13.5 Cancer
8 min read•july 30, 2024
Cancer significantly impacts nutritional status, affecting appetite, digestion, and nutrient absorption. Different cancers have unique implications, with treatment side effects further complicating matters. , a metabolic syndrome causing muscle and fat loss, is a serious concern in advanced stages.
Assessing nutritional status in cancer patients is crucial. Regular monitoring of weight, BMI, and biochemical markers helps detect changes. Dietary intake assessment using tools like 24-hour recalls and food diaries identifies potential deficiencies. Individualized nutrition care plans aim to correct deficiencies, maintain body composition, and manage treatment side effects.
Nutritional Implications of Cancer
Impact on Nutritional Status
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- Cancer can have a significant impact on an individual's nutritional status as the disease itself and its treatment can cause a range of side effects that affect appetite, digestion, and nutrient absorption
- Different types of cancer can have specific nutritional implications depending on the location and stage of the tumor, as well as the individual's overall health status
- Head and neck cancers can cause difficulty with chewing and swallowing, while gastrointestinal cancers may lead to malabsorption and nutrient deficiencies (esophageal cancer, )
- Cancer cachexia is a complex metabolic syndrome characterized by loss of muscle mass and body fat, often accompanied by anorexia, inflammation, and insulin resistance
- Cachexia can lead to significant weight loss, fatigue, and reduced quality of life (advanced stage cancer)
Treatment-Related Side Effects
- Chemotherapy and radiation therapy can cause side effects such as nausea, vomiting, diarrhea, and mucositis, which can further compromise nutritional status
- Nausea and vomiting can lead to decreased food intake and dehydration (, )
- Diarrhea can result in fluid and electrolyte imbalances, as well as malabsorption of nutrients (, )
- Mucositis can cause pain and difficulty with eating and drinking ()
- Nutritional deficiencies, such as deficiency, are common in individuals with cancer and can negatively impact treatment outcomes and quality of life
- Vitamin D deficiency has been associated with increased risk of cancer progression and mortality (, colorectal cancer)
Nutritional Status Assessment for Cancer
Anthropometric Measurements
- A comprehensive nutritional assessment is essential for identifying and addressing the unique nutritional needs of individuals with cancer
- Anthropometric measurements, such as weight, height, and body mass index (BMI), should be obtained and monitored regularly to detect changes in body composition
- Weight loss of 5% or more in one month or 10% or more in six months is considered clinically significant (cancer cachexia)
- BMI can be used to classify individuals as underweight, normal weight, overweight, or obese (BMI < 18.5 kg/m², BMI 18.5-24.9 kg/m², BMI 25-29.9 kg/m², BMI ≥ 30 kg/m²)
Biochemical and Clinical Assessments
- Biochemical data, including , , and levels, can provide insight into an individual's nutritional status and inflammatory response
- Serum albumin is a marker of visceral protein status and can be used to assess chronic malnutrition (albumin < 3.5 g/dL)
- Prealbumin is a more sensitive marker of acute changes in nutritional status (prealbumin < 15 mg/dL)
- C-reactive protein is an acute-phase protein that can indicate the presence of inflammation (CRP > 10 mg/L)
- Physical examination, including assessment of muscle mass, fat stores, and signs of nutrient deficiencies, can provide additional information about an individual's nutritional status
- Muscle wasting and loss of subcutaneous fat can be indicators of malnutrition (, reduced skin fold thickness)
- Signs of nutrient deficiencies, such as glossitis or angular cheilitis, can suggest inadequate intake of specific vitamins or minerals (, )
- Functional status, including and physical performance measures, can be used to assess the impact of cancer and its treatment on an individual's overall well-being
- Hand grip strength is a simple and reliable measure of muscle function and can be used to monitor changes over time (hand grip strength < 30 kg for men, < 20 kg for women)
- Physical performance measures, such as the six-minute walk test or the timed up and go test, can provide information about an individual's functional capacity and quality of life (reduced walking distance, increased time to complete tasks)
Dietary Intake Assessment
- Dietary intake should be assessed using tools such as 24-hour recalls, food frequency questionnaires, and food diaries to identify potential nutrient deficiencies and areas for improvement
- 24-hour recalls involve asking an individual to recall all foods and beverages consumed in the previous 24 hours (multiple recalls can provide a more accurate representation of usual intake)
