A Different Kind of Weight Watching

CURE, Winter 2010, Volume 9, Issue 4

When food fails to appeal, seek help early.

Excessive weight loss in a short time is never healthy, but for cancer patients, it can impair treatment and lower quality of life.

Statistics indicate about 30 to 50 percent of cancer patients experience some unintentional weight loss. Generally, a 5 percent or more decrease in pre-cancer body weight in a six-month period is considered abnormal. Weight loss also varies greatly depending on tumor type.

Sarah Washburn, RD, a dietitian at the Seattle Cancer Care Alliance, says managing weight loss involves a good cancer treatment plan, high-quality diet and management of comorbidities or other illnesses in addition to cancer. “It’s a multidisciplinary approach in trying to figure out how to prevent it completely or to result in weight regained.”

Many studies—such as a frequently cited landmark study published in the American Journal of Medicine in 1980—show that excessive weight loss is negatively associated with treatment outcome and survival. According to the National Cancer Institute, however, identifying and treating nutrition-related symptoms have been shown to stabilize or reverse weight loss in 50 to 88 percent of oncology patients.

Washburn emphasizes the importance of early intervention to help minimize excessive weight loss, which can delay or stop treatment. “Nutrition intervention can prevent delay of treatment by decreasing the amount of weight loss that happens during the treatment process,” she says. Gradual weight loss due to healthy eating is OK, she says, but losing five to 10 pounds a week indicates unintentional weight loss. That kind of weight loss often includes a loss of muscle, which is a problem.

Washburn says she coaches patients about nutrient-rich, calorie-dense foods to eat based on individual preferences in order to get the most out of everything they eat, as little as that may be. “For instance, adding coconut milk to soup would give it more calories and digestible fats,” she says, and adding avocado to a meal provides “a significant amount of calories and some good vitamins as well.”

Even if they can only take in a small amount, it will add up to something significant by the end of the day.

In addition to focusing on healthy, calorie-dense foods, patients can try to eat five or six small meals or snacks a day as opposed to three large meals, says Hillary Wright, RD, senior nutritionist at the Dana-Farber Cancer Institute. “Even if they can only take in a small amount, it will add up to something significant by the end of the day.”

Wright also encourages patients to eat even if they don’t feel really hungry and to try to take liquids in between meals to avoid feeling overly full or nauseated. “Many people like the idea of trying to figure out a smoothie that has extra protein added that may meet their taste preferences that they can sip on between meals,” she says.

Fortified meal supplements, such as Boost or Ensure, may be recommended as an alternative to get in enough calories when whole foods aren’t possible. “For dietary supplements, we often recommend fish oil because research tells us that weight loss associated with cancer treatment may be, in part, related to inflammation, and fish oils are high in omega-3, which are anti-inflammatory,” Wright says.

There have also been several studies evaluating the role of appetite stimulants—mainly progestogens and corticosteroids. They have shown limited benefits, with only 20 to 30 percent of patients reporting appetite improvements and any weight gained mainly consisting of fat, not lean tissue.

Wright says the nutrition staff may discuss appetite stimulants with clinicians once they have exhausted all natural means and a patient is still struggling. But, she encourages patients to seek out nutritional support early.

“Any help that the nutritionists can get in identifying people who really need to be seen is a win for the patient and a win for the clinical team,” Wright says. “Ask to see a nutritionist. Find out how that happens. And ask early. Don’t wait until the situation is desperate.”