Why is nutrition so important during my cancer treatment?

Think of nutritional support as a tool to help you be an active participant during your journey.
You have the power to:

• help fight fatigue,
• help manage weight, whether it is minimizing weight loss or helping achieve and maintain desirable weight,
• help improve treatment outcomes by helping maximize immune response,
• help prevent or correct nutritional imbalances and deficiencies.

It is estimated that between 40% and 80% of all cancer patients develop some degree of malnutrition during their illness. Any degree of malnutrition can affect the immune system, increasing the risk of infection and reducing treatment effectiveness and tolerance.

If your body doesn’t get enough of the right nutrients, you could be more likely to get an infection, or you may have difficulty tolerating your treatments. That’s why it is important to make sure you get all the nutrition your body needs.

In 1932, malnutrition was identified as a prognostic indicator of the outcome in cancer patients. A recent study published in the Journal of the American Dietetic Association showed that patients receiving nutritional support did significantly better in terms of body weight, nutritional status, and quality of life compared to the control group.

Keep in mind that malnutrition can occur more frequently in specific cancer types like gastrointestinal (GI) cancers and head and neck cancers or in patients receiving radiotherapy or chemotherapy/radiotherapy.

In order to cope successfully with cancer, you need to fight against the negative effects of the disease as well as the side effects of its treatment. Specialized cancer nutrition can help you meet the challenges of fighting fatigue, preventing weight loss and muscle wasting due to reduced appetite, mucositis/sore mouth, nausea, vomiting, diarrhea and difficulty swallowing (dysphagia).

References: 1. Spiro A, Baldwin C, Patterson, et al. The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. British Journal of Cancer. 2006;95:431-434. 2. Isenring EA, Bauer JD, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc. 2007 Mar;107(3):404-412.

How do cancer and its treatment affect nutrition?

Side effects of treatment, your body?s response to tumors, and certain medications can all contribute to changes in the way you process nutrients.

• Surgery increases your need for protein and calories to help repair and heal your body.
• Radiation and chemotherapy may interfere with your normal eating habits by causing nausea, vomiting, diarrhea, constipation, difficulty swallowing, and a sore or dry mouth.
• Chemotherapy uses "e;anticancer"e; drugs that can destroy abnormal cancer cells by stopping them from growing or multiplying uncontrollably. However, healthy cells can also be harmed, especially those that divide quickly such as cells lining the digestive tract. Harm to healthy cells is what causes side effects. These cells usually repair themselves after chemotherapy.
• Tumors may produce substances that decrease appetite and increase your body?s metabolism, causing accelerated weight loss and muscle breakdown.

When should nutritional intervention begin?

Sooner is better.

Early nutritional intervention is critical, because preventing cancer-induced weight loss and other symptoms helps promote better tolerance to treatment and a better quality of life. Novartis Nutrition offers the widest range of products that supply specialized nutrition for specific symptoms and the various points in your treatment—at diagnosis, before and throughout radiation- or chemotherapy, pre- and post-surgery, or at anytime in your journey.

It’s important to start talking to your health care professional early about your dietary needs. Preventing weight loss and muscle breakdown is much easier than reversing it.

What are the key nutrients I’ll need while I fight cancer?

It’s best to eat a healthy diet with a variety of foods. But there may be times when that isn’t a realistic option because you don’t feel up to eating. And even when you do, simply eating more food may not be enough to prevent weight loss and muscle breakdown if the underlying metabolic changes caused by the tumor are not addressed. High-calorie, high-protein products with specialized nutrients such as omega-3 fatty acids and specific amino acids can help address these metabolic changes and promote weight and muscle gain.

• Calories supply the energy you need every day, helping you maintain your weight.
• Protein helps support healing, and is essential to protect, maintain and build muscle.
• Specific amino acids, such as leucine, stimulate the process of protein synthesis in the body, which helps optimize muscle growth.
• Omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) help improve appetite and help improve the body’s immune response. Because of this, calories and protein can be used by the body to build muscle and promote weight gain.
• Fiber is important in maintaining regular bowel function and promoting “good” bacteria in the digestive system.
• Vitamins and minerals help reduce tissue damage and promote immune function. For instance, calcium and vitamin D help maintain strong, healthy bones and prevent osteoporosis.

It’s important to start talking to your health care professional early about your dietary needs. Preventing weight loss and muscle breakdown is much easier than reversing it.

How do I eat well if I’m experiencing constipation?

• Eat high fiber foods or add a fiber supplement to foods and beverages.
• Drink plenty of fluids. Try water, prune juice and warm beverages.
• Eat at regular times each day.
• Increase activity as much as possible.

How do I eat well if I’m experiencing diarrhea?