- Food frequency questionnaires assess the frequency and portion sizes of specific foods and food groups consumed over a given period (can be used to identify patterns of intake and potential deficiencies)
- Food diaries require individuals to record all foods and beverages consumed over a specified period, typically 3-7 days (provides detailed information about portion sizes and cooking methods)
Nutrition Care Plans for Cancer
Goals of Nutrition Therapy
- Nutrition care plans for individuals with cancer should be individualized based on the type and stage of cancer, treatment modality, and the individual's nutritional status and preferences
- The primary goals of nutrition therapy are to prevent or correct nutrient deficiencies, maintain or improve body composition, and minimize treatment-related side effects
- Preventing or correcting nutrient deficiencies can help to support immune function and maintain overall health (vitamin D supplementation, iron supplementation)
- Maintaining or improving body composition, particularly lean body mass, can help to preserve muscle strength and reduce the risk of complications (resistance exercise, protein supplementation)
- Minimizing treatment-related side effects can improve quality of life and adherence to treatment (small, frequent meals for nausea, low- diet for diarrhea)
Macronutrient and Energy Requirements
- Adequate energy and protein intake are essential for maintaining muscle mass and supporting immune function. The recommended energy intake is 25-30 kcal/kg/day, and the protein requirement is 1.2-1.5 g/kg/day
- Energy requirements may be increased in individuals with cancer due to increased metabolic demand and the presence of inflammation (30-35 kcal/kg/day in some cases)
- Protein requirements may be higher in individuals with cancer cachexia or undergoing surgery (1.5-2.0 g/kg/day)
- Nutrient-dense foods and high-quality protein sources, such as lean meats, fish, eggs, and dairy products, should be emphasized to meet increased nutritional demands
- Lean meats, such as chicken and turkey, provide high-quality protein and are easy to digest (grilled chicken breast, turkey meatballs)
- Fish, particularly fatty fish like salmon and tuna, are rich in , which have anti-inflammatory properties (baked salmon, tuna salad)
- Eggs are a versatile and nutrient-dense protein source that can be easily incorporated into meals (scrambled eggs, hard-boiled eggs)
- Dairy products, such as milk, yogurt, and cheese, provide protein, calcium, and other essential nutrients (Greek yogurt, cottage cheese)
Nutritional Supplements and Symptom Management
- Oral nutritional supplements or enteral nutrition may be necessary for individuals who are unable to meet their nutritional needs through diet alone
- Oral nutritional supplements are liquid or powder formulas that provide additional calories, protein, and micronutrients (Ensure, Boost)
- Enteral nutrition involves the delivery of nutrients directly into the digestive system via a feeding tube (nasogastric tube, percutaneous endoscopic gastrostomy)
- Symptom management strategies, such as small, frequent meals and the use of ginger or peppermint for nausea, should be incorporated into the nutrition care plan to alleviate treatment-related side effects
- Small, frequent meals can help to reduce feelings of nausea and early satiety (six small meals per day instead of three large meals)
- Ginger has been shown to have antiemetic properties and can be consumed in various forms, such as tea, capsules, or crystallized ginger (ginger tea, ginger chews)
- Peppermint can help to reduce nausea and improve digestion (peppermint tea, peppermint oil capsules)
Nutrition in Cancer Prevention and Treatment
Dietary Factors in Cancer Prevention
- Nutrition plays a crucial role in both cancer prevention and treatment, as dietary factors can influence the risk of developing certain types of cancer and impact treatment outcomes
- A diet rich in fruits, vegetables, whole grains, and lean proteins, while low in processed and high-fat foods, has been associated with a reduced risk of several types of cancer, including colorectal, breast, and prostate cancer
- Fruits and vegetables are rich in antioxidants, fiber, and phytochemicals that may protect against cancer (berries, leafy greens, cruciferous vegetables)
- Whole grains provide fiber, vitamins, and minerals that may help to reduce cancer risk (brown rice, whole wheat bread, quinoa)
- Lean proteins, such as fish and poultry, are associated with a lower risk of certain cancers compared to red and processed meats (grilled chicken, baked fish)
- Processed and high-fat foods, such as processed meats and fried foods, have been linked to an increased risk of cancer (hot dogs, French fries)
- Specific nutrients and bioactive compounds, such as fiber, antioxidants, and phytochemicals, have been shown to have protective effects against cancer through various mechanisms, including reducing inflammation and oxidative stress
- Fiber helps to promote regular bowel movements and may bind to carcinogens in the digestive tract (fruits, vegetables, whole grains)
