We are international

October 2002 Volume 5, Issue 3:
Step-by-Step Nutrition Action Plans
By Kim Dalzell, Ph.D., R.D., L.D.

The statistics are quite sobering: Over 40 percent of cancer patients die from causes related to malnutrition, not from cancer itself.1 If you aren’t adequately nourished or are depleted of protein or other nutrients, you may be suffering from malnutrition.

Why is malnutrition such a threat? Cancer causes changes that can alter the level of nutrients your body requires for optimal functioning. Side effects associated with chemotherapy, radiation, and surgery can complicate your ability to eat, absorb, or utilize foods. The final insult comes when a malnourished body can’t support treatment goals. When you are poorly nourished, your current treatment may not be as effective, or you might not be able to tolerate further treatments.

Over time, inadequate or improper dietary habits can wreak havoc on the healthiest individuals, even “healthy” cancer patients. If you don’t address dietary deficiencies, cachexia ensues. Think of cachexia as a downward spiral. Every cell in your body requires many nutrients to work effectively. Without the proper fuel, cells can’t do their jobs, and debilitation begins. Without an opportunity for rebuilding, the chances of recovery are greatly reduced.

Before you dismiss malnutrition as a condition for the weak and debilitated, understand that even minor degrees of undernutrition are associated with a marked increased risk of hospital admissions and death.2 Between 40 and 80 percent of all cancer patients develop some degree of clinical malnutrition.3

You can take several steps to make sure your nutritional status is up to par:

  1. Address the weakening effects of poor nutrition before they become an issue.
    Why choose to ignore your nutritional needs? Be prepared to address them right from the start. Communicate with your doctor. Discuss your risk for malnutrition with your healthcare providers and let them know you are concerned about your nutritional status. A clinical dietitian should be following your progress throughout your treatment and should be available to discuss your dietary needs or concerns. If you haven’t met with a dietitian — ask! A dietitian or nutritionist can help you identify risk factors and devise solutions to any special needs related to your diet.

  2. Ignore advice to “eat whatever you want.”
    Have you been told to eat whatever you want in order to keep your weight up? Instead, consider how nourishing your food is or whether your diet is detrimental to the immune system. Although it is better to eat something rather than nothing, what you eat can make a difference in your cancer outcome. If you eat rich, thick ice cream milkshakes and cream soups in an attempt to maintain your weight, you are not providing your body what it needs to rid itself of cancer. With a little planning and some knowledge, you can make better meals that are quick to prepare, taste good, are easy to digest, and support normal cell division and immune function.

  3. Maintain your weight.
    Weight loss is frequently used to evaluate early malnutrition and impacts the survival time of newly diagnosed cancer patients even more than their chemotherapy regimen.4 If you lose as little as five percent of your current body weight, your health and cancer recovery can be compromised. Unintentional weight loss can occur at any stage of a cancer diagnosis or treatment plan. While a few pounds here or there probably aren’t critical and most likely reflect a shifting fluid balance, it is important to be aware of weight change trends. Don’t think that you can “starve” the cancer. Rapid or progressive weight loss usually signals lost muscle mass, impaired immunity, and free radical generation, and presents the greatest risk for complications that reduce the survival and quality of life for many cancer patients. The percentage of weight loss and the rate of loss are both critical for determining whether negative health consequences may arise. The following diagram shows that as weight loss continues, the risk of health complications and death increases:5 If you think your weight loss may be affecting your health, ask your dietitian to assess your weight changes.

  4. Lose weight safely if you are overweight.
    Obesity, as well as undernutrition, can play a role in the disease process. Excess weight has been linked to a higher risk of many kinds of cancer (endometrial, kidney, postmenopausal breast, and possibly colon) and other degenerative diseases. If weight reduction is a health goal, limit your weight loss to no more than one to two pounds per week. When you have cancer, it is essential that you consult with a nutritionist who will help you determine realistic and safe goals for gradual weight loss.

  5. Learn what your needs are.
    I’m always shocked to hear that most patients do not know what their calorie and protein requirements are. Knowing what your body requires makes it easier to define your dietary goals. If you would like to know specifically what your energy and protein needs are, I suggest you contact the hospital dietitian or nutritionist. Nutritional professionals routinely calculate these requirements for every patient, so don’t hesitate to ask.

  6. Monitor your progress.
    Anyone who undergoes cancer treatment has had their blood drawn at one point or another. Laboratory tests convey a general cell response trend that helps the doctor determine when changes in your treatment plan are necessary. If you become familiar with a few of the laboratory results, you will be able to get more involved in your treatment. Looking at the numbers on a laboratory test can help you create a picture in your mind of what is going on inside of you. This visualization can be very powerful for proactive healing.

  7. Consider advanced nutrition support.
    If high-calorie shakes, appetite stimulants, and other dietary modifications don’t help you maintain your weight, you may need advanced nutritional support. Advanced nutritional support used as a adjuvant therapy to basic cancer treatment can decrease the risk of further deterioration, improve some nutritional and immunological parameters, avoid health complications associated with malnutrition, and enhance quality of life.6 Nutritional support techniques used in cancer patients have reduced complication rates of surgery by 33 percent!7 Additionally, survival rates improved, without affecting tumor growth.8 s


  1. Grant, J.P. Proper use and recognized role of TPN in the cancer patient. Nutrition 6(4): Suppl, 6S–7S, 10S, Jul/Aug 1990.
  2. Edington, J. et al. Outcomes of undernutrition in patients in the community with cancer or cardiovascular disease. Proc Nutr Soc 58(3): 655–61, Aug 1999.
  3. Kern,K. et al. Cancer cachexia. J Parenteral Enteral Nutrition 12(3): 286–98, May/Jun 1988.
  4. DeWys, W.D. et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 69: 491–497, 1980.
  5. Grant, A. and DeHoog, S. Nutritional Assessment and Support, 3rd edition (Seattle, 1985).
  6. Bozzetti, F. et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: A randomized, clinical trial. Journal of Parenteral and Enternal Nutrition 24(1): 7–14, Jan–Feb 2000.
  7. Celaya, P.S. et al. Nutritional management of oncologic patients. Nutr Hosp 14S(2): 43S–52S, May 1999.
  8. Nitenberg, G. and Raynard B. Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 34(3): 137–68, Jun 2000.

Note: Challenge Cancer and Win! Step-by-step nutrition action plans for your specific cancer, NutriQuest Press 2002, is available through amazon.com and BookMasters.

 related articles