By Mindy Athas, RD, CSO, LDN
UMGCC Outpatient Oncology Nutritionist
What Does a Cancer Dietitian Do?
Hang out and eat bonbons all day? Nah (I wish!). An oncology nutritionist, also a registered dietitian (RD), in the outpatient setting at the Greenebaum Cancer Center does many things. Primarily, we are available as needed to see patients in the three major oncology treatment areas: clinic, infusion and radiation. This means you may see me running from one end of the building to another; hopefully, with time to catch a hot tea in between. Patients may also be contacted by phone or seen in the waiting areas or other ambulatory units in and around the hospital. I have also been known to catch up with patients on my cell phone while at the food store; less ideal but nonetheless still helpful.
Patient contact usually involves discussion of the nutrition issues or concerns, current food intake and tolerance, ability to take in nourishment and digest it, and nutrition support options. I also communicate the plan of care to the team(s) involved with each patient. And patients receive nutrition education handouts, references and resources. I do like to talk (can you tell?), so I got that goin’ for me, which is nice.
What Do You Talk About?
The most common nutrition issues affecting cancer patients include nausea, vomiting, diarrhea, constipation, swallow dysfunction, lack of appetite, loss of taste, sore mouth and throat, and the need for small portions. Many patients also need nutrition support, often in the form of tube feeding, but some even need intravenous nutrition. Food, however, is much more interesting to talk about than canned tube feeds. Alas, I try to make Osmolite (a tube feed formula) enticing! Complications of cancer treatment, past medical history and co-morbidities (such as diabetes, heart issues or kidney disease) also need attention.
One of the most difficult aspects of nutrition therapy involves prioritization of issues: Do we focus on the blood sugar and carbohydrate intake, the need for increased calories (much of which come from carbs) or both? The proof is in the pudding. Finding high-calorie, low-carbohydrate foods may be the answer. The most challenging is discovering which foods the patient likes, will eat and tolerate, which also meet the nutrition needs and fit into the plan of care. Like rocket science (not really).
As part of the Clinical Nutrition Services Department, we all contribute to departmental and hospital-wide goals. This includes sitting on committees, attending meetings, helping peers and staff, educating the public, coordinating events, reviewing (and often revising) education materials, and developing resources for both patients, visitors and staff. Makes me sound smart, huh? One of my favorite things to do is design and develop nutrition education handouts. I also love to lecture and present information (as you can see) and my ultimate goal is to write a book (hopefully that will land me on Oprah’s couch!)
A Plan of Action
The outpatient nutrition plan of care needs to cover all the areas surrounding cancer treatment: Before, during and after. Patients often lose weight prior to starting treatment, then have tolerance problems during treatment, and pain issues afterward — all of which compound their nutrition troubles. Talk about life giving you lemons! And mud! Luckily, I have a very nice lemon-meringue mud-pie recipe. Cancer treatment may include chemotherapy, radiation therapy, hormone treatments, surgery, or a combination of these. Side effects from these treatments may impact the patient’s ability to eat normally, digest, and metabolize both food and nutrients. Stress, fatigue, pain, fear, and anxiety, as well as family and economic and social issues may all further exacerbate the poor nutrition picture. Makes you want to take a vacation!
Getting Down and Dirty
The outpatient oncology dietitian is able to take the time to discuss various options with patients and their families to troubleshoot nutrition concerns and help find a variety of answers. Nutrition handouts, references and resources are ways we provide ideas and solutions to numerous nutrition-related issues. For example, if you are feeling full quickly after eating a small portion only once daily, of something like chicken broth (a low-calorie food), this may be due to multiple factors. These may include:
- Poor appetite
- Sore throat
- Slow gastrointestinal (GI) tract (from pain medications)
- Fatigue (from treatment, stress and lack of sleep)
- Heavy mucus/phlegm build-up
- Mouth ulcers
The nutritionist may suggest these options:
- Take a walk outside (to perk up your appetite, relieve stress and fatigue)
- Sit down with your comrade (someone you like to eat with), and
- Snack on some homemade Mac-n-cheese (high-calorie, easy-to-swallow food) or creamed soup with added heavy cream
- In a 4-ounce cup (small portion)
- Surrounded by a nice setting (pretty tablecloth or window view)
- And repeated every 2 to 3 hours (small but frequent eating)
The RD may suggest discussing your medications with your health care team: pain meds may increase constipation by slowing down the GI tract, so you may need a laxative. Constipation can also affect your desire and ability to eat well. Medications can cause or help treat nutrition troubles. It is important to tell your team about all your medications and how they interact with you, your food and digestion, and each other. Don’t be shy about alerting your team to your problems! We may not work at Lowe’s but we can still build something together: a healthier YOU!
Eat Like a Kid (Seriously!)
Generally, eating smaller, more frequent meals and snacks is the best option. Choosing high-calorie, high-protein food gives you more bang for your buck. Think kid-friendly foods, which are often high-density (calorie/protein-rich) items in a small package. Remember Aladdin’s genie: All the power of the universe in a teeny little living space. Choose foods and drinks based on this premise. Read labels and compare. Think like a kid: eat small and often, but you don’t have to watch iCarly or Spongebob (unless you want to: they’re both really funny!)
Some Kid Favorites:
- Peanut butter and jelly
- Tuna salad with real mayo
- Cheese omelets
- Drinkable yogurt
- Ice cream with bananas, chocolate syrup, caramel and sprinkles
- Fruit topped with honey and whipped cream (yum!)
Other High-Calorie Ideas:
- Juice — especially nectars
- Creamy dressings (Ranch & Caesar)
- Dried fruit
- Nuts & seeds
- Avocado (and guacamole-ole?!)
- Fruit Smoothies
For Nutrition handouts, contact me at firstname.lastname@example.org or 410-328-5462.