The role of nutrition in cancer care

Why is nutrition important when you have cancer?

Cancer treatment, particularly chemotherapy and radiotherapy, can affect what you are able to eat and/or drink, and how well your body absorbs and uses the nutrients it gets from food. In addition, cancer itself can raise the body’s metabolic rate so that it is burning off muscle (‘lean body mass’) at a much higher rate than normal, a condition known as ‘cachexia’¹.

Together, these factors cause many people (between 30% and 80%²) to lose weight as they progress through their cancer journey, from diagnosis, through to treatment and recovery. This weight loss can have significant and negative effects on the health of the person diagnosed, being associated with increased complications, more rapid disease progression, and even delaying or leading to suboptimal treatment – with implications for rates of survival^3-5.

It is important that those diagnosed with cancer understand the implications of weight loss – and are armed with the nutritional information necessary to help them regain and/or maintain their bodyweight.

Is there a cancer diet?

Whilst there are no direct cancer-causing foods or specific cancer fighting foods (‘anti-cancer foods’), there are particular nutrients, which you should try to get enough of, to support the body during cancer treatment. Guidelines suggest those diagnosed should consume twice the amount of protein as a healthy person, in order to rebuild muscle strength⁶. Energy, in the form of calories, is also important⁶. They also need enough micronutrients, which are key for the normal functioning of the body; vitamin D deficiency is common amongst people with cancer^7,8. However, in general, people tend to eat less when they are not feeling well. Because of the effects of cancer and its treatment, it can be difficult to get enough of the right nutrition from a normal diet alone to keep the body as strong as it needs to be. At this point, your healthcare professional may recommend the use of an oral nutritional supplement.

What is an oral nutritional supplement?

An oral nutritional supplement (ONS) is a specially designed food or drink to help people with malnutrition meet their nutritional needs. Designed to help boost nutritional intake, ideally they should be taken in addition to a normal diet, rather than replacing ordinary foods and drinks. Oral nutritional supplements are available in a range of different flavours and formats and also a range of different nutrient compositions. This means that those diagnosed with cancer can benefit from an oral nutritional supplement regimen tailored not only to their particular nutritional needs, but also to their taste and format preferences.

If you are unable to eat at all, some variants can be used as a sole source of nutrition as they contain all the nutrients a body needs to function.

What types of oral nutritional supplement are available?

• Milkshake style available in either 200ml bottle or a 125ml bottle, these ready-to-drink shakes are high in protein and energy. There are also options that are high in fibre and nutritionally complete.
• Juice style which is high in energy and available in a ready-to-drink 200ml bottle, providing an alternative for people who prefer fruit juice flavours or a change from a milkshake format.
• Dessert style high energy, high protein pudding style dessert that comes in 125g pots and can be enjoyed with a spoon.

Oral nutritional supplements are clinically proven to help people living with cancer meet their nutritional needs

Boosting nutritional intake via oral nutritional supplements has been shown in clinical trials to benefit those living with cancer in a number of different ways, for example:

• Improving nutritional intake and therefore reducing weight loss^8-10
• Reducing treatment-related complications^8,10,11
• Longer life expectancy¹²
• Reducing length of hospital stay^11,13
• Improving quality of life⁹

How long should I take an oral nutritional supplement?

Each individual is different and has different nutritional needs, depending on the severity of their weight loss and/or cancer cachexia. Recommendations for oral nutritional supplements are usually between 1 and 3 bottles a day, but this varies depending on an individual’s needs.

It is also important to understand that oral nutritional supplements don’t work overnight – it takes time to rebuild the strength lost through the impact of cancer. It can be anything from a few weeks to a few months, or more. It is important that you speak with your healthcare professional to understand how much you should take and the length of treatment suited to your individual needs.

References

1. Fearon K et al. Lancet Oncol, 2011;12(5):489-95.
2. Ryan et al. Proc Nutr Soc. 2016;75(2):199-211.
3. Andreyev HJ et al. Eur J Cancer. 1998;34(4)p.503-9.
4. Prado CM, et al. Cancer Chemother Pharmacol, 2011; 67(1): p.93-101.
5. Fearon KC. Eur J Cancer 2008;44(8): p.1124-32.
6. Arends J, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr, 2016;ePub Curr Opin Support Palliat Care. 2013 Sep; 7(3): 272–277. Vitamin D in the cancer patient.
7. Kurt A. Kennel and Matthew T. Drake
8. Burden ST, et al. J Cachexia Sarcopenia Muscle, 2017.
9. Baldwin et al. J Natl Cancer Inst, 2012;104(5):371-385.
10. Kabata P, et al. Support Cancer Care, 2015 ;23(2) :365-70.
11. Manasek V. et al. Klin Onkol, 2016.
12. Martin L Senesse P et al. J Clin Oncol 2015 Jan 1: 33(1): p.90-9.
13. De Waele et al. Appetite, 2016;91:298-301.