Individuals with cancer or a history of cancer face the significant burden of nutrition impact symptoms (such as suppressed appetite, difficulty swallowing, nausea), which are associated with an increased risk of malnutrition and impaired quality of life [de Pinho et al. 2019, Anandavadivelan et al. 2018, and Crowder et al. 2018 as cited in reference i]. The below study explores the experience and perception of oncology survivors as related to nutrition and access to dietetic care.
A National Survey of Oncology Survivors Examining Nutrition Attitudes, Problems and Behaviours, and Access to Dietetic Care Throughout the Cancer Journey
Journal: Clinical Nutrition ESPEN
This cross-sectional survey involved 1073 participants in Ireland who were diagnosed with or received treatment for cancer within the past 5 years. Participants completed a questionnaire consisting of clinical, nutritional, and attitudinal questions in both open and closed question format. The questions targeted areas such as experience with nutrition-related problems, perceived importance of nutrition for cancer survivorship, experience accessing dietetic care, sources of nutrition information, and use of alternative therapies [i].
The authors found:
1. 97.8% of participants rated nutrition as “important,” with 58.2% rating nutrition as “extremely important”
2. 44.8% of participants reported experiencing a diet-related problem. 44% reported weight loss due to cancer, with 82.4% reporting unintentional weight loss. Those who met with a dietitian were more likely to be concerned about weight loss than those who did not. 23% reported weight gain. 52.3% reported that they had noticed muscle loss.
4. 39% of participants met with a dietitian, with 74% reporting the visit to be very/extremely helpful
5. 56.7% of participants who did not meet with a dietitian reported that they would have liked more support regarding eating pattern
6. 22% of participants reported not receiving recommendations related to nutrition and lifestyle. 56% agreed that they felt so bombarded by nutrition information from the media and people around them that it is difficult to know what is most appropriate to follow.
7. 36.9% of participants reported that they had tried at least one alternative therapy such as restrictive diets, vitamins, herbal remedies, or juicing or detoxes [i]
For the Patient and Caregiver
Nutrition impact symptoms are symptoms and side effects of cancer and treatment that can impact nutritional status. These may include decreased appetite, weight loss, nausea and vomiting, diarrhea or constipation, dry mouth, taste changes, mouth sores, or difficulty swallowing. In the present study, 42.6% of participants reported that they were “always/usually” asked about eating pattern or eating problems by their providers. 40.1% of participants reported that the reason they had not seen a dietitian was that they were not referred [i]. Ask your healthcare provider what options they can provide to meet with a dietitian that is a certified specialist in oncology (CSO).
For the Healthcare Team
In 2019, The Irish Nutrition and Dietetic Institute estimated that there was one dietitian for every 4500 cancer survivors in Ireland [Irish Nutrition & Dietetic Institute, 2019 as cited in reference i]. A 2019 national survey in the United States found that there was one dietitian for every 2300 individuals receiving cancer treatment [ii]. It is important to explore current barriers, options for hiring more dietitians specialized in oncology within cancer centers, and the development of nutritional screening protocols to provide early management of nutrition impact symptoms. Also important to consider is how virtual care can be applied to improve access to dietitian care for cancer survivors.
[i] Sullivan ES, Rice N, Kingston E, Kelly A, Reynolds JV, Feighan J…Ryan AM. (2020). A national survey of oncology survivors examining nutrition attitudes, problems and behaviors, and access to dietetic care throughout the cancer journey. Clinical Nutrition ESPEN, 1-9. https://doi.org/10.1016/j.clnesp.2020.10.023
[ii] Spees C. Why Oncology Centers Need More Dietitians to Help Patients Battle Cancer. (2020). U.S. News & World Report. Retrieved from https://health.usnews.com/health-care/for-better/articles/why-oncology-centers-need-more-dietitians-to-help-patients-battle-cancer