Managing Cancer Side Effects with Nutrition Video Transcript


Basic Topics in Cancer Care
Understanding Cancer: A Video Library of Cancer Information
Coping with Cancer: Managing Cancer Side Effects with Nutrition
Time: 16:46


I think that anyone that is diagnosed with cancer is first of all stunned pretty heavily.

It was like, this can't be happening to me. You always think this is something that happens to somebody else. Not anything that happens to you.

I sort of suspected something was wrong. But it's not a happy diagnosis to hear.

[ with Jacque ] Your initial feeling is you're scared to death, because you have cancer, and you think, well, this is the end of it. You know my wife and my family, they're going to be without me. But you get over that quick, because you can't dwell on that.

Hi, I'm Dena Reagan, and I'm a dietitian at M. D. Anderson Cancer Center. Strange though it may seem, what you eat during the time you're receiving treatment for cancer is important.

In this program, we're going to talk about nutrition as it relates to cancer, and I'm going to address some of our patients' most frequently asked questions. We're also going to hear from some patients and their caregivers talking about their experiences.

In the past, cancer patients were told "eat anything you want, as long as you maintain your weight". But knowing that "you are what you eat", we now advise patients to eat healthfully in order to maintain optimal nutritional status AND build up your immune system. You don't want to waste calories on "empty foods" that have little or no nutritional value.

Now many patients ask, "what should I eat during treatment", and "what foods will help build my immune system"?

A healthy diet during cancer treatment means that you're eating a variety of foods from all the food groups. Plant foods should form the basis of your diet, since they help you get the most fiber, vitamins, minerals, and phytochemicals.

Eat 7 to 10 servings of fruits and vegetables every day by aiming to fill 2/3 of your plate with plant foods. Choose a variety of colors rather than the same old things.

Now the salad bar's a great place to start.
Fill half or more of your plate with salad, top it with some healthful veggies, for protein try a boiled egg or a few nuts or sesame seeds, and use a light salad dressing. Avoid the heavier dressings, mayonnaise based salads, and fried toppings since these just add extra calories.

During some stages of cancer treatment, you may need to avoid raw foods all together, so be sure and ask your doctor about blood counts, and talk with your dietician about your options.

Cooking enhances some of the nutrients and destroys others, so mix it up. Use a variety of cooking methods and regularly include raw fruits and vegetables in your diet unless otherwise instructed by your healthcare team.

Eat beans, peas and lentils regularly. They're great sources of fiber and protein.

Choose whole grain products, because they're high in fiber, unlike refined carbohydrates.

Refined carbohydrates provide calories, but they lack important nutrients that aid immune function and help strengthen your body to respond well to your cancer treatment.

Nuts and seeds are excellent sources of healthy fats. They also provide some fiber and protein.

Having adequate protein in the diet spares muscle protein to prevent muscle wasting. This is especially important to promote wound healing after surgery, or during radiation.

Meat and dairy products are good sources of protein, but you should limit fats from these foods. Try to replace unhealthy fats with healthy fats as much as possible.

Healthy fats are divided into two groups: the monounsaturated fats and the polyunsaturated fats. Polyunsaturated fats include the very beneficial omega-3 fatty acids, as well as omega-6 fats. In addition to providing energy to your body, fats carry vitamins and proteins through the blood stream. Healthy fats help protect against heart disease and can help decrease triglycerides and blood pressure.

Unhealthy fats include trans fats and saturated fats. The most common sources of trans fats in our diet are partially hydrogenated vegetable oils. These are ingredients in many convenience items, baked goods and deep fried foods. Saturated fats are found mainly in animal foods.

Research has shown that unhealthy fats increase your risk for disease and to some degree infection. They don't add anything positive, so go ahead and avoid them during this time when good nutrition is paramount.

Many patients ask, "should I expect to lose weight during treatment?" Ultimately, the goal of a healthy diet is to maintain a healthy weight while you're undergoing treatment.

