Loss of Weight and Lean Body Mass
Those who have survived cancers of the head, neck, gastrointestinal and lung are among those more likely to be malnourished and underweight. For these cancer survivors, nutrition care should aim for positive energy balance and adequate protein to preserve or rebuild lean body mass.
Low lean body mass, especially as part of sarcopenic obesity, is associated with poor health outcomes. Loss of lean body mass often is also seen in survivors of colon, breast, and childhood cancers.
Physical activity also is important to increase strength and endurance and, when tailored to individual needs, may help improve eating by enhancing appetite.
Physical activity, including resistance training, may help protect against the loss of lean body mass. Adequate protein and calories are essential, and research is under way regarding the potential for omega-3 fatty acids to help reduce muscle catabolism and the appropriate choices among protein sources to support muscle growth.
Among the most common and debilitating problems cancer survivors face, cancer-related fatigue is a persistent tiredness not proportional to recent activity that interferes with usual functioning and isn’t alleviated with rest. Some survivors experience fatigue even years after treatment is completed. Although it may appear without a clear cause, cancer-related fatigue can occur because of new or ongoing and potentially treatable medical problems such as thyroid, pulmonary, cardiac or liver disorders; anemia; depression; poor appetite; and medications. Survivors are urged to discuss fatigue with their physicians.
Family members and friends often urge survivors with cancer-related fatigue to rest more. While adequate sleep and rest are important, research strongly supports engaging in physical activity to reduce cancer-related fatigue, and it’s one of the few evidence-based treatments currently available. Other research shows that additional, potentially helpful non pharmaceutical interventions include yoga, cognitive behavioral therapy, counseling, and relaxation techniques.
Nutrition consultation also is included in National Comprehensive Cancer Network clinical practice guidelines for assessing and addressing cancer-related fatigue. The guidelines highlight the management of nutritional deficiencies that developed during cancer treatment, adequate hydration, and electrolyte balance to prevent and treat fatigue.
Although research is lacking, anecdotal data from dietitians working with cancer survivors suggest that high-fiber, whole-food carbohydrate choices distributed throughout the day can help survivors maintain their energy level and avoid fatigue related to blood sugar swings.
Other Post treatment Challenges
Cancer survivors typically recover from the acute effects of their treatment within weeks or months after treatment ends. In some cases, however, side effects of treatment persist, such as taste changes, odynophagia (painful swallowing), dysphagia (difficulty swallowing), xerostomia (dry mouth caused by a lack of saliva), enteritis, diarrhea, constipation, and other concerns that can challenge nutritional status. The websites of the National Cancer Institute (www.cancer.gov), the ACS (www.cancer.org), the AICR (www.aicr.org), the American Society of Clinical Oncology (www.cancer.net), and the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics (www.oncologynutrition.org/erfc) provide practical tips for handling such problems. In addition, dietitians who are board-certified oncology nutrition specialists (those with the CSO credential) have special expertise in this area and are excellent resources.