It’s common for patients to develop unpleasant side effects or complications induced by chemo- and radiotherapy. There is no debate that poor nutritional status increases surgical-associated morbidity, and the patient’s nutritional status is essential in the success of treatment and healing processes in cancer patients.
According to the reviewed guidelines, nutritional intervention should be adjuvant to oncology treatment, which should be made mandatory. A multidisciplinary approach involving proactive nutritional intervention through regular follow-ups should be considered.
Nutritional interventions must be personalized according to the patient’s health history, type and stage of cancer, treatment response, and nutritional status assessment through nutritional-focused physical exams and lab tests.
If the patient has a functional digestive system, nutritional counseling should be applied to address the current nutritional requirements with considerations of disease and treatment. Additionally, nutritional supplements may be necessary to compensate for low dietary intake and prevent nutrient deficiencies. Furthermore, proper monitoring systems to regularly assess the nutrient statuses and efficacy of interventions are also essential.
If oral nutrition is inadequate and/or intestinal function is preserved, artificial nutrition should be considered via either parenteral (PN) or enteral nutrition (EN). To decide between EN and PN, the health professionals must assess the tumor site and its extent, complications, treatment plan, intent, prognosis, patient’s physical status, and the duration of the nutritional support (Gröber et al., 2016; Ravasco, 2019).
When assessing patients’ micronutrient statuses, it’s crucial to consider the inflammatory response, an important factor influencing micronutrient status. The short-term acute phase inflammatory response during illness is evidenced by increased plasma concentrations of proteins (such as C-reactive protein and fibrinogen) and decreased concentrations of proteins (such as albumin and retinol-binding protein). This is associated with a wide range of changes in circulating levels of cytokines and immunoglobulins. A chronic inflammatory state is set in when the inflammatory process persists for weeks or months. For example, certain chronic infections can last for years, causing sufficient metabolic change to alter micronutrient levels.
The components of inflammation may involve various cytokines, immunoglobulins, genes, secreted proteins, etc. Possible factors involved in the process include alteration in dietary intake, nutrient synthesis, metabolism of the individual inflammatory protein, urinary losses, alteration in plasma volume, etc. (Tomkins, 2003). The good news is that there are ways to optimize micronutrient levels to prevent or restore imbalanced micronutrient statuses.
Jenny Noland, MS, CNS, CNGS, CKNS, LDN, MBA
Functional Nutritionist in Eugene, Oregon
Board-Certified Nutrition Specialist
Board-Certified Nutritional Genomics Specialist
Board-Certified Ketogenic Nutrition Specialist
Certified Oncology Nutrition Specialist
Personalized Nutrition Therapy for Metabolic Dysfunction and Cancer Care
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References:
Gröber, U., Holzhauer, P., Kisters, K., Holick, M. F., & Adamietz, I. A. (2016). Micronutrients in Oncological Intervention. Nutrients, 8(3). https://doi.org/10.3390/NU8030163
Ravasco, P. (2019). Nutrition in Cancer Patients. Journal of Clinical Medicine, 8(8). https://doi.org/10.3390/JCM8081211
Tomkins, A. (2003). Assessing Micronutrient Status in the Presence of Inflammation. The Journal of Nutrition, 133(5), 1649S-1655S. https://doi.org/10.1093/JN/133.5.1649S