THE ROLE OF DIET IN CANCER TREATMENT

For those diagnosed with cancer and undergoing treatment, diet and
nutrition play a pivotal role. Controlling your diet during cancer care may
not only assist with healing, but may also help you to feel more in control of
your disease. It is one way to take action and actually do something yourself
to help you feel better.

People Living With Cancer (PLWC) firmly believes there is a strong link
between diet and recovery. Having suffered with ovarian cancer over a decade
ago, co-founder Linda Greeff says she really battled with diet. One major
problem is the lack of resources and localised information and studies
available. Another is that oncologists do not place enough emphasis on how
diet can help with recovery and instead encourage patients to eat whatever
they want.

In an attempt to address this imbalance, PLWC is looking to develop a
handbook of sorts that gives valuable guidelines and information about diets
depending on the specific type of cancer the patient is dealing with. Those
with throat cancer require different diets to those with ovarian cancer, for
example. Greeff ’s ovarian cancer and subsequent hysterectomy left her
hormones way off balance. ‘I picked up a lot of weight and I really battled to
lose weight. Now only, after nearly fifteen years, I am starting to stabilise. It is
a very big problem for patients that have a hormone-sensitive kind of cancer.’

PLWC has found that diet is the one area in which cancer patients can be
truly empowered and that eating a good balance of proteins, vegetables and
fruit can help the healing process. Drinking a lot of fluids is also important, as
it assists with flushing out chemicals and dead cells during treatment.

EATING FOR THE DIFFERENT PHASES OF CANCER SURVIVAL

As South Africa does not yet have its own local model for diet, physical
activity, dietary supplements and nutritional complementary therapies for
cancer prevention and treatment, PLWC uses guidelines published by the
ACS, updated approximately every five years, as a frame of reference.62
This resource highlights that the different phases of cancer survival (see
below) have different nutritional requirements. However, there are some
basics that are important during all phases:

1. Choose foods mostly from plant sources.
Eat five or more servings of fruit or vegetables each day.63
Eat other foods from plant sources, such as breads, cereals, grain
products, rice, pasta or beans several times a day.

2. Limit your intake of high-fat foods, particularly from animal sources.
Choose foods low in fat.
Limit consumption of meats, especially high-fat meats.

3. Be physically active – achieve and maintain a healthy weight.
Be at least moderately active for thirty minutes or more on most days of
the week.
Stay within your healthy weight range.

4. Limit alcoholic beverages, if you drink at all.

Ensuring that the basics are in place, you are then in a position to tailor your
lifestyle and diet for the phase you are currently in. During cancer treatment,
because loss of appetite is so common, the most important goal is to maintain
a caloric balance through eating proteins, carbohydrates and fats. Try to
follow these guidelines:

• Eat when you are hungry, even if it is not a mealtime.

• Eat several small meals or snacks throughout the day rather than three large ones.

• Eat when you feel best.

• Keep simple meals in the fridge for when you become hungry, and keep healthy snacks close by for nibbling when you get the urge.

• If other people offer to cook for you, let them. Do not be shy about telling them what you would like to eat.

• If you are able to eat only small amounts of food, you can increase the calories per serving by:

1. adding butter or margarine;
2. mixing canned cream soups with milk rather than water;
3. drinking eggnog and milkshakes; and
4. adding cream sauce or melted cheese to your favourite vegetables.

• Some find they can drink large amounts of liquids even when they do not feel like eating solid foods. If this is the case, try to get the most from each glassful by making drinks enriched with powdered milk, yoghurt, honey or powdered supplements.

• Eat your favourite foods; if familiar foods no longer taste good, try new foods and use different methods of food preparation.

Regular, light physical activity is also recommended during treatment to
improve appetite and digestion, assist with constipation and increase energy
levels and muscle mass. Nutritional supplements and antioxidant vitamins are
not recommended in great quantities, because they may reduce the
effectiveness of cancer therapies.

In the second phase, recovery from treatment, patients are advised to
obtain a nutrition and physical-activity plan to rebuild muscle strength and to
help with anaemia or impaired organ function. It is most important for
survivors in this phase to consume a nutritionally balanced and varied diet
with adequate calories and micronutrients.

There has been little research into nutrition in the third phase, preventing
cancer recurrence, second primary cancers and nutrition-related disease.
The ACS thus recommends following guidelines for the prevention of cancer,
which include avoiding tobacco, consuming a moderate amount of alcohol,
being physically active and consuming a healthy diet with an emphasis on
plant sources (see Chapter 13 for more recommendations).

It is important in the fourth phase, living with advanced cancer, to
maintain a sense of well-being and quality of life. Food choices will need to be
adapted depending on nutritional needs, while symptoms and side effects will
need to be managed.

While dietary supplements including nutrients, vitamins and minerals are
essential, the ACS warns they should not replace whole foods and those that
have not been well studied should be taken in moderate doses.

Greeff would like to see these nutritional guidelines becoming more central
to cancer treatment, because they aid patients not just with adequate nutrition
for recovery, but also allow them to gain a sense of control over their
situation.

