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Healthy Nutrition During Cancer Treatment

New York, NY (Dec 30, 2009)

Casserole on a dining room table

Innovative inpatient and outpatient nutrition programs for cancer patients at NewYork-Presbyterian Hospital help patients and caregivers learn how to make healthy food choices to improve the patient's nutritional status and wellbeing during cancer treatment regimens.

Inpatient Care

All patients admitted to the oncology departments at both NewYork-Presbyterian's Weill Cornell Medical Center and Columbia University Medical Center campuses are screened for potential nutrition problems by nursing staff. Patients who demonstrate nutrition screen risk factors (for example, weight loss or reduced intake of food) are assessed by a Registered Dietitian (RD) who specializes in the nutrition care of oncology patients. Key components of the nutritional assessment include history of the patient's appetite before treatment, weight loss before admission, any specific dietary needs or allergies, drug-nutrient interactions, body weight calculation and strategies to manage the side effects of cancer treatment. Upon completion of a nutrition assessment, the Registered Dietitian may diagnose a patient with malnutrition. Malnutrition is a common problem among patients with cancer. In severe cases, malnutrition is associated with cachexia, which means the loss of lean body mass (how much you weigh without body fat), muscle wasting (loss of muscle), and a weakened immune system. "A patient with the diagnosis of malnutrition is monitored closely by the Registered Dietitian and medical team," a practice that sets NewYork-Presbyterian apart from other institutions, said Holly Mills, MS, RD, CDN, a Registered Dietitian and Clinical Nutritionist at the Oncology Service at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Holly Mills, MS, RD, CDNHolly Mills, MS, RD, CDN

Patients are reassessed regularly for weight and intake of food. If patients are unable to maintain their goal weight or eat adequate amounts of food, the Registered Dietitian will (with the patient's consent) have a conversation with the team, patient, and family members to determine if other medical interventions such as an appetite stimulant or tube feeding are needed. Staff Registered Dietitians include the patient's family in consultations whenever possible. There are times when the Registered Dietitian may call family members at home to offer education. "Making sure the family is involved with the nutrition care plan is an essential part of patient care," said Ms. Mills. For example, family members may want to bring in food from home for a patient. However, a patient with cancer is more likely to contract a foodborne illness due to a weakened immune system. Therefore, it is critical that patients and families are educated on food safety guidelines, including safe steps in food handling, cooking, and storage. Proper hand hygiene when preparing food is also stressed. This education is especially important for patients with neutropenia.

Neutropenia is a condition characterized by low white blood cells; this increases the risk of infection. Neutropenia is usually caused by cancer treatment or the condition itself. Diets for these patients are designed to lower the risk for foodborne infections. For example, patients are not given foods that put them at high risk for infections (e.g., raw or undercooked meat, unpasteurized dairy products, aged cheese, and unwashed, raw produce).

Glenis George-Alexander, RD, CDNGlenis George-Alexander,

Innovative programs at NewYork-Presbyterian/Weill Cornell include Milkshake Thursdays, when patients are offered a choice of their favorite flavor of a nutritious milkshake. This program has been in effect for over four years and is run by volunteers and coordinated by a registered dietician. "The program is very successful and patients really look forward to it," said Glenis George-Alexander, RD, CDN, a Registered Dietitian at the Oncology Service at NewYork-Presbyterian/Weill Cornell Medical Center. Ms. George-Alexander also teaches a nutrition class for inpatients and outpatients every Wednesday. The class covers a wide range of topics including food safety, dietary fats and their effects on cancer, preventative role of antioxidants, and management of nutritional issues associated with treatment. "A lot of times patients come in with random questions and we will have a roundtable discussion," Ms. George-Alexander said. She is also available to answer patients' questions on a one-on-one basis after the class.

In an effort to provide patients and families with comprehensive nutrition counseling and education during hospitalization, the clinical nutritionists on the inpatient side are available seven days a week and work as a part of an interdisciplinary team of doctors, nurses, social workers and physical therapists. In addition, the inpatient and outpatient nutritionists communicate with each other in order to offer continuity of care for patients and family members.