For some, this may mean you have to keep from losing weight. The risks of losing too much weight too quickly could mean that you have to miss treatments, because your body isn't strong enough to handle it. Rapid, unintentional weight loss usually means that protein needs are not being met, slowing down the healing process after surgery or during radiation. You may need to adjust the size and timing of your meals in order to make sure you get enough calories each day.

For others, this may mean you have to keep from gaining weight. Overweight or obesity can make dosing of treatments difficult, may contribute to poorer outcomes in cancer patients, and increases risk for recurrence of several cancers. Excess body weight also increases risk for heart disease, diabetes, and other conditions, which can further complicate cancer treatment. So aim for adequate but not excessive calories in your diet.

Many patients wonder whether they need to buy only organic foods while undergoing treatment. There's not enough long-term data to say for certain that it's necessary to buy only organic foods; however, there's enough evidence in favor of organic food to suggest that if they're available, you have the means to do so, and it buys you some peace of mind, it's not a bad idea to buy organic foods.

Another common question is "can I take dietary supplements" while undergoing cancer treatment?

It's a good idea to take a standard multivitamin and mineral supplement, meaning it provides about 100% of your daily value on the different nutrients listed. Avoid mega doses of any single nutrient. Your dietitian should review any herbals or botanicals for potential interactions with your treatment. It's always best to get your nutrients from food. Supplements are just that. They are to "supplement" your healthy diet.

Say you've decided to use dietary supplements. The question then becomes, "how do I know which ones to buy?"

We recommend that you look for the USP label. It lets you know that the information on the label is accurate and the product pure.

Be cautious about sources of information on the Internet. Some questionable claims to watch out for include testimonials used as evidence, unreferenced data or references from nonscientific publications, too good to be true claims, statements of effectiveness for many medical conditions, and claims to treat or cure disease.

Another common question is "how does nutrition relate to the side effects of my treatment?"

Your cancer treatment may include surgery, radiation, chemotherapy, hormone therapy, or some combination of these. Some side effects experienced during treatment can be managed with nutrition.

Surgery puts the body under a great deal of stress. There may be an increased need for nutrients, especially protein, to help your wounds heal.

Surgery in the head and neck area may cause loss of appetite, and difficulty chewing or swallowing. Liquid supplements are often needed to boost calories.

Radiation therapy can cause different side effects depending on the part of the body being treated. Radiation to the head and neck may cause a dry or sore mouth, change in the taste of food, and difficulty swallowing. Your dietitian may recommend dietary modifications to meet your nutritional needs amid these challenges.

Radiation to the abdominal area may cause nausea, vomiting and diarrhea. Medications and alterations in diet can help manage these symptoms.

Chemotherapy can affect the whole digestive system causing a range of symptoms. Some are helped by medication, and some can be handled nutritionally. If you're having problems with any of these symptoms listed, ask to speak with a dietitian.

Hormone therapy typically causes weight gain, along with fatigue, decreased muscle mass and decreased bone strength. A dietitian can help you prevent weight gain and possibly lose weight, if appropriate.

Many patients wonder if it hurts or helps to exercise during and after treatment.

Scientific data indicates that patients who exercise do better than those who don't as far as treatment outcomes. Exercise improves fatigue levels, increases energy, strengthens the heart and lungs, and helps you gain muscle mass, which is of particular concern to chemotherapy patients.

Information about what to eat when you have cancer can be found everywhere, but that information may not apply to your individual situation. That's why it's important to talk with your health care provider about your diet. Ultimately, dietitians are your best source of nutritional information.

Now we're going to meet with some patients and caregivers to find out how nutrition fit into their cancer treatment.

Maria was diagnosed with breast cancer that spread to her shoulder. Her treatment included chemotherapy, surgery and radiation therapy.

