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Patients Cannot Afford to Overlook the Diet-Cancer Connection
Reading BBC Radio presenter Sheila Dillon's article Cancer and diet: Why is nutrition overlooked? I came across a few points I could argue with, but my chief complaint is that she didn't title the article "Cancer and diet: Why is nutrition still overlooked?"
Dillon notes that during her treatment for multiple myeloma, the role of diet and nutrition was practically absent from her discussion with health care professionals, and she goes on to say:
In most cancer centres in the UK, diet is still seen as almost meaningless in cancer treatment and aftercare. Yet there is good science available on the subject, though not a lot of it is what medics call "gold standard" science.
At the institutional level in the US, there is no difference. On March 28, I wrote about a paper published in the journal Nutrition and Cancer which indicted the National Comprehensive Cancer Network's disastruous attempts to offer any sort of nutritional guideline help for oncologists to give to their patients.
The Origins of the Diet-Cancer Connection
In 1982 in the United States, the National Academy of Sciences issues a landmark report entitled Diet, Nutrition, and Cancer.
This was a landmark report for many reasons, among them that it was published at a time when many people in mainstream medicine ridiculed the idea that diet could have anything at all to do with cancer or with cancer patients. This kind of ridicule for unconventional ideas in cancer research was not new: Just a generation earlier, anyone who suggested that a virus could cause cancer was browbeaten into silence.
Also, the report notes that it was the work of epidemiologists who began to make the diet-cancer connection, notably in how there might be a low incidence of certain cancers among, say, Japanese people living in Japan, but when they came over to the US they seemed to adopt the higher incidence of certain cancers seen in the States, such as colorectal cancer. While this could be explained by many different environmental factors, as the cross-cultural evidence mounted, the number of factors diminished, leaving diet as the most likely culprit.
By 1988, US Surgeon General C. Everett Koop had had enough, asserting in the Washington Post:
There no longer can be any doubt about the link between diet and disease. Your choice of diet can influence your long-term health prospects more than any other action you can take.
For nutrition-conscious cancer-concerned shoppers in the United States in 1982 or 1988, determining what foods contained which nutrients was not at all easy, since putting that information on food labels was voluntary. Not until 1993 and the arrival of the Nutrition Facts label on food packaging did this get any easier.
But if you don't know what you should or should not be eating, the label is functionally pointless for cancer patients.
On Alleviating One's Nutritional Deficits
One of the National Comprehensive Cancer Network's latest clinical practice guidelines in oncology is on Survivorship. Surely they confront nutrition head on here, because survival – in any respect, not just surviving cancer – requires food intake.
I found the word "nutrition" eight times in the guideline, generally in contexts such as this:
Alleviation of pain, fatigue, distress, or nutritional deficits can facilitate initiation of an exercise program.
"Alleviation of nutritional deficits" sounds wordy and quite awkward, like a badly formed euphemism strung together by someone deeply uncomfortable with the subject.
Either way, the NCCN does not offer any recommendations on actually alleviating those deficits.
So What Can Be Done?
Assuming one's doctor is short on information, perhaps the best that cancer patients, their caregivers and/or their loved ones can do is consult the American Cancer Society's 2012 report, Nutrition and physical activity guidelines for cancer survivors. Yes, it says "for cancer survivors," but the contents of the report go beyond that and address specific recommendations during treatment as well as after. On top of that, the ACS notes in the overview:
Although this report is intended for health care providers caring for cancer survivors, it can also be used directly by highly motivated survivors and their families.
It requires adding that those highly motivated folks should do so with their doctor's knowledge, advisement, input, and general participation. While good nutrition is good nutrition, it isn't always good for you – for instance, during anti-cancer treatments like radiotherapy and chemotherapy, when over-the-counter vitamin supplements and antioxidant pills can compromise your treatment and even encourage tumor growth.
If one's doctor is a bit ho-hum on the matter, well, shame on them. But patients shouldn't give up and are encouraged to seek a consult with a board certified oncology nutritionist.
These specialists can be found through the Oncology Nutrition Dietetic Practice Group, which functions within the ADA (the American Dietetic Association) and offers board certification to Registered Dieticians as Specialists in Oncology Nutrition, otherwise recognized as "CSO."
Where Tides Turn like Glaciers
The tides do turn in practice guidelines in medicine, but they do so at a glacial pace. This is for the best: If doctors applied new treatment guidelines as they appeared in the media, it would be chaos. There would be no consistency, and without consistency, there would be no patterns, no good evidence and no broad conclusions to reach.
Granted, the understanding of nutrition as it relates to cancer prevention, treatment and survivorship remains murky in many areas. In others, however, it is not murky. Still, responsibility for its application continues to fall at the feet of the "highly motivated" patient, and at the very least, that much needs to change.