Outpatient Care

All patients receiving chemotherapy or radiation in the ambulatory cancer centers are also screened for nutritional risk. At NewYork-Presbyterian/Columbia, patients with a risk factor or who request nutritional counseling are seen by Emily Moore, RD, CDN, who is also a Registered Dietitian and Clinical Nutritionist in the Oncology Service at NewYork-Presbyterian Hospital/Columbia University Medical Center. "Moving forward, our goal is to continue to see all patients who need nutrition services, which for the most part is 95% of cancer outpatients," Ms. Moore said. To ensure that is possible, the outpatient center is adding another Registered Dietitian to its staff.

Emily Moore, RD, CDNEmily Moore, RD, CDN

"My role is to help the patient cope with the possible side effects of treatment, alleviate these symptoms, and even prevent these symptoms," Ms. Moore said. For example, if a patient undergoing chemotherapy presents with mouth ulcers (sores), Ms. Moore can offer suggestions such as to puree or liquefy foods in a blender to make them easier to swallow, drink through a straw to bypass mouth sores, avoid irritating spices or acidic foods, eat high-protein and high-calorie foods to speed healing, and rinse the mouth often to remove food and germs. She strives to educate patients as soon as possible and to initially identify one to three nutrition goals that she can help patients with.

Lane Bower, RD, CDNLane Bower, RD, CDN

At NewYork-Presbyterian/Weill Cornell, all patients receiving treatment at the STICH Radiation Oncology Center and the infusion center are offered complimentary consultation and follow-up with Lane Bower, RD, CDN, a Registered Dietitian in the Oncology Service at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Patients can be referred by their physicians or request an appointment directly with Ms. Bower. She offers email and phone follow-ups when a patient can't make it to the center. Based on the results of patient surveys, Ms. Bower is also working to improve hospital lunches at the centers by taking beverage orders, removing foods containing high-fructose corn syrup, and implementing a milkshake program like the one offered in the inpatient department. She makes biweekly rounds to patients with new recipes pertaining to the center's weekly theme. "If our theme is hydration, I will educate patients on ways to avoid dehydration such as avoiding caffeine and offer, for example, a recipe for a mocktail drink." Furthermore, in an effort to provide patient-centered care, she surveys patients to see what she can do to improve food and beverages at the center. For example, when patients said they preferred hot drinks to cold beverages, the center installed a hot coffee/tea/hot chocolate machine. Ms. Bower is currently working to set up a cooking class and post-treatment nutrition support group and hopes that this will be available in the near future.

During follow-up sessions, Ms. Moore and Ms. Bower aim to make patients' quality of life better by discussing what meals to prepare, what food safety guidelines to follow, and how to manage the side effects of treatment. Their ability to speak English and Spanish is a great asset at these institutions, which serves a large Spanish-speaking population. In addition, they stress cultural sensitivity and make sure to include the patients' families in discussions. "I always ask 'who prepares the meals and who goes food shopping?'", Ms. Moore said. If the primary food preparer is not able to come to the hospital with the patient, Ms. Moore, with the patient's permission, calls the family member at home to discuss food safety.

"Our infusion and radiation teams are the best around because of their level of care, which goes far beyond clinical practice," Ms. Moore said. "I have been taken by the care and personal interest that our staff members share with patients. This is a team that I am proud to be a part of." Physical comfort for the patient is important; the outpatient center at NewYork-Presbyterian/Columbia is currently moving to a larger floor that is double in size, offers private flat screen TVs and music for each patient, snacks and meals, as well as amenities for families.

Food for the Fight

The Registered Dietitians at NewYork-Presbyterian have co-produced an instructional video with the American Institute for Cancer Research titled "Food for the Fight." The video advises cancer patients undergoing therapy how to maintain a healthy, balanced diet in the face of symptoms like nausea, vomiting, and aversion to certain tastes and smells (common side-effects of cancer therapy). It also provides nutrition information for survivors. The video can be seen on YouTube

Contributing to this article:

Lane Bower, RD, CDN, is a Registered Dietitian, Oncology Service at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Glenis George-Alexander, RD, CDN, is a Registered Dietitian, Oncology Service, NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Holly Mills, MS, RD, CDN, is a Clinical Nutritionist, Oncology Service, NewYork-Presbyterian Hospital/Columbia University Medical Center.
Emily Moore, RD, CDN, is a Clinical Nutritionist, Ambulatory Care Network Nutrition Services, NewYork-Presbyterian Hospital/Columbia University Medical Center.

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