Malnutrition in Cancer Care — [VIDEO PODCAST] Ep 14

Weight loss and malnutrition can be caused by the effects of cancer, such as malabsorption, or adverse effects from cancer therapies. CANCER BUZZ spoke to Kelay Trentham, registered dietitian, nutritionist, and administrative fellow for the MultiCare Health System in Tacoma, Washington, and Christie Mangir, patient advocate and breast cancer survivor. Hear how malnutrition affects people with cancer in different ways, even impacting cancer treatment plans. This is the first episode in a three-part series on malnutrition in cancer care.

Guests:

Kelay Trentham, MS, RDN, CSO, FAND
Senior Operations Specialist
MultiCare Health System
Tacoma, WA

Christie Campo Mangir, MS
Assistant Director, Education Programs
Association of Community Cancer Centers
San Francisco, CA

Related Content:

• Making the Business Case for Hiring a Registered Dietitian Nutritionist
• "Prescribing" Exercise and Nutrition in Cancer Care
• Supporting Cancer Survivors in Making Healthful Lifestyle Changes
• That's My Farmer: A Research-Based Nutrition & Wellness Program
• Telehealth: Connecting Patients with Nutrition Services
• A Quality Improvement Nutrition Program
• Nutrition: The 7th Vital Sign
• Empowering Caregivers

Transcript

CANCER BUZZ: Welcome back to CANCER BUZZ TV. I'm your host Summer Johnson. CANCER BUZZ TV is a resource of the Association of Community Cancer Centers (ACCC) to bring oncology professionals the news and the latest trends in cancer. This is the first episode in a three-part series on malnutrition in cancer care. Weight loss and malnutrition in cancer can be caused by the effects of cancer on nutrition, such as malabsorption, or can be caused by adverse effects from cancer therapies.

And it affects people in different ways, even impacting treatment plans here to talk with us about it today is Kelay Trentham, MS, RDN, CSO, FAND, a registered dietician, nutritionist, and administrative fellow for the MultiCare Health System in Tacoma, Washington. And Christie Campo Mangir, MS, a patient advocate and breast cancer survivor.

It's great to see you both. Now, Kelay, can you start us off by sharing some of the effects of malnutrition on people living with cancer?

Kelay Trentham, MS, RDN, CSO, FAND: Sure. Malnutrition often manifests as weight loss. That’s the most obvious experience that people have. But a lot of times it's accompanied or initiated by, you know, diminished appetite, diminished enjoyment of food.

Um, it results a lot of times in loss of muscle mass, which can, uh, impact a person's ability to do normal everyday things, um, and enjoy enjoyable things in their life, um, impacts their energy level, um, you know, increases fatigue. And also, um, just their overall quality of life can really be diminished. Um, as a result of malnutrition, not only that, um, it can really impact the ability to tolerate treatment.

Malnutrition can result when people are undergoing treatment in an increase in treatment side effects to both chemotherapy, radiation, and sometimes treatment interruptions, more hospitalizations. And again, all of those things really impact, uh, one's quality of.

CANCER BUZZ: Christie, what were some of the nutritional challenges that you experienced during your cancer journey?

Christie Campo Mangir, MS: Absolutely. Well, everything Kelay said really resonates with me. My struggles with nutrition began even before I was diagnosed. And that was one of the red flags for me, that something was wrong. I was having a lot of trouble eating well and experiencing GI upset in the months, leading up to my diagnosis.

And the weight loss that I experienced then is actually what led me to discover the lump in my breast. Once I was actually diagnosed with breast cancer, I needed to start a chemotherapy and targeted therapy regimen right away. I experienced a lot of issues with nausea, with GI upset, with fatigue, during treatment, my tumor responded very well to the therapies.

My body did not respond very well. I was on four different antiemetic drugs at any given time. I. Experienced extreme fatigue. I had no appetite. I went from somebody who loved eating and snacking to dreading when I had to take in any sort of calories to just keep my energy going. My husband and my mom took such good care of me during this time—but it was truly one of the things that all three of us struggled with the most was how to get me the nutrition and the energy I needed so that I could continue to tolerate the lifesaving treatments that I was on.

CANCER BUZZ: Kelay, are there associated risk factors of nutrition, deficiencies? If so, what are they?

Kelay Trentham, MS, RDN, CSO, FAND: Well, there's a lot of risks. If folks are malnourished and it's not being addressed and they're in the midst of treatment, trying to get through their treatment—as I had mentioned earlier, you know, they can have an increase in treatment intolerance, meaning, heavy side effects, um, to either chemotherapy or radiation,

Which at times can mean that the decision the provider needs to make is to hold treatment or reduce the dose. Um, and this, you know, this means that people are not getting as much of the treatment, um, to control the disease and that can impact the outcome. Um, other things that can occur is people can be at higher risk for infection.

Um, if they do end up hospitalized, they can have longer lengths of stay. And overall be sicker than they might have been if they were able to maintain their nutritional status. And as Christie mentioned, you know, they're also, um, you know, I think there's. Other things than just that clinical side to think about.

There's that fact of, you know, when they're malnourished and they're fatigued and tired and you know, their body isn't working as well. They're not able to enjoy friends and family. They're not able to take care of, you know, kids or family, um, and, and enjoy the things in life that they normally would during a time when, you know, having something like that to enjoy is really important by way of comfort.

Getting through, you know, what can be really hard treatment. There’s a lot of risk on a lot of levels. I would say.

CANCER BUZZ: Christie, did your struggles with malnutrition affect your cancer treatment?

Christie Campo Mangir, MS: Yeah, my experience with malnutrition really impacted every stage of my treatment journey. So while I was going through chemotherapy and targeted therapy, while fortunately I was able to tolerate targeted therapy for the full course of treatment, my side effects were so bad.

Between muscle pain and weakness, my husband had to carry me sometimes up and down the stairs because I wasn't able to walk. And my oncologist made the decision to run an MRI and see how my treat was progressing to see if we could stop treatment early. So not only did I have a dose reduction, but I also ended my chemotherapy regimen after five cycles, instead of six. I am lucky in that I was able to achieve a pathologically complete response at the time of my surgery–even with that reduced cycle.

But that can have huge impacts on a patient. I also needed to delay my surgery by an extra month so that I could put on weight and regain strength, my recovery from my double mastectomy and reconstruction was incredibly difficult because I was already so weak. I also dealt with multiple infections and hospitalizations, um, and added weakness that went along with that.

Um, so it really had downstream impacts on my entire treatment, and it truly took me even a year or two to fully regain my weight and my strength after.

CANCER BUZZ: Christie, what else should we keep in mind as we are working to care for patients in the best way possible

Christie Campo Mangir, MS: Nutritional care is such an important part of whole person care.

You know, my mother-in-law, uh, she was dealing with multiple myeloma for 10 years and she always said that I have so many specialists for different parts of my body, but I have nobody looking at me as a whole person, and she was frustrated with her nutritional challenges throughout the course of her treatment.

And I think it's just so important for cancer care professionals to understand that this is a critical part of people's lives, eating and, and getting the, the nourishment and energy that they need and really integrating nutritional care into their whole person. Comprehensive care is critical for each and every cancer patient.

CANCER BUZZ: Thank you so much, Christie for sharing your patient experience with us. And thank you, Kelay. You can find more resources related to malnutrition in cancer care in the show notes or on the ACCC website, make sure to keep an eye on this channel for the next episode in this malnutrition series. There's even more free content and discussions available on the CANCER BUZZ audio podcast. From all of us here at CANCER BUZZ TV. Thank you for watching I'm Summer Johnson.