I had loss of appetite. And I never lost any weight. Sometimes I wanted to lose a little bit of weight. I've never weighed this much in my life! [ Smiles ]

Mr. Zamora:
What happens during this period of time is that the patient, my wife, was no longer able to do some of the things that she was able to do before. She was not able to cook. She was not able to go to the store because of her immune system being low. So it was important then that as a husband then that I would take on some of those roles.

He fixed my meals, and I ate. And it's much easier if someone else fixes your meals. [ Laughs ]

Liquid nutritional supplements and medications helped Maria handle the nausea she experienced during chemotherapy.

You find yourself desperate for doing as much as you can to make sure that things are done to help the patient, and what we found out is that not everything that we would hear were the things to do, so it was important that we listened to the doctors and listened to the dietitians.

A diagnosis of prostate cancer was a real wake-up call for Lyle. We worked together during consults and via e-mail to make dietary changes that research has shown would help his body fight cancer.

That began to help me put my thinking together about the fact that I wasn't as helpless as I thought I was when I came here. That I could make choices that made it difficult for the cancer cells to grow and to develop. That I would be helping myself considerably in terms of the treatments that I would be receiving here at M. D. Anderson.

Lyle cut out refined carbohydrates, unhealthy fats, and began controlling his salt intake. Despite initiation of hormonal therapy, he went from 263 pounds to 219 in about 6 months, but it wasn't easy.

I think anyone who knew me would know that it would be almost impossible for me to give up cookies and pies and cakes...

Lyle began exercising again, with his doctor's approval. It was difficult, but before long, he was feeling much better.

...and you begin feeling good about yourself. You feel that you can do it. You feel that you are getting a competitive spirit back. And I believe very strongly that each patient needs to make the commitment to fight the fight in their terms.

Joe was diagnosed with cancer in his esophagus. He underwent chemotherapy and radiation to the neck. Early on, he and wife Dorothy met with a dietitian.

And she said, [but] with this type of cancer that you have, they are going to give you a feeding tube, which I was totally against. It just sounded bizarre to me.

Their dietitian taught them how to use the tube. A month after radiation, Joe had trouble swallowing. He ended up using the feeding tube for about 2-weeks

And it's a very simple procedure. You just feed yourself with this canned liquid material that they use for food, and you sit in a chair and you watch TV [ or you read ], and you're being fed, but nothing is through your mouth.

Exercise was already a part of Joe's lifestyle, which helped him avoid that common side effect... fatigue.

So with a regimen of vitamins and eating healthy and exercising, That's what's keeping me going. I was going to say I suspect, but I don't suspect. I know.

Wayne was diagnosed with cancer in his neck. Surgery was followed by external radiation, another surgery, internal radiation, then chemotherapy.

All along our greatest concern was that he not have a feeding tube.

That's right.

That was really our mantra, no feeding tube, no feeding tube.

Their dietician explained that a 10% loss of body weight would necessitate a feeding tube. Meanwhile, radiation side effects made eating difficult, even on a liquid diet.

Well, you lose all of your taste buds. You lose everything in there, so it's really more feel is what it is than anything, and texture of things, and smell.

Jacque created a spreadsheet to keep track of medications, calories, and the time of day taken and a menu plan with 3 different options for each meal. If Wayne's weight dropped, they increased the calories. If it went up, they reduced the calories.

Make your choices early on to take your foods and even if you don't feel like, if you have a day when you're down emotionally, go ahead and try to get that food down, go ahead and get that liquid down. Whatever is required, because it'll pay off tomorrow.

There are some days I go in there and open that refrigerator and I just can't hardly stand to look at that drink But you have to do it. You have to go ahead and take it.

It's part of the medicine really.

That's right. It's just as medicinal as the things that come out of the little pill bottles.

We hope that this program has been informative. For additional educational materials, visit M. D. Anderson's Learning Center, or attend one of our nutritional classes. Registered dietitians who specialize in the care of cancer patients are available for you here at M. D. Anderson, so ask your doctor or nurse for a referral, or contact us directly at the Department of Clinical Nutrition, (713) 792-2254.