Who Can Cancer Patients Trust for Nutritional Advice?

Cancer patients want good advice. They want answers to questions about diet and nutrition. In lymphomas, because these cancers affect the immune system, they want to know how they can change their diets to support the work their immune system is doing.

Should they go to their doctors for direction or guidance? Of course they should. But do doctors really know all that much about nutrition? After all, in the United States, nutrition is not part of any core curriculum in medical school, so they aren't learning it there.

More than likely, seeking information about what cancer patients should and should not eat, doctors will do what patients do: turn to the Internet.

And that's where the disaster begins.

ONLINE DIETARY CHAOS

By now we should expect that, on a topic like nutrition and cancer, the internet would be a fluid mass of contradictions about what one should or should not be eating. And that's precisely what can be found.

But surely if we can count on one institution to be consistent, it is the National Comprehensive Cancer Network (NCCN), that incredible network of 21 major hospitals operating under the banner of the National Cancer Institute and the one that issues the most widely used and trusted standard treatment guidelines for oncology.

The NCCN includes the distinguished likes of MC Anderson, Stanford, Duke, Memorial Sloan-Kettering, Fred Hutchinson, Johns Hopkins, and more.

So they're reliable in this regard, right?

According to findings published online in the journal Nutrition and Cancer the answer is a profound and disappointing and booming-loud wrong.

CONTRADICTION

In Dietary Recommendations During and After Cancer Treatment: Consistently Inconsistent? researchers conducted a nutrition-based review of the 21 NCCN websites.

Just 4, out of 21, provided any nutritional guidelines. And of those four:

• -- Two promoted a low-fat, high-carbohydrate diet recommending 5:1 and 7:1 ratios of carbohydrate to fat food types
• -- Two promoted weight maintenance during treatment, endorsing a 1:1 ratio of carbohydrate to fat

7 of 21 got lazy and featured a total of 9 external links to other web sites (including big ones, like the National Cancer Institute, the American Cancer Society, the American Society of Clinical Oncology, and even Pubmed), which would be OK if those links had nutritional guidelines for cancer patients.

Four do in fact provide nutrition guidelines, but again:

• -- Two of them promoted a low-fat, high-carbohydrate diet
• -- The other two promoted high-caloric intake to maintain weight

Five of the links featured no nutritional content relevant to cancer patients (meaning cancer prevention diet information didn't count). It's as though whoever included those links didn't even bother to look.

CONCLUSIONS

The researchers are left to conclude that …

Consistent online dietary recommendations are lacking for patients during and after cancer treatment.

And that…

External referenced websites advocate a variety of nutritional approaches that are inconsistent with each other and NCCN member websites.

WHO CAN YOU TRUST?

So where can you go for sound advice? Despite everything you have just read, I am obligated (and rightfully so) to direct you to your doctor and/or health care team. That should always be your first stop.

I can suggest however that a patient or caregiver discuss with their health care team the possibility of arranging a consultation with a small but growing group of professionals: board certified oncology nutritionists.

They 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."