Nutritional issues in cancer treatment

04/05/2023

According to the European Society for Clinical Nutrition and Metabolism (ESPEN), up to 10-20% of cancer patients die as a result of malnutrition before dying from the tumor itself1. Improving nutritional status is a supportive therapy to help patients cope with prolonged treatment.

Current status of cancer and nutrition

According to the GLOBOCAN 2020 report of the International Center for Cancer Research, Vietnam has 182,563 new cancer cases and 122,690 cancer deaths, meaning that for every 100,000 people, there are 159 new cancer diagnoses. and 106 people died from cancer. Compared to 2018, Vietnam’s rate of new cases has increased 9 places, ranking 90/185 countries surveyed, and the death rate increased 6 places, ranking 50/185 countries surveyed2.

According to the European Society for Clinical Nutrition and Metabolism (ESPEN), up to 10-20% of cancer patients die as a result of malnutrition before dying from the tumor itself1. Meanwhile, in Vietnam, up to 50 – 80% of cancer patients lose weight during treatment and about 30% of patients die due to physical exhaustion3.

Malnutrition is a common problem in cancer patients, caused by both the presence of the tumor and medical and surgical anticancer treatments. Malnutrition has a negative impact on the patient’s quality of life and the patient’s body due to toxicity during treatment. Therefore, nutrition plays an important role in the treatment and care of cancer patients. However, according to ESPEN, cancer-related malnutrition remains largely unrecognized worldwide and underestimated in clinical practice.

Nutrition plays an important role in the treatment and care of cancer patients (Photo: Freepik)

Nutrition plays an important role in the treatment and care of cancer patients (Photo: Freepik)

Nutrition plays a particularly important role in preventing the risk of weight loss and malnutrition, thereby helping patients have the strength to cope with long treatment sessions. This issue needs to be focused from the moment the patient is diagnosed with cancer and maintained throughout the treatment process. Every cancer patient will experience a number of unwanted reactions during treatment, affecting more or less the amount of food and nutrition consumed in the body. Below are some nutrition and eating problems that patients often encounter.

Some common nutritional issues in cancer patients

Side effects during treatment

Most cancer treatments often leave side effects that affect the patient’s food tolerance and nutrition.

Table 1. Some common side effects that interfere with eating during cancer treatment.

Phản ứng phụ Phương pháp điều trị
Hóa trị Xạ trị Liệu pháp sinh học (Liệu pháp miễn dịch) Liệu pháp hormone Phẫu thuật
Difficulty swallowing x x
Dry mouth x x
Mucositis x x
Changes in sense of smell and taste x x
Feeling full early x x
Nausea and vomiting x x x x x
Diarrhea x x x x
Constipation x x x x
Anorexia, weight loss x x x
Weight gain x

Side effects due to tumor location

Besides, some locations of the tumor also cause many obstacles for patients in eating.

Table 2. Some side effects that interfere with eating caused by tumor location

Side effects Vị trí khối u
Head, neck Esophagus

Stomach

Pancreas, Liver, Small Intestine Large intestine
Difficulty swallowing x x
Dry mouth x
Taste changes x
Feeling full early x x
Nausea and vomiting x x
Stomach-ache x x
Diarrhea, malabsorption x x x
Constipation x x
Anorexia. weight loss x x x

Wasting due to the metabolic situation of the tumor

Tumor metabolism can harm the patient’s nutritional status, causing weight loss and reduced body mass index. This problem often occurs in patients with tumors in the lungs, pancreas, or upper gastrointestinal tract (mouth, esophagus, stomach). In cachectic patients, lipid, protein and carbohydrate metabolism will change, and tumors can reduce glucose absorption, increase glycolysis, and reduce energy intake10. This abnormal metabolism is a direct reaction of the tumor and the immune system, disrupting the homeostatic cycle and affecting body mass.

Nutritional advices for cancer treatment

Each patient will have unique nutritional problems, with different physical conditions, side effects, disease conditions, and needs a suitable nutritional regimen consulted by doctors and nutritionists. For example, for people with a healthy weight and stable nutritional status, the patient’s diet needs to be ensured to maintain weight and body mass index11. For malnourished people, the patient’s diet may need to increase energy and protein to support the function of important organs in the body12. Meanwhile, obese patients need to consider moderate weight loss (≤ 1 kg/week) while still maintaining lean muscle mass13.

The American Cancer Society has some suggestions to overcome symptoms related to the patient’s food intolerance due to treatment or tumor location, such as dividing meals into smaller portions, eat your largest meal when you feel most hungry, eat your favorite foods or foods that are easy to swallow, only drink a small amount of water during meals but drink more water gradually throughout the day, avoid food and drinks with strong smells, keeping a comfortable, well-ventilated living space, using dairy products, and foods rich in energy and protein (meaning small quantity but high quality).

 Cancer patients need to build a nutritional regimen suitable for their physical condition, under the advice of doctors and nutritionists​ (Photo: Freepik)

Cancer patients need to build a nutritional regimen suitable for their physical condition, under the advice of doctors and nutritionists​ (Photo: Freepik)

The use of foods rich in protein, energy and nutrients is also encouraged to improve nutrition status and supplement the body with enough nutrients. These medical nutritional foods help supplement energy, protein, carbohydrate, lipid, fiber, vitamins and minerals for patients, making up for nutritional deficiencies in main meals. Patients need to consume enough protein to maintain and regenerate lean muscle mass. In a systematic review, energy-dense oral intake products were shown to help reduce complications during treatment. Additionally, a 2012 Cochrane review showed that using immune-enhancing formulas containing fish oil, arginine and nucleotides helps reduce infections and post-operative complications15. Omega-3 supplements also improve taste, body weight and quality of life in patients undergoing chemotherapy and radiation therapy16.

