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LIFESTYLE
MEDICINE

poor dietary intake, leads to increased weight loss, and loss of muscle Developing and implementing a nutrition plan is not a one-off event.
and fat mass — a state often described as cancer cachexia. Cancer This plan requires continual evaluation/revision to meet patients'
cachexia contributes to impaired function, decreased performance sta- changing needs in their cancer journey. Continuous monitoring and
tus, decreased tolerance to cancer treatment and poor overall survival. adaptation to patients’ needs, being proactive to prevent nutrition-re-
Three stages of cachexia have been described in the literature — pre- lated complications, and open and empathetic communication with
cachexia, cachexia and refractory cachexia. The goal of nutritional in- patients and families, as well as continued engagement of all multidis-
5
terventions in GI cancer patients is to intervene at the pre-cachexia ciplinary team members, is imperative.
stage before the patient develops full-blown cachexia. In conclusion, diet plays a pivotal role in managing patients with gas-
In light of the above, the importance of a comprehensive and indi- trointestinal cancers. The metabolic and physical changes associated
vidualized nutrition plan for the GI cancer patient cannot be over- with cancer impair dietary intake, leading to weight loss, malnutrition
stated. This process requires a multidisciplinary approach involving the and cachexia. Having a comprehensive and individualized diet and nu-
oncologist, gastroenterologist, dietitian and even the social worker. This trition plan is imperative in patients with gastrointestinal cancers. This
list is by no means exhaustive, as other specialists might be involved in requires a multidisciplinary approach from the onset with continued
the management of the patient along their cancer journey. evaluation/revision of the diet/nutrition plan to meet the evolving
Crafting a comprehensive and individualized nutrition plan starts needs of the GI cancer patients.
with an initial assessment of the patient’s nutritional status. This initial
assessment considers several factors, including current weight, recent References:
weight loss, diet, exercise programs, symptom management, potential 1. Arnold M, Abnet CC, Neale RE, Vignat J, Giovannucci EL, McG-
cancer treatment effects and any intercurrent comorbidities. Two com- lynn KA, Bray F. Global Burden of 5 Major Types of Gastrointesti-
monly used nutritional assessment tools include the Malnutrition nal Cancer. Gastroenterology. 2020 Jul;159(1):335-349.e15. doi:
Screening Tool (MST) and the Patient Generated Subjective Global 10.1053/j.gastro.2020.02.068. Epub 2020 Apr 2. PMID:
6,7
Assessment (PG-SGA). 32247694; PMCID: PMC8630546
An initial nutritional assessment will inform dietary recommenda- 2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023.
tions tailored towards the nutrition needs and preferences of the pa- CA Cancer J Clin. 2023 Jan;73(1):17-48. doi: 10.3322/caac.21763.
tient. For example, for upper GI cancer patients, the emphasis will be PMID: 36633525
on small frequent meals addressing symptoms like dysphagia. For pan- 3. Shaw, C. (2021). Management of diet in gastrointestinal cancer. Pro-
creatic cancer patients, the use of exogenous pancreatic enzymes with ceedings of the Nutrition Society, 80(1), 65-72.
limitation to ingestion of sweets and sugars is emphasized. The overall doi:10.1017/S0029665120007041
goal of the nutrition plan is geared towards a well-balanced diet rich 4. Burden, ST, Hill, J, Shaffer, JL et al. (2010) Nutritional status of pre-
in essential nutrients. operative colorectal cancer patients. J Hum Nutr Diet 23, 402–407
In maintaining essential nutrients, we should ensure monitoring and 5. Fearon, K, Strasser, F, Anker, SD et al. (2011) Definition and classi-
supplementing essential micronutrients, including vitamin B12, iron, fication of cancer cachexia: an international consensus. Lancet
folate and vitamin D. This includes managing potential drug-nutrient Oncol 12, 489–495
interactions. 6. National Cancer Institute. Nutrition in Cancer Care (PDQ)—
It will be of little benefit to the patient if they have access to a well- Health Professional Version: Nutrition Therapy. Updated Novem-
balanced diet but are bedeviled by problems of fatigue or poor appetite, ber 3, 2022
which can compromise overall food intake. Thus, the nutrition plan 7. Isenring E, Cross G, Daniels L, et al. Validity of the malnutrition
should necessarily include plans for the management of chemotherapy- screening tool as an effective predictor of nutritional risk in oncol-
induced side effects impacting nutrition (nausea, vomiting, diarrhea, ogy outpatients receiving chemotherapy. Support Care Cancer.
anorexia), addressing symptoms like reflux and taste changes, and a pro- 2006;14(11):1152-6
gram for enhancing physical activity within the patient's capabilities.
Food intake can be further facilitated by empowering patients and care- Hycienth Ahaneku MD, PhD, is a medical oncologist/hematol-
givers with nutritional knowledge. Furthermore, there should be meas- ogist providing care for patients at Texas Oncology San Antonio
ures for addressing psychological and social aspects of nutrition, such Medical Center. Dr. Ahaneku is a member of the Bexar County
as providing support groups and counseling services. Engaging the serv- Medical Society.
ices of social workers, clinical psychologists and psychiatrists can be
helpful in this regard.

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