The Science Nook on Lung Cancer

by Jenna Koroly, MS, RD, CSOWM, CDN

Delving into the research on nutrition and lung cancer, two recent studies present information on risk factors associated with lung cancer as well as promising nutritional interventions for the patient.

 

Study 1

Nutrition Support and Dietary Interventions for Patients with Lung Cancer: Current Insights

 

Journal: Lung Cancer: Targets and Therapy

 

More than half of individuals with lung cancer are clinically malnourished (i). Nutrition therapy, appropriate exercise prescriptions, and Omega-3 fatty acid supplementation may prove beneficial for these patients (ii).

In this 2016 review, the authors explore malnutrition, nutritional risk, and nutrition interventions for patients with lung cancer.

 

Malnutrition and nutritional risk

Lung cancer patients are at increased nutritional risk.  Side effects such as nausea, vomiting, loss of appetite, dysphagia, esophagitis, and fatigue are common.  Results show that 69% of those with lung cancer were found to be clinically malnourished (i).  And among patients with lung cancer, those with Metastatic and localized types were seen to have rates of malnutrition of 73% and 5%, respectively (iii).   Treatment can make matters difficult.  Radiotherapy was shown to cause 31% of patients to lose 5% or more of their weight within 90 days of beginning the treatment (iv, v), with half of those patients undergoing this extreme weight loss during the post-treatment period of care (ii).  This exacerbates common side effects and prolongs treatment time.

 

Nutritional interventions

Personalized nutrition counseling was shown to be important. Working with a Registered Dietitian improved energy and protein intake in those patients undergoing chemotherapy (vi), which improved weight status and built lean muscle mass, subsequently improving physical and functional wellbeing (vii). A team-oriented approach is best.  For advanced cancer patients with a broad range of cancer types, healthcare teams comprised of dietitians, exercise physiologists, physical therapists, and physicians led to the most significant improvements in fatigue and weight maintenance for patients (x).

Supplements are popular among cancer patient populations with one of the most promising being the Omega-3 fatty acids. Due to the mixed findings on the benefit in lung cancer patients, clear recommendations for Omega 3 supplementation cannot be made (ix).

 

FOR THE PATIENT AND CAREGIVER

Weight loss is an unwelcome and disheartening burden for many lung cancer patients, and we understand that challenge. Taking a proactive approach prior to beginning treatment to avoid unintentional weight loss is essential. Because severe weight loss is associated with poor treatment outcomes, longer length of treatment time, and more severe treatment side effects, enrich your diet with calorie dense foods such as peanut butter and avocados to keep the weight up prior to going through treatment. Work closely with a Registered Dietitian from the beginning to understand calorie needs at this point in your journey, and then apply it. Use the calorie recommendations and create appropriate meals at home, or make smart decisions when ordering out.  You can control your food intake, which will help guide your journey.

 

FOR THE HEALTHCARE TEAM

Monitoring nutritional status of lung cancer patients is crucial, especially post-treatment. Nutrition interventions to support weight and muscle maintenance and combat malnutrition may include individualized nutrition counseling with a Registered Dietitian and exercise therapist trained in cancer. If the patient is currently taking Omega-3 supplements, it is acceptable, although there is no compelling evidence as to any significant positive effects.  Make sure that the supplement is third party tested, review the medication list for any potential interactions and also consider food sources of the nutrient.

 

Study 2

Obesity, Metabolic Factors and Risk of Different Histological Types of Lung Cancer: A Mendelian Randomization Study

 

Journal: PLoS ONE

 

Metabolic risk factors may be correlated with lung cancer, and can provide better insight into lung cancer prevention.

In this study, published in June 2017, the authors used genetic instruments to explore associations between metabolic risk factors and lung cancer.

Mendelian randomization, the analytic tool used, bases results on genetic markers in the individual, reducing the chances of reverse causation (xii).

Genetic associations between higher BMI and increased risk of squamous and small cell carcinoma were discovered, which may be explained by an association between increased BMI and increased number of cigarettes smoked per day. In addition, the authors found a positive correlation between fasting insulin levels and lung cancer risk.

Maintaining a healthy weight and following a dietary pattern to avoid spikes in blood sugar levels may offer possible strategies in decreasing the risk of lung cancer, based on the findings of this study.

The ongoing research on lung cancer arms patients and caregivers with the tools needed for improved outcomes and the knowledge of treatment modalities for the future.  

 

FOR THE PATIENT AND CAREGIVER

Avoid weight gain and spikes in insulin.  Consume whole plant-based foods consistently throughout the day, even trying 5-6 smaller meals. Eat more fruits, vegetables, and whole grains and decrease refined carbohydrates in the diet. To further reduce spikes in insulin, try pairing complex carbohydrates with protein in the same meal. Choose the appropriate portion sizes using the USDA MyPlate tool.

 

FOR THE HEALTHCARE TEAM

Listen to the patient, and help to make healthier substitutes such as unprocessed for refined carbohydrates (try oatmeal instead of cheerios) and unsaturated for saturated fats (try olive oil instead of coconut oil or butter), while still making eating enjoyable. If the patient has diabetes, spread meals out throughout the day and maintain consistent amounts of carbohydrates at each meal and snack, compatible with their current insulin regimen and daily calorie needs.

 

References:

1. Read JA, Choy ST, Beale P, Clarke SJ. An evaluation of the prevalence of malnutrition in cancer patients attending the outpatient oncology clinic. Asia-Pacific Journal of Clinical Oncology. 2006;2(2):80–86

2. 
 Kiss, N. Nutrition support and dietary interventions in patients with lung cancer: current insights. Lung Cancer: Targets and Therapy. 2016;7:1-9.
   

3. Hébuterne X, Lemarié E, Michallet M, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr. 2014;38(2):196–204.
   

4. Kiss NK, Krishnasamy M, Isenring EA. The effect of nutrition intervention in lung cancer patients undergoing chemotherapy and/or radiotherapy: a systematic review. Nutr Cancer. 2014;66(1):47–56.
   

5. Kiss N, Isenring E, Gough K, et al. Early and intensive dietary counselling in lung cancer patients receiving (chemo)radiotherapy – a pilot randomized controlled trial. Supportive Care in Cancer. 2014; 22(1 Suppl):S116. 

   

6. Fearon KC, Barber MD, Moses AG, et al. Double-blind, placebo- controlled, randomized study of eicosapentaenoic acid diester in patients with cancer cachexia. J Clin Oncol. 2006;24(21):3401–3407.
   

7. van der Meij BS, Langius JA, Smit EF, et al. Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the nutritional status of patients with stage iii non-small cell lung cancer during multimodality treatment. J Nutr. 2010;140(10):1774–1780.
   

8. Goodwin J, Neugent ML, Lee SY, Choe JH, Choi H, Jenkins DMR, Ruthenborg RJ et al. The distinct metabolic phenotype of lung squamous cell carcinoma defines selective vulnerability to glycolytic inhibition. Nature Communications. 2017;8:15503.

9. Carreras-Torres R, Johansson M, Haycock PC, Wade KH, Relton CL, Martin RM, et al. Obesity, metabolic factors and risk of different histological types of lung cancer: A Mendelian randomization study. PLoSONE. 2017;12(6):e0177875.