Oncology (cancer) Talk
My second week at the hospital - check! Today was a productive day as we’ve finished our artificial sweetener poster. After the entire morning of designing, moving boxes around, finding the right colours, arranging the references, we printed it off for the senior dietitian to look at.
Subheadings:
Will it cause cancer?
Who is it suitable for?
Sucralose, cyclamic acid and pregnancy
Aspartame and phenylketonuria (PKU)
Clinical Oncology Clinic
After a quick lunch, we headed off to the clinical oncology clinic which was on the other side of the building. We took an underground secret pathway and once we were there, it was different from what I’ve expected. The clinic was spacious and relaxing filled with peace and serenity. There was an area in the centre of the clinic near the sitting area full of plants and trees surrounded by glass. What caught my eye was the enormous bright yellow sign that said NUCLEAR MEDICINE which intimidated me a bit and patients were sat outside waiting to be called.
Nutrition in Cancer Care Presentation
The talk lasted for an hour covering the basics of nutrition for cancer patients and was held by one of the junior dietitians. Everything below is translated from Chinese to English.
All patients and carers were highly engaged and eager to ask questions. As no leaflets were supplied, everyone took out their phones and begun snapping pictures of the slides.
What I found out was that people were often bombarded with non-scientific advice that has been passed down from their grandparents and families often having concepts strongly related to traditional Chinese medicine (TCM).
Patients were curious about these myths:
Chicken is poisonous because of high levels of antibiotics and hormones that can result in tumours
Duck has a "cooling toxicity (?)" which affects the healing process
Hands-off the seafood as it can result in eczema, asthma, diarrhoea and abdominal pain
However, malnutrition and weight loss is commonly seen in cancer patients and it is important to avoid any food restrictions unless required e.g. kidney disease and diabetes.
However, if antibiotics were of major concern, just avoid the skin as it tends to accumulate in fat but the levels are far too low to result in problems.
Food Fortification
Many patients who have lost their appetite or are unable to eat due to symptoms tend to have congee (rice porridge), a staple food in HK which is low in energy and nutrients.
Hence, it is recommended to add sources of carbohydrates (root vegetables such as potatoes and pumpkins), protein (minced beef, pork, fish, egg, and tofu) and fats (olive and sesame oil) to the congee.
Practical tips to manage or alleviate symptoms (e.g. sore/dry mouth) were also mentioned such as the use of straws, sucking on ice cubes to stay hydrated, mashing solid foods to make it easier to swallow and always refer yourself to a speech & language therapist (SLT) if swallowing becomes difficult.
It was a surprise to me when the next few slides about the neutropenic diet (clean diet/low microbial diet) was recommended as I remembered this is a controversial area. It has been suggested that those who have a weaker immune system (lower neutrophil count, a type of white blood cell) after chemotherapy treatment may follow a neutropenic diet to reduce bacteria intake from food and minimise the risk of infection. Things to avoid:
Unpasteurised dairy products (probiotic yoghurts, soft cheeses such as brie, blue cheese)
Under-cooked food (sashimi, smoked fish, smoked meats, eggs, lightly cooked foods)
Fruits with thin skin (due to bruises that can be undetected)
Expired foods
Hygiene (not washing hands)
Frequently Asked Questions (FAQ)
Several FAQs were listed on the slide and it raised more questions within the room as everyone had different opinions.
1. Can we eat bird's nest soup?
Myth: they can lead to an increase in growth factors (e.g. IGF) resulting in higher cancer risk.
Myth: they can prevent the growth of cancer cells.
There's no evidence suggesting that they can increase cancer risk and instead birds nest is rich in amino acids and could be added to your diet. However, they are considered to be a delicacy in China and hence the price is ridiculously high. Instead, eggs are an excellent and way cheaper choice that boasts all nine amino acids.
2. Should we avoid soybean products?
Myth: Soybeans leads to cancer.
These contain isoflavones and often avoided by cancer patients due to previous rodent studies showing these compounds could lead to a higher risk of breast cancer. However, humans process isoflavones differently from rodents and it seems to have either no effect at all or even reduce breast cancer risk. BUT this only applies to food sources but NOT in supplements due to high dosages which could affect the treatment effectiveness and may increase the risk of breast cancer.
3. Can we take Lingzhi (Reishi) mushrooms during treatment?
Myth: Lingzhi mushrooms can cure cancer by boosting the immune system and reducing tumour size.
While some studies show that these mushrooms can boost the immune system, lingzhi mushrooms in supplements can actually reduce chemotherapy treatment effectiveness and should be avoided.
Milky-based supplements
Oral nutrition supplements (ONS) are either added on top of current meals (1-2 bottles per day) or certain ones could replace meals completely (6-8 bottles per day).
Price
Although this was a public hospital, supplements are not prescribed for outpatients and they would have to purchase them at local pharmacies which comes at a very high price.
One cup or bottle would cost around £ 2 - 3 on the lower end (condensed and specialised formulas are 1.5x more) and if someone is having 2 - 3 per day, that would be equivalent to £120 - 180 per month! Now some people may be consuming more than 3 cups or bottles (e.g. 5 per day = £ 300 per month) and this is an enormous financial burden for patients especially for those who cannot work.
Types
The supplements used in HK were basically the same as the UK with more specialised formulas but fewer flavours available (only 3 flavours for fortijuice). There are variations between hospitals as well just like the different NHS trusts.
Brands that were mentioned
Powdered formulas
Average: $10 to 20 (£1 - 2) per cup
Ensure, Nutren Optimum (contains probiotics)*, Enercal Plus, Fresubin Fibre
* not recommended for patients undergoing chemotherapy.
Tube-feeding formulas
Recommended: Isocal HN
Juice formulas
Average: $20 (£1 - 2) per bottle
These formulas cannot replace meals.
Special formulas
Diabetes
Average: $20 (£2) per cup
Diabetes: Glucerna, Nutren Diabetes
Artificial sweeteners, sugar alcohols and fructose are used in place of sugar which does not result in rapid increases in blood glucose levels. However, there is an absence of good-quality studies to demonstrate how this would benefit those with diabetes.
Cancer
Average: $40 (£4) per cup
With additional omega 3 fatty acids and antioxidants but studies have not shown that they are more beneficial than normal supplemental drinks.
Not suitable for:
Those taking anti-platelet medications or have problem with blood clotting
Those on a low-residue diet
Specialised formulas are expensive but Cancer Societies may offer a slight discount with those registered with them. However, these were not recommended by the dietitian.
Condensed formulas
Recommended: Fresubin 2kcal
Average: $30 - 48 (£3 - 5) per cup
I was surprised to listen to the myths that the audience had brought up and the lack of basic nutritional knowledge in the entire group e.g. no one knew what a healthy BMI was (someone yelled 20 and 23 which is technically correct) which should really be taught in the school system. Hence, nutrition talks and education sessions for the public are so important. Overall the dietitian made it very easy to understand without diving deep into the biochem and it was an very interesting topic
