The statistic is shocking: Severe malnutrition and weight loss play a role in at least one in five US cancer deaths. Yet nutrition too often is an afterthought until someone's already in trouble.
A move is on to change that, from hospitals that hire gourmet chefs to the American Cancer Society's dieticians-on-call phone service. With cancer, you have got to "bring a lot more nutrients to each spoonful of food," Certified Master Chef Jack Shoop is learning. A former restaurateur, he is newly in charge of the kitchen at the Cancer Treatment Centres of America in Philadelphia.
Tempting the palate a hurdle
Don't underestimate the added temptation should the result resemble pictures in a glossy food magazine: "The visual heartiness, and the actual hardiness, of these foods has to be understood for them to embrace it," Shoop insists.
Tempting the palate is a huge hurdle: At diagnosis, up to a quarter of patients already have their appetite sapped, and most cancer treatments can bring side effects that worsen the problem. Aside from the well-known nausea, vomiting and diarrhoea, some cancers inhibit absorption of the nutrients patients force down. Not to mention strangely altered taste, mouth sores, dry mouth, difficulty swallowing and constipation.
About half of all cancer patients eventually suffer serious weight loss and malnutrition, a wasting syndrome called cachexia where they don't just lose excess fat but vital muscle. A healthy person's body adjusts when it doesn't get enough calories, slowing metabolism to conserve nutrients. A cancer patient's body doesn't make that adjustment; metabolism even may speed up.
The National Cancer Institute estimates cachexia is the immediate cause of death for at least 20% of cancer patients, although advanced cancer might have eventually claimed many of them.
How much weight loss is too much?
The institute defines patients as at-risk when they've lost more than 10% of their usual weight. Other research suggests that patients who lose more than 5% of their pre-cancer weight have a worse prognosis than people who can hang onto the kilograms.
For their best shot at doing that, the American Cancer Society urges patients to ask to be assessed by a registered dietician up front, right at diagnosis. While that's common at designated cancer centres where dieticians work on-staff, it is not routine elsewhere and surveys suggest just a third of patients have access to cancer nutritionists where they're being treated.
Nutrition helps treatment
"Patients who are well-nourished as they're going through treatment have shorter hospital stays, are better able to tolerate treatment," not to mention have better quality of life, says nutrition chef, Colleen Doyle.
Desperate patients often hunt their own nutrition advice on the Internet but can't tell the good from the bad. The No. 1 Web-perpetuated myth: that sugar feeds tumour cells. Not true, says Maureen Huhmann, who chairs the American Dietetic Association's oncology nutrition group. In fact, protein-packed milkshakes and smoothies can literally be lifesaving for some patients.
"I don't want people to start losing weight because they cut foods out of their diet when they don't really need to," says Huhmann.
Overweight and malnourished
Then there are people overweight when diagnosed who delight at shedding pounds - until they learn they're not just losing fat but muscle, too. "You can be overweight and even obese and still be malnourished. It's a dilemma," says Carolyn Lammersfeld, the Cancer Treatment Centres' nutrition director who works with Shoop, the chef, to help patients find palatable options.
Typically, a cancer patient needs as much as twice the protein of a healthy person and about 10% more calories. Some tumours bring bigger nutritional threats than others: Gastrointestinal and lung cancers tend to cause more weight loss than breast cancer.
Same goes for HIV/Aids
Malnutrition caused by HIV/Aids is also called "Slim Disease" because patients suffering from the disease literally tend to waste away. People living with Aids suffer from anorexia, diarrhoea, nausea, vomiting, fevers, and opportunistic infections, which all put an enormous strain on body reserves of energy, protein and micronutrients.
In addition, many of the anti-AIDS drugs can cause nausea, anorexia and vomiting, which interfere with food intake.
Anti-nausea medications developed in the past decade bring relief to many patients, although they're not always covered by insurance. Among options are a synthetic version of an ingredient from marijuana; cancer experts don't promote smoking marijuana although some advocates claim it helps. Doctors also can prescribe appetite stimulants and, for worst cases, feeding tubes.
But eating by mouth is best, and dieticians can offer tips to help: Snacking throughout the day instead of trying to force down large meals can help, and high-fat or high-fibre foods make nausea last longer. – (Sapa/Health24, May 2009)
Aids: Can diet help?
Malnutrition stunts the mind