What patients eat may boost energy.
Fatigue can be demoralizing and frustrating for cancer patients, many of whom consider the side effect more distressing than even pain or nausea, since those are more easily managed by medications. Although fatigue is nearly universal among cancer patients, it remains largely undertreated and under-researched.
Little is known about the cause and mechanisms of fatigue, but studies suggest it may be related to the cancer itself, treatment side effects, or comorbid illnesses. One area of research expected to gain more interest is the role of diet and nutrition in managing cancer-related fatigue.
“There is still a major gap in research in this area,” notes cancer researcher Barbara F. Piper, DNSc, RN, professor and chair of nursing research at the University of Arizona College of Nursing in Tucson. “And in lieu of the evidence, the best guidelines we have are the guidelines that are available for nutrition in healthy people,” says Piper, who served on the National Comprehensive Cancer Network panel that issued updated guidelines on cancer-related fatigue in March.
In the meantime, that leaves dietitians like David Grotto, RD, LDN, to tailor nutritional plans to individual patients based on a comprehensive assessment of their needs and health status. “Most patients don’t have years to wait for good clinical trials in this field,” says Grotto, president of Nutrition Housecall, LLC, a Chicago-area company whose services include in-home nutrition consultations for cancer patients. “I literally have patients who are too fatigued to eat.”
Patients should discuss fatigue symptoms with their doctor, and if appropriate, consult with a registered dietitian. A detailed assessment can determine if a patient is getting the proper amount and types of nutrients and fluids. Grotto says adequate nutrition can be especially difficult for patients experiencing appetite and taste changes. A dietitian can suggest palatable substitutes that meet an individual’s target for calories, carbohydrates, proteins, and healthy fats.
Complex carbohydrates, such as fruits, vegetables, and whole grains, offer a good source of long-lasting energy, Grotto says. Simple carbohydrates, such as sugar, provide a brief surge of energy followed quickly by a return of fatigue, and should therefore be limited.
Protein, a key ingredient in managing cancer fatigue, builds and repairs damaged body tissue. If cancer uses the body as a fuel source, some patients may lack protein reserves in their muscles, which can leave them short of energy. “Their bodies may really be crying out for additional sources of protein,” Grotto says. Good sources of protein include fish, lean meat, eggs, soy, and beans.
Nutrient-rich snacks—hard-boiled eggs, peanut butter on toast, or soups—come in handy when a patient is too tired to whip up a full meal. Five or six smaller meals throughout the day as opposed to the traditional three-meal-a-day schedule may be helpful for patients with nausea and vomiting.
Many patients find it useful to keep a food diary, says Dee Sandquist, MS, RD, director of nutrition, diabetes, weight management and wound healing at Southwest Washington Medical Center in Vancouver, Washington. “That way, we can work together to identify the food groups they may not be eating enough of or perhaps too much of,” she says.
Patients should resist the urge to use vitamins or dietary supplements to make up for what’s lacking in their diet without consulting their doctor, cautions Sandquist. Some supplements can interact with medications or have harmful side effects.
While patients and physicians await solid evidence that diet may improve cancer-related fatigue, what has been proven to boost energy is exercise, such as moderate walking, biking, and swimming.