Nutrition Care in Cancer Treatment

May 3, 2021

In 2019, the World Health Organization estimated the worldwide incidence of cancer and found it to be the first or second leading cause of death before age 70 in more than 60% of the 183 countries examined. Around the world, the burden of cancer incidence is growing rapidly, with almost 10 million cancer deaths worldwide in 2020.¹

Population growth, an aging population, and socioeconomic factors are cited as reasons for the increase. Although economic and living conditions have improved in most countries, these improvements represent a complex issue.¹ Some of the environmental exposures and lifestyle changes associated with socioeconomic improvements that drive the incidence of cancer include tobacco use, overweight and obesity, lack of physical activity, low fertility and older age for first birth. These trends are valuable in predicting the future burden of cancer globally and allow experts to examine ways to modify cancer risk.²

Certain side effects of cancer and treatment can be helped with nutrition intervention. Nausea, weight loss, muscle loss and malnutrition are common side effects while undergoing cancer treatment, and many cancer survivors are motivated to seek out guidance on food choices and dietary supplements to improve quality of life and survival rate.³ It’s important to examine ways that healthcare professionals might better understand the role that nutrition can play in symptom management.¹

The European Society for Clinical Nutrition and Metabolism (ESPEN) Examines Cancer Survivors Attitudes Toward Nutrition Intervention
Cancer survivors at 20 different clinical sites in Ireland were surveyed about their attitudes toward nutrition, and since similar examinations have not been compiled, these findings were groundbreaking. Participants with all major types of cancer were represented in the surveys and 97.8% of respondents rated nutrition as important. Nearly 45% of respondents reported suffering from a diet-related problem, 45% reported having lost weight due to their cancer, and weight gain was reported by 23% of respondents.³

Without access to qualified healthcare practitioners, like dietitians, many people undergoing cancer treatment seek out unqualified and unreliable sources. In fact, more than one third of the respondents reported trying at least one of the following strategies; restrictive diets, vitamin/mineral supplements, herbal remedies, and juicing and detoxes without counseling from a qualified healthcare professional.³

Some cancer survivors do seek out qualified nutrition guidance, and this effort is backed by The European Society for Clinical Nutrition and Metabolism (ESPEN) as their 2017 guideline recommends that all cancer patients be screened regularly for malnutrition. Almost 40% of the respondents surveyed received treatment from a registered dietitian, and 93% rated the encounter as helpful. More than 55% of the respondents who did not see a registered dietitian stated that they would have liked more diet advice. The most common reason why respondents did not receive nutrition counseling was that a referral was not offered.³

Unintentional Weight Loss and Malnourishment in Cancer Treatment
Cachexia, the loss of muscle mass and body mass due to advanced malnutrition, is insidious.4,5 Unfortunately, much of the time, cachexia remains undetected and untreated. It has a dramatic impact on the patient’s quality of life and response to treatment is estimated to be responsible for up to 20% of cancer deaths. Up to half of all patients with cancer experience cachexia. Side effects of cancer progression and treatment including anorexia, decreased physical activity, decreases in secretion of anabolic hormones and metabolic changes leading to abnormalities in protein, lipid and carbohydrate metabolism are thought to be factors in the development of cachexia. It has been proposed that pro-inflammatory cytokine activity that results in systemic inflammation is at the root of cachexia.4

Physical Activity as a Countermeasure for Cachexia
Physical activity is a promising method for preventing cachexia. Although there are few studies on the effectiveness of physical activity against cachexia, exercise can help suppress the body’s inflammatory response to cancer through improvements in insulin sensitivity, protein synthesis, and anti-oxidative enzyme activity.4

Nutritional Interventions Can Help Malnourished Patients with Cancer Improve Quality of Life
A systematic review examined the effectiveness of nutrition consultation for cancer survivors. The results show mixed benefits on the clinical advantages of oral nutritional interventions, possibly due to a mixture of types and length of feeding interventions examined. Although the effects on body weight and energy intake are inconsistent, improvements in quality of life were noted. When compared with routine care, nutrition intervention was associated with a significant boost in energy intake, 430 kcal/day, and a weight gain of 1.9 kg.6

Many patients with cancer experience changes in appetite, food intake, and improper digestion and nutrient absorption. A registered dietitian can perform an assessment and nutritional screening to determine the best strategy for dietary recommendations.5

For those looking to increase protein intake based on a dietitian recommendation, Orgain has a variety of ready to drink shakes and protein powders that can be easily incorporated into smoothies and foods Alison Tierney, MS, RD, CD, CSO, Oncology Dietitian and Orgain Nutrition Advisory Board Member explains, “I’ve firsthand seen the power of plant-based nutrition to positively impact the lives of not only cancer patients, but any individuals seeking to live their best life. And in the high-paced, busy lives we live, the high standards Orgain applies to their products allows individuals to focus on high quality nutrition when we don’t have the time or energy to spend hours in the kitchen.”

Since many cancer patients and survivors are motivated to seek nutrition intervention to improve quality of life, this presents an opportunity for healthcare professionals to refer patients to a registered dietitian. The American Institute for Cancer Research issued recommendations for Living Well with Cancer and Beyond which includes a recommendation for cancer patients to ask their doctor about a referral to a registered dietitian and a certified exercise physiologist to focus on healthy changes that can help patients cope with cancer.7

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1 Sung H. Ferlay J. Siegel R. Laversanne M. Soerjomataram I. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer Journal for Clinicians 2021; 0:1-41. doi: 10.3322/caac.21660.
2 Lortent-Tieulent J. Georges D. Bray F. Vaccarella S. Profiling Global Cancer Incidence and Mortality by Socioeconomic Development. International Journal of Cancer 2020; 147:3029-3036. DOI: 10.1002/ijc.33114
3 Sullivan E. Rice N. Kingston E. Kelly A. Reynolds J, et al. A National Survey of Oncology Survivors Examining Nutrition Attitudes, Problems and Behaviours, and Access to Dietetic Care Throughout the CancerJjourney. Clinical Nutrition ESPEN 2021; 41:331-339.
4 Aoyagi T. Terracina K. Raza A. Matsubara H. Takabe K. Cancer Cachexia, Mechanism and Treatment. World Journal of Gastointestinal Oncology 2015; 7(4):17-29. DOI: 10.4251/wjgo.v7.i4.17
5 Gangadharan A. Eun Choi S. Hassan A. Ayoub NM. Durante G, et al. Protein Calorie Malnutrition, Nutritional Intervention and Personalized Cancer Care. Oncotarget 2017; 14:24009-24030.
6 Baldwin C. Spiro A. Ahern R. Emery P. Oral Nutritional Interventions in Malnourished Patients with Cancer: A Systematic Review and Meta-Analysis. Journal of the National Cancer Institute 2012;104:371–385. DOI: 10.1093/jnci/djr556
7 American Institute for Cancer Research. Living Well with Cancer and Beyond. 2019. Available at:, accessed 3/28/2021.

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