getting all the vitamins and minerals as well as the correct number of calories to stay as healthy as possible in order to be strong enough to fight the disease.   

Importance of MNT in cancer treatment 

Cancer treatment can be extremely stressful and can take a toll, whether you are going through surgery, chemotherapy or radiotherapy. In addition, malnutrition can lead to treatment toxicity, disease complications, physical impairment, and lower survival rates.1 However, there are effective ways to combat these issues, and here we will discuss the importance of MNT as an integral part of caring for and treating cancer patients.    

The relationship between cancer and nutrition

Effects of cancer on nutritional status

Cancer is known to have a major effect on nutritional status even before people are diagnosed. A study found that prior to receiving treatment, 51% of patients already had problems with nutrition, 43% were at risk of malnutrition, and over 40% were anorexic. In addition, 64% suffered weight loss.1

Nutrition can be affected by a number of reasons such as: 

  1. Anorexia - loss of appetite
  2. Cachexia - weight loss due to muscle wasting
  3. Malabsorption - nutrients are being consumed in the right manner however, the body is unable to absorb them properly to gain the benefits 
  4. Hypermetabolism - the tumour cells are using up the nutrients too quickly compared to the food intake.2  

Impact of cancer treatment on nutritional needs

Malnutrition is thought to be involved in the death of >50% of cancer patients and a direct cause of death in up to 40%.5 Good nutrition has the ability to boost treatment outcomes for people with cancer, improving overall survival rates. Treatment side effects and the disease itself can cause loss of nutrients and muscle loss. Foods high in protein, carbohydrates and fat will keep the body weight constant and provide energy for damage repair, help the immune system and reduce serious side effects.3 Drinking plenty of fluids will aid hydration. Talking to a professional for a targeted diet plan, taking into consideration individual needs depending on the type of cancer and treatment, can make a real impact on health during these tough times. 

Common nutritional challenges faced by cancer patients

Milliron et al (2022) identified the following side effects of treatment: extreme exhaustion in 58% of patients, dry mouth in 30%, 24% felt sick and 20% suffered from constipation and diarrhoea. In addition, finding it hard to chew and swallow, ulcers, vomiting and food tasting strange are also present.4 It can be difficult to maintain nutritional status during treatment, but the benefits of MNT are huge for good overall well-being and for increasing the chances of recovery.

Goals of MNT for cancer patients

Optimal nutrition to support treatment efficacy

Any treatment received for cancer will work much better if you are able to eat properly. Trying to stay as healthy as possible by taking vitamins, minerals and supplements helps to tolerate the treatment which can lead to quicker recovery and better health after treatment.5    

Controlling body weight and mass

Muscles in the body can quickly lose their mass, reducing energy and causing weight loss. Eating a healthy diet can build your strength and encourage damage repair in the body, helping you to live well and handle the treatment.5   

Management of treatment side effects

Severe side effects can be hard to deal with. Certain types of food may help with loss of appetite and not being able to taste the food well. Changing recipes to include stronger flavours and basing them on what you like will make things easier to eat. Getting as much information from your health care professionals on what to expect will help you to plan how to deal with them.5

Enhance the quality of life and overall health

Remaining healthy improves your quality of life and provides you with the energy to live life to the full, reducing the frequency and length of hospital visits. A nutritional plan that is according to your lifestyle and financial means can make a real difference to overall physical and mental health.5

Components of medical nutrition therapy

Dietary recommendations and modifications

Macronutrient balance

Macronutrients fall into 3 groups: protein, carbohydrates and fats. These three components are known to be depleted in cancer patients, leading to muscle wasting, energy reduction, infections and lower quality of life. Recommended daily doses for protein intake is up to or above 2 g/kg, for carbohydrate intake is < 5 g/kg and for fat up to a maximum of 2 g/kg.5

Micronutrient supplementation

Micronutrients refer to the vitamins and minerals required to stay healthy. However, intake of micronutrients should not exceed the recommended daily allowance6 and be monitored closely to avoid electrolyte toxicity. Supplements should only be taken after consulting with professionals.   