Leanmax Hope – Medical Nutritional Product that help gain weight and muscle for cancer patients

According to experts, specialized nutrition that helps gain weight and muscle plays an important role in supporting cancer treatment. Leanmax Hope is a specialized nutritional product for cancer patients, which has been clinically proven and included in the diet for cancer patients at Hanoi Medical University Hospital.

Experimental results show that supplementing 2 glasses of Leanmax Hope milk every day will help cancer patients gain weight (average 1.4kg) and muscle (average 1.2kg) after 8 weeks. At the same time, the patient’s quality of life is also significantly improved: Fatigue and pain are reduced; Increase mobility; Improve quality of life.

Leanmax Hope product brings such good results thanks to its high energy content (474 kcal/ 100g of powder) with the following specific nutritional ingredients:

– High energy, BCAA, whey protein, MCT fat which is easy to be absorbed: Supports weight recovery and increases muscle mass.

– Prebiotics FOS/Inulin, Vitamins B and lactose-free: Supports appetite and improves digestion.

– Omega 3,6 with Antioxidant (vitamins A, C, E and Selenium): Helps increase immunity and reduce fatigue.

– Nano Curcumin, Arginine, Vitamin C: Supports reducing inflammation and healing surgical wounds quickly.

In 2018, the Leanmax products, including Nutricare’s Leanmax Hope, was recognized as a National Medical Nutrition Brand. This product is for patients with cancer and patients undergoing chemotherapy/radiation therapy. Adults and children over 3 years old who need high-energy nutritional supplements to restore health can also supplement Leanmax Hope in their daily diet. At the same time, Leanmax Hope products are currently widely distributed in hospitals nationwide, especially the two leading hospitals in the country in treating pediatric cancer patients, including: National Pediatric Hospital (Hanoi) and Pediatric Hospital II (Ho Chi Minh City), to supplement nutrition for pediatric cancer patients being treated here.

 Leanmax Hope is researched and developed by Nutricare nutritional scientists (Photo: Nutricare)

Leanmax Hope is researched and developed by Nutricare nutritional scientists (Photo: Nutricare)

The fight against cancer is a long-term battle, Leanmax Hope Medical Nutrition product is a companion to support cancer patients in order to have enough strength to continue fighting the disease.

Thus, facing cancer not only requires a doctor’s treatment regimen but also requires a combination of good nutrition and an optimistic spirit to fight the disease. Proper nutritional supplementation for cancer patients helps increase the patient’s chance of recovery after treatment.

References

  1. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017 Feb;36(1):11-48.
  2. Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021: 71: 209- 249.
  3. https://moh.gov.vn/chuong-trinh-muc-tieu-quoc-gia/-/asset_publisher/7ng11fEWgASC/content/dinh-duong-va-cham-soc-giam-nhe-can-thiet-voi-nguoi-benh-ung-thu?inheritRedirect=false
  4. Grant BL: Nutritional effects of cancer treatment: chemotherapy, biotherapy, hormone therapy and radiation therapy. In: Leser M, Ledesma N, Bergerson S, et al., eds.: Oncology Nutrition for Clinical Practice. Oncology Nutrition Dietetic Practice Group, 2018, pp 97-114.
  5.  American Cancer Society: Cancer Surgery. Atlanta, Ga: American Cancer Society, 2019
  6.  McGuire M: Nutritional care of surgical oncology patients. Semin Oncol Nurs 16 (2): 128-34, 2000.
  7.  Leser M: Medical nutrition therapy for esophageal cancer. In: Leser M, Ledesma N, Bergerson S, et al., eds.: Oncology Nutrition for Clinical Practice. Oncology Nutrition Dietetic Practice Group, 2018, pp 181-6.
  8.  Nguyen A, Nadler E: Medical nutrition therapy for head and neck cancer. In: Leser M, Ledesma N, Bergerson S, et al., eds.: Oncology Nutrition for Clinical Practice. Oncology Nutrition Dietetic Practice Group, 2018, pp 201-8.
  9. Petzel MQB: Medical nutrition therapy for pancreatic and bile duct cancer. In: Leser M, Ledesma N, Bergerson S, et al., eds.: Oncology Nutrition for Clinical Practice. Oncology Nutrition Dietetic Practice Group, 2018, pp 219-28.
  10. Gambardella A, Tortoriello R, Tagliamonte MR, et al.: Metabolic changes in elderly cancer patients after glucose ingestion. The role of tumor necrosis factor-alpha. Cancer 79 (1): 177-84, 1997.
  11. Rock CL, Doyle C, Demark-Wahnefried W, et al.: Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62 (4): 243-74, 2012 Jul-Aug.
  12. Hamilton C, Boyce VJ: Addressing malnutrition in hospitalized adults. JPEN J Parenter Enteral Nutr 37 (6): 808-15, 2013.
  13. Kushi LH, Doyle C, McCullough M, et al.: American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62 (1): 30-67, 2012 Jan-Feb
  14. Clinical management and supportive care services. In: Association of Community Cancer Centers: Cancer Program Guidelines. Association of Community Cancer Centers, 2012, pp 10-25.
  15. Burden S, Todd C, Hill J, et al.: Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev 11: CD008879, 2012.
  16. Colomer R, Moreno-Nogueira JM, García-Luna PP, García-Peris P, García-deLorenzo A, Zarazaga A, et al. N-3 fatty acids, cancer and cachexia: a systematic review of the literature. Br J Nutr 2007;97:823e31.
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