• Drink plenty of mild, clear liquids throughout the day.
• Eat small, frequent meals and snacks.
• Avoid greasy, fried, spicy or very sweet foods.
• Eat foods high in soluble fiber such as applesauce and bananas.
• Adding a nutritional product, such as Glutasolve®, to your hot beverages and cold, soft foods can help heal your digestive system.

For your best health, it’s important to talk with your health care professional about any symptoms you are experiencing, or if you’ve lost any weight recently, even if it’s only a few pounds.

How do I eat well if I’m experiencing difficulty swallowing?

• Drink 8 cups of liquids per day.
• Thick liquids may be easier to swallow than thin and can be thickened with a commercial thickener like RESOURCE® ThickenUp® (or use pre-thickened liquids like RESOURCE® Thickened Juices). Ask your speech language pathologist or registered dietitian to which consistency you should thicken liquids.
• Eat soft or pureed foods; add gravy, sauce or butter to moisten foods for easier swallowing.
• Eat small frequent meals. Take small bites of food and small sips of beverages.
• Avoid dry meat, plain rice, bread, raw vegetables, dried fruits and nuts.
• Adding a nutritional product, such as Glutasolve®, to the thick liquids and soft foods you eat can help heal your digestive system.

For your best health, it’s important to talk with your health care professional about any symptoms you are experiencing, or if you’ve lost any weight recently, even if it’s only a few pounds.

How do I eat well if I’m experiencing fatigue?

On some days you may feel you just cannot eat. You can lose your appetite if you feel depressed or tired. Or side effects such as nausea or mouth and throat problems may make it difficult or painful to eat.

But remember, maintaining strong nutritional status during chemotherapy is very important. You will want to focus on a diet high enough in calories to keep up your energy level and high enough in protein to rebuild healthy tissues that cancer treatment may harm.

People who eat well can cope with side effects and fight infection better. Also, their bodies can rebuild healthy tissues faster.

And studies show people can play an active role in improving treatment outcomes through fortifying your body’s nutritional status.

Good nutrition may be a challenge, but here are some tips to help you do the best you can.

• Fortify snacks like pudding with Benecalorie® so you can have something rich in calories and protein whenever you feel like it.
• If you do not want to eat solid foods, try beverages instead. RESOURCE® Breeze is a fruity beverage that goes down easily. IMPACT® Advanced Recovery™ is a creamy alternative. Soups or hot beverages enhanced with can pack important calories and nutrients into even the smallest portions.
• Vary your diet by trying new foods and recipes.
• When possible, take a walk before meals; this may make you feel hungrier.
• Try changing your mealtime routine. For example, eat in a different location.
• Eat with friends or family members. When eating alone, listen to the radio or watch TV.
• Speak with your dietitian about your specific nutrition needs.

For your best health, it’s important to talk with your health care professional about any symptoms you are experiencing, or if you’ve lost any weight recently, even if it’s only a few pounds.

How do I eat well if I’m experiencing nausea and vomiting?

• Eat small amounts of food, and eat more often. Products like Benecalorie® can help boost caloric intake in a very small volume.
• Dry, salty foods may help settle your stomach.
• Let someone else cook for you. Sometimes the smell of food cooking can make you feel sick.
• Cold foods, and foods low in fat, may be easier for your stomach to handle.
• Fresh air may help you feel better.

For your best health, it’s important to talk with your health care professional about any symptoms you are experiencing, or if you’ve lost any weight recently, even if it’s only a few pounds.

How do I eat well if I’m experiencing sore mouth?

• Drink plenty of liquids to help keep your mouth moist.
• Avoid citrus and acidic foods or beverages, such as orange juice.
• Cold or frozen foods can help your mouth feel better.
• Soft food or food that has been put in the blender may be easier to eat. Try foods like creamy soups or casseroles, macaroni and cheese, cottage cheese, yogurt, pudding, milkshakes, egg or tuna salad, creamy pasta dishes, meatloaf or mashed potatoes and gravy.

For your best health, it’s important to talk with your health care professional about any symptoms you are experiencing, or if you’ve lost any weight recently, even if it’s only a few pounds.

How do I eat well if I’m experiencing weight loss?

• Eat well during times when you feel good.
• Keep high-calorie snacks on hand, such as ice cream, peanut butter, cheese and crackers, pudding, nuts, dried fruits or granola bars.
• Enhance your meals by using nutritional products, such as Benecalorie® or Beneprotein®, which can increase calories and protein.
• A nutritional drink, such as RESOURCE® Breeze, taken 1-2 times a day may be helpful.
• Since liquids can make you feel full, try to eat first and then drink your liquids.
• Exercise may improve your appetite, so walking each day before meals may help.
• If you feel full soon after you start eating, try to eat smaller amounts more often. For example, eat every 2-4 hours.