Fluid intake

It is crucial to replenish the loss of fluids due to vomiting or diarrhoea. Dehydration can lead to weakness and dizziness and disrupt the functions of the body. Recommended fluids should not exceed 30–35 mL/kg body weight per day5 but may depend on individual needs.

Individualised meal planning

Calorie requirements

Everyone needs a certain amount of calories to have the energy for normal day-to-day living. The recommended caloric intake for cancer patients is 20–25 calories a day for bedridden patients and 25–30 calories a day for mobile patients.5

Meal timing and frequency

If you suffer from a lack of appetite, altering your eating patterns may be the answer. Eating smaller portions more often, structuring meal times, or eating when hungry could all help with nausea

Dietary restrictions

Cancer cells respond to a lack of nutrients differently from normal cells. While normal cells employ mechanisms to resist this stress and can reduce their growth resulting in protection from chemotherapy, cancer cells have lost this ability and can be killed. Dietary restrictions such as a fasting-mimicking diet and ketogenic diet can be used to starve cancer cells of important nutrients to boost treatment outcomes.7 

Nutritional support therapies

There are different ways that MNT can be provided depending on the type of cancer you have and your overall health. 

  1. Enteral nutrition- a feeding tube is used to insert food directly into the stomach. 
  2. Parenteral nutrition- food is injected into the blood through a vein, avoiding the gut. 
  3. Oral nutritional supplements- taken by mouth  

Assessing nutritional status and needs

Nutritional screening tools

The European Society of Parenteral and Enteral Nutrition (ESPEN) recommends three methods to screen patients for risk of malnourishment.

  1. Nutritional Risk Screening 2002 (NRS-2002) for patients in hospital.
  2. Malnutrition Universal Screening Tool (MUST) for patients in hospitals and care homes. 
  3. Mini Nutritional Assessment (MNA-SF) for elderly patients

Nutritional assessment tools 

Assessment tools gather a lot more information about malnutrition and how severe it is. The main tools include:

  1. Subjective Global Assessment (SGA)
  2. ASPEN criteria
  3. ESPEN criteria
  4. Global leadership initiative on malnutrition8

Patient education and counselling

Importance of nutritional support

There are many ways that nutritional support can help you as you go through cancer treatment and recovery. Support should be sought from healthcare professionals so it is accurate. In the absence of official support, people tend to go to online sources or to family and friends. However, this information can be incomplete or contradictory in nature and not relevant.9 

The role of nutrition in managing cancer is well known, but still, many patients feel it's an unmet need. Having nutritional counselling as part of the treatment will ensure everyone receives the best care possible.   

Strategies for managing side effects

Not all patients suffer from all side effects as they are related to the treatment being given and the type of cancer. Being able to manage them will not only aid recovery but also provide empowerment over your health and well-being. It is important to talk to your healthcare providers so issues can be dealt with quickly. A comprehensive guide to managing side effects can be found here: https://pennybrohn.org.uk/2023/08/17/coping-with-chemotherapy/

Long-term dietary recommendations

The American Institute for Cancer Research and World Cancer Research Fund have provided guidelines for cancer survivors, which include:

  1. Maintaining a healthy weight
  2. Staying active
  3. Increasing intake of plant foods
  4. Limit meat consumption
  5. Reduce alcohol
  6. Take nutritious supplements10

FAQs

What is the best nutrition for cancer patients?

Foods high in proteins, carbohydrates and fats are recommended to counteract weight loss and lack of appetite. Plants-based food are also considered better for high levels of vitamins and minerals. Beans, pulses, tofu, fish, poultry, eggs, potatoes, bread, rice, pasta and fruits are all best in a healthy balanced diet including plenty of water.

What are the main goals of medical nutrition therapy for patients with cancer?

