As RDNs working with cancer patients, you have seen first-hand the impact of cancer and treatments on nutritional status and functional status. Are nutrition problems underprioritized, underdiagnosed and undertreated?
Over 40 years ago Dr Charles Butterworth brought to light clinical malnutrition’s adverse effect on patient outcomes. Clinical nutrition support has come a long way in 40 years...or have we?
Recent studies show that up to 40% of cancer patients have anorexia and weight loss prior to diagnosis and 40-80% of cancer patients experience malnutrition during treatment (Muscaritoli, 2019; Voss, 2021). Over 40% of patients with a diagnosis of malnutrition did not receive any nutrition support (Arends,2016).
RDNs Seeking Solutions
One of the trailblazers in promoting protein intake for cancer patients was Martha Krachenfels, MS, RD, co-founder of Unjury® Protein. She saw the impact cancer treatments had on her father. Martha’s dad endured radiation treatments which caused burns that deteriorated into serious open wounds.
The key nutrition recommendation for wounds is very high intake of high-quality protein. Unfortunately, the hospital directed him to use a common all-purpose nutrition drink that was not at all high in protein. That product had a “perfect storm” of deficiencies:
- He didn’t like it
- It upset his stomach, and
- Its protein content was far below what he needed
Martha’s dad was given a false sense of security that the nutrition drink would help resolve his declining nutrition status and heal the open wounds. It did neither.
UNJURY® was started by the wife and husband team of Martha Krachenfels MS RD, and Jerome Krachenfels, in 2002.
Protein is our passion. Quality, Taste and Tolerability are the hallmarks of our products.
Role of RDN
We believe that treatment of cancer-related malnutrition and sarcopenia requires targeted nutrition therapy. Studies have demonstrated that inflammation of cancer tumors, chemotherapy, radiation treatments, and surgery increases inflammation in the body (Greten, 2019). Sustained inflammation results in a change in the way the body uses macronutrients.
Sustained inflammation results in less efficient use of dietary protein resulting in decreased protein synthesis, impaired muscle tissue synthesis and increased protein breakdown for energy. Reduced muscle mass leaves the patient without a vital reservoir of amino acids and effector molecules like cytokines and myokines. These molecules are released by muscle to help the body combat illness, infection and muscle wasting. When more than 20% of total lean mass is lost, the body prioritizes dietary protein towards replenishing lean mass instead of the usual roles of protein-i.e. healing wounds, maintaining a strong immune function (Argiles, 2016).
Metabolic changes in the muscle and loss of muscle mass leads to increased risk of insulin resistance and impaired glucose tolerance. Insulin resistance is commonly seen with increased lipid oxidation and overflow of lipids due to dysfunctional adipose tissue leading to fat deposition in skeletal muscles (Trouwborst,2018). Moreover, fat infiltration into skeletal muscle is linked to sarcopenia, metabolic dysfunction and aging. Fat infiltration in the muscles leads to decreased muscle mass and impaired mobility function (Correa-de-Araujo, 2020; Shou, 2020).
Loss of muscle mass results in loss of strength, loss of stamina, more fatigue and weaker immune system. Lower muscle mass results in lower energy requirements to maintain body weight. Even when weight is lost during cancer treatment, without sufficient high-quality protein and exercise, regain can be more fat stores instead of replenishing muscle mass (Byun, 2021).
We recognize that malnutrition is associated with poor outcomes and higher costs of care. We support the evidenced-based recommendations of clinical oncology nutrition professionals focusing on malnutrition and sarcopenia. We believe in the benefits of pre-habilitation to prepare patients for treatment and nutrition rehabilitation post treatment.
Consider these questions as you craft and Action Plan:
- Does your healthcare setting screen all cancer
patients for malnutrition and sarcopenia at diagnosis and as clinically
indicated throughout treatment?
- The Oncology Nutrition DPG website provides a list of screen tools shown to be valid and reliable in both inpatient and ambulatory care settings. https://www.oncologynutrition.org/practice-resources/screeningtool
- How are you addressing loss of muscle mass and declining functional status in pre-habilitation and rehabilitation?
- What are your plans to expand oncology nutrition service?