THE ROCKY ROAD OF TREATMENT

Cancer treatment has some unique and debilitating side effects. It is
important to understand that you are not alone and that your friends and
family are there to help you through the tough times and to ensure that you
receive an adequate and nutritional diet based on your particular needs.

Dietitian Nathalie Mat explains that eating is often an area of conflict for
those undergoing chemotherapy and their families. ‘The family will want the
cancer patient to eat and may get upset when the person has a poor appetite
or is unable to eat much. If an individual is battling with oral intake they
should see a dietitian who can recommend supplements or meal replacements
that are easier to consume.’

The Queensland Cancer Council says that loved ones should not shy away
from taking an active role in the patient’s diet during cancer treatment, and
provides advice on how to assist in an empathetic and unobtrusive manner:
Encouragement and support is important, but try not to push the patient
to eat or drink.

Be prepared for the patient to experience taste changes from day to day,
particularly during treatment periods.

Make sure the patient has food at home that is ready to eat when they feel
like eating. For example, tinned fruit in the cupboard or yoghurts in the
fridge, and a frozen meal in the freezer.

Be flexible and willing to try new ideas and recipes.

Eating is a social activity and effort spent on making it a pleasurable
experience will be worthwhile. Eat with the patient as often as possible, as
people often eat better with company.

A well-balanced diet may not be achievable, and the patient may only
want a small range of foods. This is not a problem, as it is likely to be for a
short period of time.64

Although the side effects of treatments can be terrible, they can be relieved
with the right diet and eating regime. ‘Dietitians can also provide strategies to
help cancer patients cope with the side effects of the chemotherapy,’ affirms
Mat.

PLWC has collected many resources to help those dealing with particular
side effects. One that they recommend is the Queensland Cancer Council’s
booklet, Understanding Nutrition.65 It outlines the various side effects of cancer
treatments and gives advice and guidelines on how to deal with them.

One of the most common side effects is loss of appetite.

Recommendations include trying to keep a regular eating pattern of small
meals every few hours during the day, taking advantage of times when you do
feel like eating, stocking a range of prepared foods and snacks, drinking fluids
after and between meals so that the fluids do not fill you up during meals,
partaking in gentle activity to stimulate appetite, enjoying meals with family
and friends where possible, and eating your favourite foods.

Another side effect, directly related to loss of appetite, is weight loss. Try
including more foods like meat, fish, poultry, milk, dairy products, eggs,
legumes and nuts in your diet to help you gain weight. And weigh yourself
often to check that you are maintaining your weight.

When it comes to hormonal cancers like breast cancer, side effects may
include weight gain resulting from a number of factors including steroids or
medications that cause the body to store excess fluid. If the latter is the case, it
is suggested that you talk to your doctor. Aim to keep your weight as stable as
possible during treatment with moderate, regular physical activity (always
check with your doctor before commencing an exercise programme). Once
treatment is finished, consult a dietitian about reducing your weight.

Nausea and vomiting are other common side effects, especially during
chemotherapy. Take a look at page 40 for what you can do to alleviate these.

Difficulty chewing and swallowing, a dry or coated mouth, taste changes,
indigestion and heartburn are also possible side effects of treatment. Some
could even be a direct result of your type of cancer. You may simply need to
alter your diet by including smaller meals and more fluids, moistening food
with things like gravy or sauces, or altering the flavour of foods.

Other side effects can include diarrhoea, constipation and bowel
obstruction. There is no need to feel embarrassed by any of these conditions.

In some cases, increasing or decreasing the amount of fibre in your diet may
help, along with including certain foods and drinking plenty of fluids.

TOWARDS RECOVERY

Understanding your type of cancer and the side effects will help you deal with
your illness head on. Consult organisations like PLWC and resources like the
ones offered by the Queensland Cancer Council, as well as your doctor
and/or a dietitian. The WCFR and AICR’s comprehensive Food, Nutrition,
Physical Activity, and the Prevention of Cancer: A Global Perspective details the
different types of cancers and gives nutritional advice for each. It is a very
good resource to work through if you want to understand how nutrition plays
a role in your specific type of cancer.

The New South Wales Cancer Council also offers detailed advice on what
to eat for the various types of cancers. For people dealing with brain cancer,
for example, they suggest having daily at least two servings of fruit, five
servings of vegetables, four to five servings of bread, cereals, rice and pasta,
two to four servings of milk and dairy foods, one to two servings of meat and
alternatives, one tablespoon of fats and oils, and six to eight glasses of fluid.66
And while the Internet is not the best resource for finding accurate
information, it can be a vast support group of sorts.

Once you are as well informed as possible, you can begin adopting the
habits and eating patterns that could ease you in treatment and see you into
recovery.

A word of caution though: examining health and the role it can play in
cancer is not intended to provoke you into questioning your diet, emotions
and habits leading up to your diagnosis. Leave the past in the past, and
instead use the information to aid treatment and recovery.

Adopting healthy behaviours will lead to an overall improvement in
quality of life whether you are undergoing treatment for cancer, are
recovering from cancer or have never been diagnosed with cancer. Having
this knowledge by your side will empower you to positively and actively
achieve good health.