  • Tolerating treatment
  • Managing side effects
  • Boosting treatment outcomes
  • Preventing infections
  • Reducing hospital visits
  • Improving quality of life
  • Increasing survival

Summary

MNT has an important role to play in looking after cancer patients. It can have many positive impacts, including improving nutritional status, managing side effects, tolerating treatment, boosting treatment outcomes, lowering the risk of infection, and improving overall quality of life. You have the power to make sure MNT is provided to you and talk to your healthcare team to update them on any changes so action can be taken at the earliest opportunity. MNT should be provided as mandatory so all patients can benefit and have the best chance of complete recovery from cancer.  

References

  1. the PreMiO Study Group, Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, et al. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget [Internet]. 2017 [cited 2024 Feb 20]; 8(45):79884–96. Available from: https://www.oncotarget.com/lookup/doi/10.18632/oncotarget.20168.
  2. Salas S, Mercier S, Moheng B, Olivet S, Garcia M-E, Hamon S, et al. Nutritional status and quality of life of cancer patients needing exclusive chemotherapy: a longitudinal study. Health and Quality of Life Outcomes [Internet]. 2017 [cited 2024 Feb 20]; 15(1):85. Available from: https://doi.org/10.1186/s12955-017-0660-6.
  3. Kim DH. Nutritional issues in patients with cancer. Intest Res [Internet]. 2019 [cited 2024 Feb 21]; 17(4):455–62. Available from: http://www.irjournal.org/journal/view.php?doi=10.5217/ir.2019.00076.
  4. Milliron B-J, Packel L, Dychtwald D, Klobodu C, Pontiggia L, Ogbogu O, et al. When Eating Becomes Torturous: Understanding Nutrition-Related Cancer Treatment Side Effects among Individuals with Cancer and Their Caregivers. Nutrients [Internet]. 2022 [cited 2024 Feb 20]; 14(2):356. Available from: https://www.mdpi.com/2072-6643/14/2/356.
  5. Yalcin S, Gumus M, Oksuzoglu B, Ozdemir F, Evrensel T, Sarioglu AA, et al. Nutritional Aspect of Cancer Care in Medical Oncology Patients. Clinical Therapeutics [Internet]. 2019 [cited 2024 Feb 21]; 41(11):2382–96. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0149291819304837.
  6. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition [Internet]. 2017 [cited 2024 Feb 21]; 36(1):11–48. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261561416301819.
  7. Buono R, Longo VD. Starvation, Stress Resistance, and Cancer. Trends in Endocrinology & Metabolism [Internet]. 2018 [cited 2024 Feb 22]; 29(4):271–80. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1043276018300171.
  8. Serón-Arbeloa C, Labarta-Monzón L, Puzo-Foncillas J, Mallor-Bonet T, Lafita-López A, Bueno-Vidales N, et al. Malnutrition Screening and Assessment. Nutrients [Internet]. 2022 [cited 2024 Feb 22]; 14(12):2392. Available from: https://www.mdpi.com/2072-6643/14/12/2392.
  9. Mullee A, O’Donoghue A, Dhuibhir PU, O’Donoghue N, Burke D, McSharry V, et al. Diet and Nutrition Advice After a Solid Tumor Diagnosis. JCO Oncology Practice [Internet]. 2021 [cited 2024 Feb 22]; 17(7):e982–91. Available from: https://ascopubs.org/doi/10.1200/OP.20.00685.
  10. Barrera S, Demark-Wahnefried W. Nutrition during and after cancer therapy. Oncology (Williston Park). 2009; 23(2 Suppl Nurse Ed):15–21.

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Ghazala Khan

Doctor of Philosophy-PhD, University of Bedfordshire, UK

Ghazala is a cancer scientist with experience as an academic and a comprehensive background in oncology. With a double master's and a PhD in cancer immunotherapy, she has extensive research and development expertise. As a passionate communicator of science and author of several papers, Ghazala’s role in medical communications enables her to disseminate scientific knowledge to a broad audience. Using multiple mediums she enables scientific and health research to be clear and concise with the ultimate goal of improving healthcare for all.

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