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Reducing Malnutrition Among Patients With Lung Cancer

Barry Thias, Bridget

doi: 10.1097/01.COT.0000657780.99628.3f
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cancer and nutrition
cancer and nutrition:
cancer and nutrition

Researchers behind a recently awarded 3-year research grant hope that the study's results shift the current lung cancer treatment routine by demonstrating the importance of nutrition. Colleen Spees, PhD, RD, and Carolyn Presley, MD, will conduct a randomized clinical trial evaluating the impact of nutritional counseling and medically tailored meals for patients with lung cancer at four U.S. medical centers. The participating locations are the Ohio State University Comprehensive Cancer Center, Tufts Medical Center, Fox Chase Cancer Center, and MD Anderson Cancer Center. The goal of the intervention is to help reduce malnutrition and treatment-related toxicity in patients.

“We know that patients with lung cancer have many difficulties going thru treatment and the transition into survivorship,” Spees noted. “If we can help patients be well-nourished, they will handle their treatment better. We know that up to 70 percent of patients with lung cancer at some point in their treatment are malnourished.”

Many patients are not accustomed to having nutritional care from the health care team because of problems with reimbursement. Populations that are most vulnerable are people who don't have health insurance, as well as those from underserved populations and low socioeconomic status.

“I am an oncologist specializing in lung cancer. I think that nutritional care for our patients has largely been reactive and not proactive,” Presley noted. “There is research that suggests that, once patients start losing weight and getting to a certain body mass index, it's sort of a point of no return. What we try to do is actually prevent patients from having to stop their treatment. We feel that providing intensive nutritional counseling will potentially serve as a proactive recipe. Removing food insecurity will help a large portion of the population we are serving.”

Spees said many patients put off having their symptoms checked. A high percentage of lung cancer patients aren't diagnosed until late in the process, which complicates their recovery. Many of the patients are older and have had earlier symptoms of coughing, asthma, and bronchitis. But many may not be able to afford a co-pay, they lack transportation, or live in a rural area with limited access to health care. They don't get as rapid a diagnosis as, for example, a woman finding a lump in her breast might. These patients aren't getting seen early by their primary health care provider to get a diagnosis.

Patients in the interventional research study group will receive behavioral-based remote medical nutrition therapy.

“We are successfully pairing dietitians with a background in oncology with patients,” Spees explained. “The dietitian meets with patients at least once a week talking to them via Skype or email. This is proactive and similar studies have shown that patients develop a relationship with their dietitian. The dietitians are trained to provide nutritional support to the patient and help them with everything they are going through and to identify problems.”

For example, if a patient explains about a sore in their mouth, that might mean they are having trouble swallowing, so immediately the dietitian is going to help them by prescribing a softer diet. Likewise, a patient recovering from surgery might need a higher protein diet. The dietitian works with the patient on a weekly basis to make sure they are receiving optimal nutrition. If the dietitian discovers the patient has extreme anxiety or depression, they can alert the principle investigator working with the patient. Dietitians are trained to catch things early, like swallowing problems or anorexia, so they can ensure patients see a primary care provider to get concerns addressed before they get to the point of no return.

The majority of lung cancer patients will undergo chemotherapy or immunotherapy. A small subset will receive targeted oral medication. Some chemotherapy treatments can cause patients' white and red blood cells to decrease. That has a direct effect on the bone marrow.

“We are hoping that, in addition to the vitamins we give patients, better nutrition will minimize some of the common toxicities and side effects such as nausea, vomiting, and diarrhea,” Presley said. “We also see some autoimmune toxicities and we think there may be a relationship with the microbiome, so we are hoping to see if some foods are able to decrease or eliminate these autoimmune toxicities from immune therapy.”

The researchers have a dissemination plan to share the results of the 3-year study by publishing them in journals and presenting at various national and international conferences.

“We want a platform that will reach oncologists and policymakers because we are talking about a paradigm shift,” Spees stated. “If we can get at the beginning of the diagnostic process and assess a patient's overall status in terms of macro and micro nutritional content, that will make a big step on how patients are treated. It is a novel idea and we don't know anyone else who has studied this aspect. Good nutrition is a lot cheaper than hospital admissions.”

Presley agreed. “A lot of journals in the areas of lung cancer, as well as supportive and nutritional care, are going to be interested in publishing this data. We have a food insecurity problem in the United States and insurance companies are paying hundreds of thousands of dollars. We want to show that providing healthy food to people can improve outcomes.”

Bridget Barry Thias is a contributing writer.

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