- Antioxidants, such as vitamin C, vitamin E, and beta-carotene, help to neutralize free radicals and protect cells from oxidative damage (berries, nuts, sweet potatoes)
- Phytochemicals, such as lycopene and resveratrol, have been shown to have anti-inflammatory and anti-cancer properties (tomatoes, grapes)
Nutrition During Cancer Treatment
- During cancer treatment, optimal nutrition can help to maintain muscle mass, support immune function, and improve overall quality of life
- Adequate protein intake is essential for preserving lean body mass and promoting wound healing (lean meats, fish, eggs, dairy products)
- Omega-3 fatty acids, found in fatty fish and fish oil supplements, may help to reduce inflammation and improve treatment response (salmon, sardines, fish oil capsules)
- Vitamins and minerals, such as vitamin D and zinc, play important roles in immune function and may help to reduce treatment-related side effects (fortified dairy products, oysters, pumpkin seeds)
- Nutritional interventions, such as the use of immunonutrition formulas containing arginine, omega-3 fatty acids, and nucleotides, have been shown to improve surgical outcomes and reduce postoperative complications in individuals with cancer
- Immunonutrition formulas are designed to support immune function and reduce inflammation (Impact, Pivot)
- Arginine is an amino acid that plays a role in wound healing and immune function (meat, poultry, fish, nuts)
- Nucleotides are the building blocks of DNA and RNA and may help to support cell growth and repair (organ meats, mushrooms, yeast)
- Maintaining a healthy weight and engaging in regular physical activity are also important for cancer prevention, as has been linked to an increased risk of several types of cancer
- Achieving and maintaining a healthy BMI (18.5-24.9 kg/m²) through a balanced diet and regular physical activity can help to reduce cancer risk
- Regular physical activity, such as brisk walking or cycling, has been shown to reduce the risk of several types of cancer, including breast and colorectal cancer (30 minutes of moderate-intensity activity per day)
Key Terms to Review (33)
24-hour dietary recall: The 24-hour dietary recall is a method used to assess an individual's food and beverage intake over the previous 24 hours. This tool helps to gather detailed information about dietary habits, nutritional intake, and can be useful for identifying potential nutrient deficiencies or excesses.
5-fluorouracil: 5-fluorouracil (5-FU) is a chemotherapy medication used primarily to treat various types of cancer, particularly colorectal, breast, and stomach cancers. It works by inhibiting DNA synthesis in cancer cells, thereby preventing their growth and division. This drug is often used in combination with other therapies to enhance its effectiveness and is a key component in the management of solid tumors.
Alcohol consumption: Alcohol consumption refers to the ingestion of beverages that contain ethanol, a psychoactive substance that can affect physical and mental health. It plays a significant role in various health contexts, influencing chronic conditions and potentially impacting the progression of diseases such as cancer. Understanding its effects is crucial for developing nutrition care plans and health strategies tailored to individual needs.
American Institute for Cancer Research: The American Institute for Cancer Research (AICR) is a nonprofit organization dedicated to cancer prevention and survival through research and education. AICR emphasizes the link between diet, physical activity, and cancer risk, aiming to inform the public about how lifestyle choices can influence cancer development and recurrence.
Antioxidant-rich diet: An antioxidant-rich diet is a dietary pattern that emphasizes the consumption of foods high in antioxidants, which are compounds that help neutralize free radicals in the body. This type of diet often includes fruits, vegetables, nuts, and whole grains, which are known to have protective effects against oxidative stress. By reducing oxidative damage, an antioxidant-rich diet may play a significant role in lowering the risk of chronic diseases, including cancer.
Breast cancer: Breast cancer is a type of cancer that develops from the breast tissue, often forming in the lobules or ducts that supply milk. It is one of the most common cancers among women and can also affect men, with risk factors including genetics, age, lifestyle, and environmental exposures influencing its development. Understanding breast cancer involves recognizing its various types, stages, and the importance of early detection through screening methods like mammograms.
C-Reactive Protein: C-reactive protein (CRP) is a substance produced by the liver in response to inflammation. It plays a key role in the immune system and is often measured in blood tests to assess inflammation levels in the body, making it a useful marker for various health conditions, including cardiovascular diseases and cancer.
