Phase I: Cancer Treatment
Surgery, radiation therapy, and chemotherapy can change nutritional needs and impair the intake, digestion, absorption, and utilization of food. The need for caloric intake is usually increased during cancer treatments. Changes such as unintentional loss of body weight, loss of lean body mass (muscle), unintentional weight gain, eating and digestive difficulties, and fatigue are usually temporary but can sometimes persist.
Cancer treatment may interfere with the ability to eat, digest, or absorb food due to side effects such as nausea, vomiting, changes in taste or smell, loss of appetite, or bowel changes. When these problems occur, usual food choices and eating patterns may need to be temporarily adjusted.
For example, small, frequent meals or snacks may be easier to tolerate than are three large daily meals. Food choices during this time should be easy to chew, swallow, digest, and absorb and should be appealing, even if they are also high in calories or fat.8-11
During active cancer treatment, maintaining caloric balance is the most important nutritional goal. If it is not possible to meet nutritional needs through regular diet alone, nutritious snacks or drinks may be advisable. Commercially prepared liquid nutritional products (e.g., Boost,® Ensure,® Resource,® or NuBasics®) can also be helpful to assist with intake of calories and nutrients. These products are best used as only temporary aids.
Ann's NOTE: Try a green drink, chlorella product, brewer's yeast, etc. for nutrients.
Even though cancer treatment can cause fatigue, light, regular physical activity during treatment should be encouraged to improve appetite, stimulate digestion, prevent constipation, maintain energy level and muscle mass, and provide relaxation or stress reduction.
Advice from a nutritionally qualified health care provider can be helpful in assessing problems with eating and physical activity and in creating an individualized plan to meet the specific challenges faced during the cancer treatment phase.
The use of nutritional supplements is a topic of considerable controversy, especially in the cancer treatment phase. It is counterproductive for patients to take vitamin supplements that contain high levels of folic acid, or to eat fortified food products that contain high levels of folic acid when using chemotherapy agents, such as methotrexate, that act by interfering with folic acid metabolism.
This interaction illustrates the importance of asking and advising survivors about supplement use during treatment. Moderate amounts of foods such as breakfast cereals that do not exceed the Dietary Reference Intake established by the National Academy of Science (formerly known as the Recommended Daily Allowance) for folate are unlikely to reduce efficacy of these drugs.
Many vitamin supplements contain higher levels of antioxidants, such as vitamins C and E, than the Dietary Reference Intakes.12-16 Other dietary supplements may contain high levels of non-vitamin antioxidant phytochemicals or antioxidant minerals. Since free radicals are involved in carcinogenesis and since some epidemiologic and laboratory studies have suggested that certain antioxidants may reduce cancer risk, some survivors and clinicians might conclude that antioxidants are effective in preventing cancer recurrence.
However, oxidative damage is involved in the cytotoxic actions of radiotherapy and several classes of chemotherapy agents. Taking antioxidant vitamins during chemotherapy or radiation therapy might therefore reduce the effectiveness of those therapies,17 and some experts have therefore recommended against taking antioxidant supplements during such treatment.18
Others, though, have pointed out that the possible harm of supplements is only hypothetical, and that there might be a net benefit from supplements that could help protect normal cells from the collateral damage associated with these therapies.19-21 Even endogenous antioxidants, such as melatonin, might work to enhance chemotherapy,22 but such findings have not consistently been reproduced.23 Unfortunately, this is one of the many critical questions without a good answer at this time. Therefore, it would be prudent to advise patients undergoing chemotherapy or radiotherapy not to exceed the upper intake limits of the Dietary Reference Intakes for vitamin supplements and to avoid other nutritional supplements that contain antioxidant compounds.12-23
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