Do the side effects of radiation require specialized nutrition?

Radiation therapy, like chemotherapy, affects both normal cells and cancer cells. Side effects of radiation depend on what part of the body is treated. Common side effects of radiation include skin changes and fatigue.

Strategies for dealing with fatigue include incorporating short rest periods throughout the day and doing only as much as you are able. Walking or light exercise may help. And naturally, good nutrition—plenty of water, healthy food and nutritional products—can help you keep your energy up.

Where can I find emotional support?

Cancer treatment can bring major changes to a person's life. While it can help cure your cancer, it can sometimes affect overall health, cause stress, disrupt day-to-day schedules and strain personal relationships. It is no wonder, then, that some people feel tearful, anxious, angry or depressed at some point during their treatment.

These emotions can be perfectly normal, but they can also be disturbing. Fortunately, there are ways to deal with these emotional side effects, just as there are ways to cope with the physical side effects of radiation or chemotherapy.

You can draw on many sources of support. Here are some of the most important:

• Doctors, nurses and other health professionals. If you have questions or worries about your cancer treatment, talk with members of your health care team.
• Cancer counseling professionals. There are many kinds of counselors who can help you express, understand and cope with your feelings. Depending on your preferences and needs, you may want to talk with a psychiatrist, psychologist, social worker, sex therapist or member of the clergy.
• Friends and family members. Talking with friends or family members can help you feel a lot better. Often, they can comfort and reassure you in ways that no one else can.
• Cancer support groups. Support groups are made up of people who are going through or have gone through the same kinds of experiences as you.
• One-to-one programs. Support can also be found in one-to-one programs that put you in touch with another person of the same gender very similar to you in age, type of cancer and so forth.

Where can I get more information about my cancer or my treatment?

Your doctor or nurse is your best source of information about your cancer. The following organizations can provide you with additional information.

American Cancer Society®

National Home Office
1599 Clifton Road NE
Atlanta, GA 30329
1-800-ACS-2345
http://www.cancer.org

Cancer Care®

275 7th Avenue
New York, NY 10001
1-800-813-HOPE
http://www.cancercare.org

The National Cancer Institute's Cancer Information Service

31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
1-800-4-CANCER
Those with TTY equipment may call 1-800-332-8615
http://www.cancer.gov/cis or http://cis.nci.nih.gov

The National Cancer Institute (NCI) is the lead Federal agency for cancer research. Since Congress passed the National Cancer Act in 1971, NCI has continued to collaborate with top researchers and medical facilities across the country to conduct innovative research leading to progress in cancer prevention, detection, diagnosis and treatment. These efforts have resulted in a recent decrease in the overall cancer death rate, and have helped improve and extend the lives of millions of Americans.

National Comprehensive Cancer Network®

Patient Information and Referral Service
1-888-909-NCCN
http://www.nccn.org

These resources refer to Web sites maintained by third parties over whom Novartis Medical Nutrition has no control. As such, Novartis makes no representation as to the accuracy, completeness, adequacy, or any other aspect of the information contained on such Web sites.

Is the impact of strong nutritional status on the ability to fight fatigue, minimize weight loss and heal well researched?

Nutritional support is commonly accepted as a component of comprehensive cancer care. Depending on how recently you received your diagnosis, as well as the nature of your diagnosis, you may have already had a discussion with someone on your health care team about the role of nutrition in your treatment plan. All the same, you and your health care team may find the following clinical information helpful.

Strong nutritional status can help minimize weight loss, help achieve and maintain desirable weight, help prevent or correct nutritional imbalances and deficiencies, and maximize immune response.

It is estimated that between 40% and 80% of all cancer patients develop some degree of malnutrition during their illness. Any degree of malnutrition adversely affects the immune system, therefore increasing the risk of infection and reducing treatment effectiveness and tolerance.

You are in control when it comes to actively maintaining your nutritional status. Remember, whenever possible you should consume a variety of foods. When your ability to eat is affected, you can “fortify” your real food to get more nutrition from smaller amounts. If you’re unable to consume foods orally, your health care team will discuss options with you.

The goal of nutritional support is to potentially improve outcome, promote tolerance to therapy, maintain nutritional and functional status and enhance quality of life.

Key Nutritional Needs

• Adequate calories and protein
• Adequate levels of vitamins and minerals
• A source of immune-enhancing nutrients—dietary nucleotides and fish oil—as a nutritional adjunct to major surgery
• Elemental or semi-elemental source of protein for malabsorption complications
• Low fat content for malabsorption complications

References

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