Great strides have been made in treating cancer to achieve a 5-year survival rate of 68%. Targeted therapies and advances in genetics are enabling more personalized patient care for several cancer types. Treating cancer patients goes beyond the cancer itself; clinicians need to treat the whole patient. Nutrition is an often overlooked element of care.
Weight loss has been shown to be a poor prognostic sign in cancer. Malnutrition can impair the response to treatment, quality of life, and the immune system. Patients need recommendations that extend beyond the broad strokes of adding calories, drinking more, and picking up nutritional supplements. Specific food restrictions or recommendations can depend on chemotherapy treatment, disease, and symptoms. A personalized approach to nutritional care must include a medication review, an assessment for nutritional risk, weight loss, food intake, symptoms, and comorbidities. It has been estimated that 80% of cancer patients never receive an evaluation from a registered dietitian (RD).
Meeting Patient Needs
Medical, surgical, and radiation oncologists likely realize the need to address nutrition. However, practitioners are increasingly overloaded and time demands hamper achievement of this objective. New solutions for the patient are needed. Pharmacists who are specially trained in drug toxicity, drug interactions, and counseling can help meet many patient needs. Several academic centers have integrated clinical pharmacist practitioners into outpatient oncology clinics. Specialist pharmacists in Medco’s Oncology Therapeutic Resource Center integrate food restrictions or recommendations within the counseling they routinely provide by phone to a population of about 900,000 people. This is particularly important for those taking oral cancer medications because intake influences absorption and bioavailability, thus circulating drug levels.
“…80% of cancer patients never receive an evaluation from a registered dietitian.”
The American Cancer Society and American Dietetic Association’s Oncology Nutrition Dietetic Practice Group have both developed nutritional standards for cancer patients that emphasize healthy eating. However, there is a supply gap in RDs with oncology expertise, limiting the availability for individual patient support to address needs that change through treatment and recovery. There are only about 1,700 RDs within the Oncology Dietetic Practice Group of the American Dietetic Association, and only 300 RDs are certified as specialists in oncology. One solution that expands the availability of personalized dietary recommendations and oncology RD expertise to cancer patients is to maximize the use of web-based services, as available through enrollment in a program like TherapEase Cuisine (http://www.therapeasecuisine.com).
Food for Thought
Clinicians should become aware of food and drug interactions that may influence dose and drug availability in cancer patients. It should also be noted that there are some dietary recommendations to consider in special clinical situations. For instance, neutropenic and immune deficient patients require special food preparation. Salad bars—which are often thought to be a healthy choice—are generally not appropriate for these patients. In addition, certain foods are preferred to help manage side effects, such as constipation, diarrhea, mouth ulcers, and nausea.
As cancer clinicians are increasingly stressing the use of personalized anti-cancer therapies, they have less time available to address other aspects of care, especially nutrition. Counseling by pharmacists specializing in oncology can provide important education for patients on cancer drug dosing and administration and specific foods or supplements that may influence their treatment. Additional dietary recommendations can help ameliorate cancer-related wasting and nutritional deficits. Registered dietitians—either in person or those who are accessible online—must be considered a part of therapeutic teams that provide patient-centered care for anyone undergoing treatment or recovering from cancer.
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American Cancer Society. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. Page 2. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002577. Accessed July 15, 2010.