Caloric restriction: Caloric restriction refers to reducing calorie intake without malnutrition, often with the goal of promoting longevity and health. This dietary approach has been studied for its potential benefits in reducing the risk of chronic diseases, including certain types of cancer, by influencing metabolic processes, inflammation, and cellular repair mechanisms.
Cancer Cachexia: Cancer cachexia is a complex syndrome characterized by severe weight loss, muscle wasting, and a decline in overall health that occurs in many cancer patients. It is not simply a result of reduced food intake, but involves metabolic changes driven by the tumor itself and inflammatory responses, leading to alterations in metabolism and nutrient utilization. This condition significantly impacts the quality of life and treatment outcomes for individuals with cancer.
Carotenoids: Carotenoids are a class of naturally occurring pigments found in plants, algae, and some bacteria, responsible for the vibrant red, orange, and yellow colors in many fruits and vegetables. They are important antioxidants and play a key role in human health by supporting immune function and promoting eye health, particularly through their conversion to vitamin A.
Cisplatin: Cisplatin is a platinum-based chemotherapy drug widely used in the treatment of various types of cancer, including testicular, ovarian, bladder, and lung cancers. It works by interfering with the DNA replication process in cancer cells, ultimately leading to cell death. The drug is a key component of many treatment regimens and has significantly improved survival rates for patients with these malignancies.
Colorectal cancer: Colorectal cancer is a type of cancer that begins in the colon or rectum, parts of the large intestine. It typically develops from polyps, which are small growths that can become cancerous over time. Factors like diet, genetics, and lifestyle choices significantly impact the risk of developing this disease, making it a major public health concern.
Doxorubicin: Doxorubicin is a chemotherapy medication used to treat various types of cancer, including breast cancer, bladder cancer, and leukemia. It works by interfering with the growth and spread of cancer cells in the body by inhibiting DNA replication and RNA transcription. This powerful drug is often combined with other treatments to enhance its effectiveness, but it can also cause significant side effects.
Fiber: Fiber is a type of carbohydrate that the body cannot digest, which is essential for maintaining digestive health and overall well-being. It helps regulate the body’s use of sugars, keeping hunger and blood sugar in check. Different types of fiber can provide benefits throughout life, from supporting healthy growth and development in children to aiding in the prevention of chronic diseases such as cancer and gastrointestinal disorders.
Flavonoids: Flavonoids are a diverse group of phytonutrients found in many fruits, vegetables, and beverages that possess antioxidant properties. They play a significant role in plant pigmentation and protection, and their consumption has been associated with various health benefits, particularly in reducing the risk of certain chronic diseases, including cancer.
Food Frequency Questionnaire: A food frequency questionnaire (FFQ) is a dietary assessment tool used to evaluate an individual's food intake over a specified period by asking about the frequency and portion sizes of various foods consumed. This tool is particularly valuable for identifying dietary patterns, monitoring nutritional status, and assessing the relationship between diet and health outcomes.
Hand grip strength: Hand grip strength is a measure of the force exerted by the muscles in the hand and forearm when gripping an object. It serves as a valuable indicator of overall muscular strength and functional ability, particularly in relation to health outcomes in various populations, including those affected by chronic diseases like cancer.
Head and neck radiation therapy: Head and neck radiation therapy is a specialized treatment that uses high-energy radiation to target cancer cells in the head and neck region. This therapy is often used to treat various cancers, including those of the throat, mouth, and nasopharynx, and can be employed as a primary treatment or as an adjunct to surgery and chemotherapy.
High-protein diet: A high-protein diet is a dietary plan that emphasizes the consumption of protein-rich foods while reducing the intake of carbohydrates and fats. This type of diet has been linked to various health benefits, including weight loss and muscle gain, and it plays a significant role in the context of cancer, particularly in how it may influence cancer risk, progression, and patient recovery.
Impact nutrition formulas: Impact nutrition formulas are specially designed nutritional products that provide essential nutrients to individuals with specific health needs, particularly those who are critically ill or have chronic diseases. These formulas aim to support recovery and improve clinical outcomes by delivering a balanced blend of macronutrients, micronutrients, and bioactive compounds that can enhance immune function and promote tissue healing.
