Dr. Erin Stella Sullivan RD
Lecturer in Nutritional Sciences & Cancer Research Dietitian, King’s College London
Dr. Samantha Cushen RD
Lecturer in Human Nutrition and Dietetics & Cancer Research Dietitian, University College Cork
Nutrition care can improve clinical outcomes and quality of life,1 help rebuild strength and reduce the risk of cancer recurrence for people living with and beyond cancer. 2-3
For People Living With and Beyond Cancer (PLWABC), optimal nutrition can be the difference between surviving and thriving, offering a powerful tool to support people through cancer treatment, recovery and survivorship.
Impact of nutrition on life after cancer
PLWABC experience debilitating symptoms that affect their dietary intake which, combined with fatigue, can lead to weight and muscle changes.4-5 Muscle loss is common across all cancers, at all weights and ages and leads to poorer outcomes, like survival, quality of life and treatment complications.6-10
The dietitian’s impact on cancer care
The main goal of nutrition in cancer is to improve or maintain nutritional status, with a particular focus on preserving muscle mass,11 to help reduce treatment-associated side effects, support recovery and improve the overall wellbeing of PLWABC.3
A CORU Registered Dietitian (RD) is a regulated healthcare professional who is qualified to support PLWABC in managing these challenges, providing tailored individualised nutritional support to manage symptoms, maintain muscle health and optimise nutritional status.12
While most PLWABC believe nutrition is important,
only 39% have seen a registered dietitian.
Nutrition awareness and access
Research from University College Cork showed that while most PLWABC believe nutrition is important, only 39% have seen a registered dietitian. Over half find it challenging to sort through the nutrition messaging online and in the media, exposing them to misinformation and scaremongering.13
With just one RD for every 4,500 cancer patients,14 it is unsurprising that PLWABC feel confused about nutrition. In the absence of widespread access to evidence-based dietetic care, PLWABC are often convinced by unregulated ‘nutrition experts’ to adopt potentially harmful alternative practices, such as restrictive diets, herbal remedies and supplements.
Dietitians provide evidence-based, individualised care
Unfortunately, other healthcare professionals do not get much nutrition training, so it is important to speak to a RD if you have any nutrition concerns after a cancer diagnosis. Most hospitals will have an RD, but you might need to ask to see them, as referral is not routine.
If you are wondering whether you need to change your diet or are thinking about taking any supplements, an RD is the best person to advise you on how this might affect your other treatments.
Red flags that suggest you should see an RD include weight changes (even if you have previously been recommended to lose weight), difficulty eating normally, concerns about gut symptoms or feeling like you are losing strength.
The Vienna Declaration says that nutrition care is a human right, so don’t be afraid to ask for a dietitian.
This was written on behalf of the INDI and IrSPEN.
[1] Daly LE, Dolan RD, Power DG et al. (2020) Determinants of quality of life in patients with incurable cancer. Cancer 126, 2872–2882.
[2] Laviano, A., Di Lazzaro, L. and Koverech, A., (2018). Nutrition support and clinical outcome in advanced cancer patients. Proceedings of the Nutrition Society, 77(4), pp.388-393.
[3] Prado, C.M., Purcell, S.A. and Laviano, A., (2020). Nutrition interventions to treat low muscle mass in cancer. Journal of cachexia, sarcopenia and muscle, 11(2), pp.366-380.
[4] Kubrak C, Olson K, Jha N et al. (2010) Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck 32, 290–300. 22
[5] Omlin A, Blum D, Wierecky J et al. (2013) Nutrition impact symptoms in advanced cancer patients: frequency and specific interventions, a case-control study. J Cachexia Sarcopenia Muscle 4, 55–61.
[6] Daly LE, Prado CM & Ryan AM (2018) A window beneath the skin: how computed tomography assessment of body composition can assist in the identification of hidden wasting conditions in oncology that profoundly impact outcomes. Proc Nutr Soc 77, 135–151.
[7] Cushen SJ, Power DG, Teo MY et al. (2017) Body composition by computed tomography as a predictor of toxicity in patients with renal cell carcinoma treated with Sunitinib. Am J Clin Oncol 40, 47–52.
[8] Prado CM, Cushen SJ, Orsso CE et al. (2016) Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact. Proc Nutr Soc 75, 188–198.
[9] Bozzetti F (2017) Forcing the vicious circle: sarcopenia increases toxicity, decreases response to chemotherapy and worsens with chemotherapy. Ann Oncol: Official J Euro Soc Medical Oncol/ESMO 28, 2107–2118.
[10] von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle 2010;1: 129–133.
[11] Arends J, Baracos V, Bertz H et al (2017) ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 36(5):1187–1196.
[12] Irish Nutrition and Dietetic Insitute, What Is a Dietitian? , www.indi.ie
[13] Sullivan ES, Rice N, Kingston E et al (2021) A national survey of oncology survivors examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey. Clin Nutr ESPEN 41:331–339.