How can UNJURY® Protein help your cancer patients deal with nutrition impact symptoms and meet their protein requirements?
UNJURY® Protein is recommended at All of America’s Top Hospitals. The shakes and soups taste great and have all the amino acids that patients need to support their immune system and rebuild their strength.
Please let us know how this paper was helpful. If you would like samples for patients, including our popular savory flavor, UNJURY® Chicken Soup Flavor please request at firstname.lastname@example.org .
Mary Litchford PhD, RDN, LDN
UNJURY® Protein Nutrition Advisor
- Muscaritoli M, Lucia S, Farcomeni A et al: Prevalence of malnutrition in patients at first medical oncology visit: The PreMiO study. Oncotarget 8:79884-79896, 2017
- Muscaritoli M, Arends J, Aapro M: From guidelines to clinical practice: A roadmap for oncologists for nutrition therapy for cancer patients. Ther Adv Med Oncol 11:1758835919880084, 2019
- Arends J, Bachmann P, Baracos V, et al: ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36:11-48, 2017 Feb;36(1):11-48. doi: 10.1016/j.clnu.2016.07.015. Epub 2016 Aug 6. PMID: 27637832.
- Byun, Mikyong et al. “Physical and Mental Health Factors Associated with Poor Nutrition in Elderly Cancer Survivors: Insights from a Nationwide Survey.” International journal of environmental research and public health vol. 18,17 9313. 3 Sep. 2021, doi:10.3390/ijerph18179313
- Greten,F et al. Inflammation and Cancer: Triggers, Mechanisms, and Consequences. Immunity.2019.51(1).27-41.
- Argiles, J, et al. Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease. 2016 JAMDA.17(9)789-796.
- Chew J, Yeo A, Yew S, Lim JP, Tay L, Ding YY, Lim WS. Muscle Strength Definitions Matter: Prevalence of Sarcopenia and Predictive Validity for Adverse Outcomes Using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Criteria. J Nutr Health Aging. 2020;24(6):614-618. doi: 10.1007/s12603-020-1371-y. PMID: 32510114.
- Yang M, Hu X, Xie L, Zhang L, Zhou J, Lin J, Wang Y, Li Y, Han Z, Zhang D, Zuo Y, Li Y, Wu L. Screening Sarcopenia in Community-Dwelling Older Adults: SARC-F vs SARC-F Combined With Calf Circumference (SARC-CalF). J Am Med Dir Assoc. 2018 Mar;19(3):277.e1-277.e8. doi: 10.1016/j.jamda.2017.12.016. PMID: 29477774.
- Mo YH, Zhong J, Dong X, Su YD, Deng WY, Yao XM, Liu BB, Wang XQ, Wang XH. Comparison of Three Screening Methods for Sarcopenia in Community-Dwelling Older Persons. J Am Med Dir Assoc. 2021 Apr;22(4):746-750.e1. doi: 10.1016/j.jamda.2020.05.041. Epub 2020 Jul 12. PMID: 32669238.
- Clinical Oncology Society of Australia Cancer-Related Malnutrition and Sarcopenia Working Group. Cancer-Related Malnutrition and Sarcopenia Position Statement. Clinical Oncology Society of Australia. August 2020.
- Correa-de-Araujo R, Addison O, Miljkovic I, et al. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging. Front Physiol. 2020;11:963. Published 2020 Aug 7. doi:10.3389/fphys.2020.00963
- Trouwborst I, Bowser SM, Goossens GH, Blaak EE. Ectopic Fat Accumulation in Distinct Insulin Resistant Phenotypes; Targets for Personalized Nutritional Interventions. Front Nutr. 2018;5:77. Published 2018 Sep 4. doi:10.3389/fnut.2018.00077
- Shou, J., Chen, PJ. & Xiao, WH. Mechanism of increased risk of insulin resistance in aging skeletal muscle. Diabetol Metab Syndr 2020.12, 14 (2020). https://doi.org/10.1186/s13098-020-0523-x
- Voss,A ed. Oncology Nutrition in Clinical Practice. Chicago, IL: Academy of Nutrition & Dietetics.2021.