GOOD nutrition is hugely important for cancer patients according to nutritional scientist Dr Aoife Ryan of UCC, whose research showed that up to 80% of cancer patients unintentionally lose weight which can have a devastating impact on their quality of life.
One in five cancer deaths are caused by wasting, not the actual cancer itself.
Wasting affects, not just the muscles involved in moving, but also those vital to breathing and in the heart.
“Nutrition for cancer patients is so important, proper nutrition can greatly increase a patient's chance of survival and it can improve their quality of life,” said Dr Ryan, who has previously lectured in the University of New York.
“Wasting is a big issue with cancer patients.
“Many can look normal, even overweight but they could have suffered devastating muscle loss,” she added.
According to research carried out by Dr Ryan and her team, just 4% of cancer patients have obvious malnutrition and the majority of patients ‘appear’ normal. In fact, almost 60% are overweight or obese.
However, 19% have suffered ‘severe’ weight loss, almost 50% have myosteatosis (very poor quality muscle), 42% meet criteria for cancer cachexia (wasting) and 40% are sarcopenic (suffering from severe muscle waste).
“This loss of muscle can have a major impact on movement as well as the respiratory system and heart,” said Dr Ryan.
“It’s vital that patients remain weight stable and stay active, this can increase life expectancy and vastly improve their quality of life.”
The nutritional sciences group at UCC performed a detailed study of the nutritional status and quality of life in Irish cancer patients attending CUH and the Mercy hospital for chemotherapy.
Ongoing since 2011, 1,020 patients have been recruited to-date.
Each patient underwent a nutritional status assessment including a CT assessment of body composition which is the way of assessing body composition, quality of life (EORTC) and provided blood samples.
Prior to this research being performed, there was no Irish data on the levels of malnutrition in oncology.
“It’s good now for Ireland to have this bank of research to call on,” said Dr Ryan.
Her team’s research also showed that patients commonly reported a lack in appetite (37%), nausea (35%), and vomiting (11%) in the week preceding the study.
Just over 50% meanwhile reported changes in their sense of taste, while 21% reported changes in sense of smell while on chemotherapy. Most commonly reported was a “metallic” taste to food, followed by food tasting “bland”.
“It’s important for cancer patients to talk to a dietitian as soon as they’re diagnosed to ensure that muscle loss or wasting is prevented immediately,” she added.
“All cancer patients are entitled to see a dietitian but there are only 65 in the country, not nearly enough to deal with all the cancer patients.
“The graduates are there every year but the jobs aren’t being advertised because of what appears to be a lack of funding, which is disappointing because early contact with a dietitian can increase the life expectancy of cancer patients.
“Patients often come into contact with a dietitian when wasting has already began and it can sometimes be too late to address the situation,” she added.
Losing more than 5% of your body weight and cancer cachexia were significantly associated with a poorer global quality of life score, as well as poorer physical, emotional and social function scores and higher levels of symptoms such as fatigue, nausea and vomiting, pain, appetite loss and diarrhoea.
Weight loss, Sarcopenia (muscle wasting), myosteatosis (poor density muscle) and cachexia are all significantly associated with reduced survival.
The average survival rate for those without muscle loss was 44.8 months against 19.4 months in those with muscle loss.
Patients have a 42% increased risk of death if they have lost muscle mass.
Other research by the group also showed that cancer patients displaying symptoms of wasting experience more toxic side effects to chemotherapy which often requires the dose to be reduced or the treatment stopped prematurely because of poor tolerance.
“This will, in turn, affect the treatment they’re getting, showing just how important it is to remain weight stable,” said Dr Ryan.
“The focus should be on high-protein, high-calorie meals and snacks.
“Cancer patients often have reduced appetites and eat less so it’s important that when they do it, it is good protein filled food which can reduce wasting.
“We’re also working to ensure people don’t fall into these fad diets which can actually be dangerous and have a negative impact on treatment,” she added.
To help with this, UCC’s nutritional science department have published 3 free cookbooks for malnourished cancer patients, written in lay language which translates the science of nutrition and cancer into simple nourishing recipes.
‘Good Nutrition for Cancer Recovery’ contains 60 recipes for cancer patients who are experiencing poor appetite and involuntary weight loss.
Funded by the Health Research Board (HRB), 20,000 free copies were distributed to hospitals throughout Ireland.
‘Eating well with Swallowing Difficulties in Cancer’ (2016) contains 60 texture-modified recipes (liquidized, soft, pureed, semi-solid) for those with dysphagia.
Seven thousand free copies of this book were published.
‘Nourishing your body during pancreatic cancer treatment’ (2017) contains 90 recipes for pancreatic cancer patients.
These books are a first of their kind for cancer patients and have won two Irish Healthcare Awards (2015, 2016) and are endorsed by professional bodies (Irish Society of Medical Oncology, INDI).
“These books are free and approved by healthcare professionals unlike some in bookshops detailing fad diets and supposed means of survival, which can be very upsetting for cancer patients,” said Dr Ryan.
In UCC at present, nutritional scientists are working with food scientists to develop other strategies to deliver calories and especially protein in tasteless forms which could, for example, dissolve in the mouth, or could be added to food to increase protein content without affecting the taste or volume of food.
Nutritional scientists at UCC have also been working with food scientists to create oral nutritional supplements (ONS) rich in EPA fish oils and other proteins and nutrients.
Food scientists are able to completely mask the ‘fishy taste’.
They also have the knowledge and expertise to develop the ONS so it has calories, good quality protein, and a balance of vitamins and minerals, vital for cancer patients.
Nutritional scientists then test these products in patient groups and determine their effects.
Dr Ryan also cited the importance of physical activity, saying that though it can be difficult, cancer patients need to remain active to prevent muscle loss.
“When people are ill they tend to lie in bed and be very inactive because it’s difficult to find the energy, increasingly so for cancer patients,” she said.
“However, it’s so important for cancer patients to remain active.
“As well as dietitians, cancer patients should see a physio after their diagnosis to determine the best course of action.
However, calories and protein alone cannot defeat muscle wasting, according to Dr Ryan, who said that the inflammatory state in the body of a cancer patient is programmed for muscle breakdown.
“This is why I feel it will be a multimodal programme involving nutritional gels and diets, exercise and activity as well as anti-inflammatories such as ibuprofen, to reduce the effects of wasting,” she said.
UCC will conduct a randomised controlled trial with 10 international partners where patients with pancreatic or lung cancer will be given a multimodal regimen of exercise, NSAIDS (anti-inflammatories) and EPA enriched oral nutritional supplements for 12 weeks.
Muscle mass will be assessed at 6 weeks by CT scan with Dr Ryan hoping to see that a multimodal regimen can prevent or decrease muscle loss.
“We just signed the contract with a team in Norway who are facilitating the trial,” said Dr Ryan.
“We’re hoping that it will reduce wasting or even reverse the effects.
“If it can, then this can be implemented as a new treatment and hopefully have a positive impact on the lives of cancer patients,” she added.