Nutrition for Improved Gynecological Cancer Outcomes

Even the mildest cancer treatment can be rough on the body. At its worst, a course of chemotherapy can rob patients of their appetite and energy and leave them weak, thin and exhausted, at risk for secondary infections and other issues.

But such poor effects don’t have to be a given. With proper nutritional support, patients can come through cancer treatment at a healthy weight and with a strong immune system.

To improve patient outcomes, the gynecological oncology (GYO) team at Sylvester Comprehensive Cancer Center recently brought Carlotta Orlando, M.S., RDN, LDN, a certified specialist oncology dietitian, to advise on nutrition for cancer treatment.

Improving treatment outcomes through nutrition

Orlando works closely with the GYO medical team, caregivers, and patients to develop individualized nutritional plans. She also works with patients post-treatment on issues like weight management to help prevent cancer recurrence.

While patients might expect Orlando to hand them a detailed monthly meal plan, she takes a more goal-oriented approach to nutritional planning.

“In cancer treatment, a lot of things change from day to day, symptoms or treatment-wise. So, it’s very unrealistic to say to a patient, ‘You have to eat this for the next 30 days,’ and then they have poor appetite, or nausea and vomiting or taste alteration,” she says.

Orlando prioritizes specific goals when creating a nutrition plan, such as preventing nausea or slowing muscle mass loss. She also considers patient preferences, food tolerance, treatment needs, level of food literacy and whether they have a caregiver who can help. Some patients want many details in their plans, and others prefer simplicity.

Patients are often surprised by the lack of standard “good” nutritional advice when it comes to nutrition for cancer treatment.

“Though fruits and vegetables are important, I’m not going to talk about eating the rainbow when I have someone in front of me who has a poor appetite and is losing a lot of weight,” says Orlando. “I’m going to focus on the things they can tolerate and how we can maximize calories and protein.”

Practical support for common cancer treatment issues

Since the effects of cancer treatment can vary widely, even in the same patient, Orlando advises patients to mix it up.

“What’s funny about nutrition and taste in particular is that this week, you might be having an altered taste with certain foods. Then you retry them after a couple of weeks, and they taste fine. And instead, another food might taste different, or things might taste metallic,” she says.

Regularly switching foods can help. Orlando also recommends using the FASS technique (combining fat, acid, sugar and salt) to improve food taste— for instance, creating a marinade of olive oil, lemon juice, honey and soy sauce.

Orlando’s nutritional toolbox helps address the most common issues patients experience.

For instance, muscle wasting and fat loss, also called cancer cachexia, is one of the most serious issues associated with advanced cancer.

“It’s related to every bad outcome in oncology,” says Abdulrahman Sinno, M.D., chief of the GYO division.

Orlando suggests a high-calorie, high-protein diet to prevent muscle wasting. She often collaborates with the medical team to incorporate appetite stimulants. She also encourages physical exercise, which stimulates appetite and helps patients generally feel better.

For other common symptoms, like a metallic taste in the mouth, patients can try marinating meats or drinking something sweet while eating. Switching silverware to plastic or bamboo utensils can also help, as can regular oral washes.

Ginger can help with nausea, as can eating small and frequent meals and separating eating from drinking. Fiber intake, hydration and physical activity can treat constipation, while diarrhea requires foods that thicken the stool, like potatoes, oatmeal, bananas and fiber supplements.

A pre- and post-surgery nutrition boost

Currently, Orlando and Dr. Sinno are working on pre-surgery nutrition guidance so patients can be at their healthiest when undergoing postoperative cancer treatment. The ERAS program (for Enhanced Recovery after Surgery) includes a nutritional protocol to improve surgical outcomes.

Where traditional guidelines require a patient to fast for eight hours or more before surgery and eat little afterward, updated guidelines indicate that under normal circumstances, patients can safely consume liquids up to two hours before surgery and begin a regular diet immediately afterward.

Two weeks before surgery, patients will also receive a plan for a high-calorie, high-protein, anti-inflammatory diet to be in the best shape possible when they go into surgery.

A vision for comprehensive cancer care

In keeping with Sylvester’s philosophy of the importance of holistic cancer treatment, Orlando joins a cancer support services team that also includes mental health professionals, acupuncturists, an exercise physiologist, massage therapists, spiritual care, and yoga therapists.

While treating the whole person instead of just the cancer may seem intuitive, Dr. Sinno says that Sylvester’s multifaceted approach is fairly unique.

“It’s truly a testament to the vision of Sylvester, of looking at cancer in a comprehensive way,” he says. “Anyone can give chemo, but the thing that makes a difference in a patient’s outcomes, how she responds to treatment and how she feels during treatment, are these services that will optimize her quality of life, before, during, after and throughout the course of her treatment.”

Jodie Nicotra is a contributor for Sylvester Comprehensive Cancer Center.

Tags: Cancer Care, cancer treatment, chemotherapy, Nutrition, oncology dietitian, patient outcomes, Sylvester Comprehensive Cancer Center