Irinotecan: Irinotecan is a chemotherapy drug used primarily in the treatment of metastatic colorectal cancer. It works by inhibiting the enzyme topoisomerase I, which is essential for DNA replication, thereby preventing cancer cells from dividing and growing.
Iron deficiency: Iron deficiency is a common nutritional deficiency characterized by insufficient iron levels in the body, leading to reduced production of hemoglobin in red blood cells. This condition can result in anemia and affects various bodily functions, including energy levels and immune response. Symptoms can range from fatigue and weakness to more severe complications if not addressed, connecting closely with signs of nutrient deficiencies and the potential implications in health conditions such as cancer.
Low-fat diet: A low-fat diet is a dietary approach that restricts the intake of fats, particularly saturated and trans fats, while emphasizing the consumption of fruits, vegetables, whole grains, and lean proteins. This type of diet is often recommended for weight management and reducing the risk of chronic diseases, including certain types of cancer, by promoting healthier eating habits and lowering overall caloric intake.
Mediterranean Diet: The Mediterranean diet is a dietary pattern inspired by the traditional eating habits of countries bordering the Mediterranean Sea, emphasizing whole foods, healthy fats, and a balanced intake of nutrients. It is characterized by high consumption of fruits, vegetables, whole grains, legumes, nuts, and olive oil, while being lower in red meat and processed foods. This diet has been linked to various health benefits, including reduced risks of certain diseases and improved overall wellness.
Obesity: Obesity is a complex health condition characterized by an excessive amount of body fat, which can lead to various health issues. It is often assessed through measurements like Body Mass Index (BMI) and is linked to several chronic diseases, making its understanding vital in evaluating nutrition, growth, and overall health across different life stages.
Omega-3 fatty acids: Omega-3 fatty acids are a type of polyunsaturated fat that is essential for human health. They play critical roles in brain function, normal growth and development, and inflammation regulation. These fats are mainly found in fish, flaxseeds, and walnuts, and they are known to have several health benefits related to cardiovascular health, pregnancy outcomes, and chronic diseases.
Plant-based diet: A plant-based diet emphasizes foods derived from plants, including fruits, vegetables, whole grains, legumes, nuts, and seeds, while minimizing or eliminating animal products. This dietary pattern is associated with a range of health benefits and plays a significant role in cancer prevention and management due to its high content of antioxidants and phytochemicals.
Prealbumin: Prealbumin is a protein synthesized by the liver, primarily serving as a transport protein for thyroxine and retinol-binding protein. It is often used as a nutritional marker to assess protein status and is particularly sensitive to changes in dietary intake, making it a valuable indicator for malnutrition and other health conditions, including cancer.
Serum albumin: Serum albumin is a protein found in blood plasma that plays a critical role in maintaining oncotic pressure and transporting various substances throughout the body. It is crucial for assessing nutritional status and can indicate overall health, particularly in the context of liver function, kidney disease, and inflammation.
Temporal Muscle Wasting: Temporal muscle wasting refers to the reduction in size and strength of the temporal muscles, which are located on the sides of the head and are crucial for chewing. This condition is often observed in individuals suffering from malnutrition or chronic illnesses, such as cancer, where the body starts to break down muscle tissue for energy. Recognizing temporal muscle wasting is important for assessing nutritional status and determining the need for dietary interventions in patients with debilitating diseases.
Vitamin b12 deficiency: Vitamin B12 deficiency occurs when there is insufficient vitamin B12 in the body, leading to impaired production of red blood cells and potential neurological issues. This deficiency can manifest in various signs and symptoms that affect physical health, cognitive function, and overall well-being, as well as potentially being linked to cancer risk due to its role in DNA synthesis and cell division.
Vitamin D: Vitamin D is a fat-soluble vitamin essential for maintaining healthy bones and teeth, supporting immune system function, and aiding in the absorption of calcium and phosphorus. Its status is critical across different life stages, influencing overall health and development, especially in relation to various health conditions and nutrient requirements.
Walter Willett: Walter Willett is a prominent epidemiologist and nutrition expert known for his significant contributions to the understanding of diet and its relationship to health, particularly cancer. He is a professor at Harvard University and has played a vital role in large-scale epidemiological studies, including the Nurses' Health Study, which have provided valuable insights into how dietary patterns influence cancer risk and outcomes.