WASHINGTON — The statistic is shocking: Severe malnutrition and weight loss play a role in at least one in five 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 fancy gourmet chefs to the American Cancer Society’s dietitians-on- call phone service.
With cancer, you’ve got to “bring a lot more nutrients to each spoonful of food,” Certified Master Chef Jack Shoop is learning. A former restaurateur, he’s newly in charge of the kitchen at the Cancer Treatment Centers of America in Philadelphia.
Don’t underestimate the added temptation should the result resemble Bon Appetit: “The visual heartiness, and the actual heartiness, of these foods has to be understood for them to embrace it,” Shoop says.
Tempting the palate is a huge hurdle: At diagnosis, up to a quarter of patients already have their appetite sapped, and most treatments can bring side effects that worsen the problem. Aside from the well- known nausea, vomiting and diarrhea, 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 percent 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 percent of their usual weight. Other research suggests that patients who lose more than 5 percent of their pre-cancer weight have a worse prognosis than people who can hang onto the pounds.
For their best shot at doing that, the American Cancer Society urges patients to ask to be assessed by a registered dietitian upfront, right at diagnosis.
“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 Colleen Doyle, nutrition chief at the society, which offers nutrition advice through its hotline, 1-800-ACS-2345.
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: Sugar feeds tumor cells. Maureen Huh mann, who chairs the American Dietetic Association’s oncology nutrition group, says protein-packed milkshakes and smoothies can, in fact, be lifesaving for some patients.
How cancer patients can keep weight on
Some tips from cancer specialists and dietitians to help patients keep weight on:
• Try to eat five or six small meals throughout the day rather than three large ones.
• Cancer patients tend to need more protein than healthy people. Peanut-butter crackers; yogurt and fruit; a hard-boiled egg and piece of toast all are good mini-meals.
• Drink between meals, not with them, to avoid filling up on liquid.
• Don’t try your comfort food if you’re vomiting. It may create an aversion.
• Foods high in fat or fiber make nausea last longer.
• White, bland foods tend to help with nausea, such as Cream of Wheat, mashed potatoes and cottage cheese.
• Odors often worsen nausea, and foods served at room temperature rather than warm tend to have milder odors.
• Fresh ginger about 30 minutes before eating also can take the edge off nausea, but not the ginger flavoring common in sodas. A study published last week found ginger capsules work.
• Certain cancer medications, particularly painkillers, cause constipation, so keep up the fiber whenever the nausea passes.
• Take special care to stay hydrated when diarrhea strikes. Bananas, rice, applesauce and toast are good options.
• Many patients find foods that once tasted good now taste metallic. Citrus sometimes counters that; try sucking lemon drops or drinking lemonade with meals, or using citrus-based marinades. Other patients may have a treatment-caused, and correctable, zinc deficiency.
• Tell your doctor about any over-the-counter dietary supplements. Some, such as St. John’s wort, can cause dangerous interactions with numerous anti-cancer medications. Even high amounts of acidic vitamin C can worsen stomach problems.
• Staying hydrated and eating foods moistened with sauces and gravies help dry mouth; also, doctors can prescribe artificial saliva.
• High-protein, high-calorie milkshakes and canned supplements such as Ensure help sneak in extra nutrients and are especially helpful for patients with mouth sores. Make your own with whole milk and a few tablespoons of dry milk or protein powder.
• Ask for a consultation with a dietitian who specializes in cancer before you start losing weight. Specially designated cancer centers have dietitians on staff, and insurance may cover other consultations if the doctor orders it. The American Cancer Society’s toll-free hotline — 800-ACS-2345 — connects patients in the Southeast to dietitians on call and will find nutrition answers for people elsewhere. To try to find nearby dietitians, go to .
• Look for recipes targeted to cancer patients. The cancer society, which posts some at ., plans a new cookbook in July.
The Associated Press
