Cancer & Nutrition
Body composition & oncology research
The majority of patients with advanced cancer experience involuntary weight loss and malnutrition. Weight loss is related to increased morbidity, decreased quality of life and shorter survival. Cancer Cachexia represents a complex metabolic situation, which is characterized by inflammation, degradation of skeletal muscle (sarcopenia) and abnormalities in metabolism that leads to progressive functional impairment.
For reasons that are poorly understood, patients with malnutrition have been shown to tolerate less treatment. The development of chemotherapy-induced toxicity often necessitates treatment interruptions, drug dose reductions or premature cessation of therapy. Predicting toxicity to chemotherapy is very difficult and identification of biomarkers associated with outcome or toxicity remains a huge challenge.Recent studies have demonstrated an association between severe skeletal muscle depletions (sarcopenia) and excess toxicity during chemotherapy treatment. CT scans are taken as part of the diagnostic process in cancer patients and can be used for detailed body composition analysis, minimising patient and clinical burden as well as cost.
Research from our unit is contributing to international evidence that muscle wasting (sarcopenia significantly increases toxicity to chemotherapy drugs, meaning patients are sicker and require either dose reductions, delays or premature stoppage of their treatment. Future clinical trials investigating dose reductions in patients with sarcopenia and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.
Nutrition and cancer recovery
Cancer-induced weight loss affects 30-80% of patients with solid tumours and is associated with poorer tolerance to chemotherapy, impaired quality of life, more frequent hospital admissions and significantly reduced survival. International data has shown that cancer patients who lose more than 10% of their pre-illness weight have death rates that are significantly higher than weight-stable cancer patients. The reasons for this are cancer patients tolerate less treatment (chemotherapy) and develop more side effects of treatment.
Even though many cancer patients try to eat as much food as they can, they are unfortunately dealing with a series of complex changes in their metabolism. The cancer itself produces many ‘hormones’ that directly break down muscle and fat stores. It also switches on the immune system to produce chemicals that cause inflammation in the body and also reduce appetite. The net result can be rapid weight loss over a short period of time. Medics often refer to it as ‘cachexia’ . It is a huge challenge to get these patients to stabilise their weight, and even a greater challenge to get them to gain weight.
At present we have no effective drug therapy to either improve metabolism, cause weight gain or safely stimulate appetite. Food and food supplements are really all we can offer at present. In 2014 we produced a book ‘Good nutrition for cancer recovery’ This book was produced with funding from the Health Research Board (HRB) and allowed us to develop a resource of nourishing recipes enriched with extra energy and protein to help slow down weight loss. Thanks to the funding from the Irish Health Research Board (HRB) and some generous corporate partners including Dairygold, the National Dairy Council and the Irish Dairy Board, 19,000 copies of this book were printed in October 2014 and distributed free of charge to over 70 locations in Ireland and the UK where cancer patients are treated. The feedback to date has been overwhelmingly positive from both health care professionals and cancer patients and the book was awarded the Best Patient Lifestyle Education Project award at the Irish Healthcare Awards 2015.
The team at UCC are hugely grateful to both the HRB and all our colleagues who worked with us in developing this book, especially Eadaoin Ni Bhuachalla (research dietitian at UCC), our academic colleagues in the Culinary Institute at Cork Institute of Technology (Ann O’Connor, Jane Healy and Dr Margaret Linehan), our dietetic colleagues in the Irish Nutrition & Dietetic Institute, our medical oncology colleagues (especially Dr Derek Power, Consultant Medical Oncologist at the Mercy University Hospital) and the wonderful team at Breakthrough Cancer Research especially Eoghan O’Sullivan and Orla Dolan. We also hugely grateful to the food photographer (Marta Miklinska) and the graphic design artist (Jeremy Cunningham).
Nutrition and cancer prevention
It is estimated that 2.8 million cancer cases could be prevented globally on an annual basis if people followed a healthy diet, became more physically active and maintained a healthy body weight. This project aims to develop a book of advice and recipes on how to help prevent cancer and is being developed in conjunction with Breakthrough Cancer Research. It will contain a collection of delicious and healthy recipes, utilising a range of ‘super foods’ proven to have anti-cancer properties.