The Importance of Nutrition for Lymphoma Patients

Shayne Robinson, RD, CSO, CDN
Shayne Robinson, RD, CSO, CDN

Cancer patients often look for foods to slow the progression or cure their lymphoma. Food alone is not a treatment or a cure for lymphoma, but malnutrition (the state of being poorly nourished) can impact response to lymphoma treatment, worsen outcomes, and decrease survival. As an oncology dietitian, my role includes helping patients avoid malnutrition, so they can tolerate their medical treatment and have the best outcomes and quality of life.

Malnutrition may be due to the cancer itself and/or the side effects of cancer treatment. In cancer patients malnutrition is associated with shortened survival (1-7). Malnutrition may decrease the response (1,2,7) and increase the side effects of chemotherapy (6,8,9). It may reduce quality of life (2,10-12) and shorten survival (1-7). Registered Dietitians, Board Certified in Oncology Nutrition, (RD CSO) develop individualized nutrition plans to help each patient make healthy food choices and manage the side effects of the disease and/or treatment to prevent malnutrition.

There are a few studies that look specifically at the effects of malnutrition on the outcomes of lymphoma patients. A study published in 2015 in the Annals of Hematology of 177 patients with newly diagnosed extranodal natural killer T- cell lymphoma nasal type (a sub type of NHL-common in East Asia, especially China) looked at a prognostic nutrition index (PNI). The subjects were divided into 2 groups by PNI score. The group that had “severe nutrition impairment” was compared to the group with “normal nutrition status”. The group with severe nutritional impairment had lower rates of complete remission, five year overall survival (26.6% vs. 71.6%), and 5 year progression free survival (21.9% vs. 43.77%) than the normal nutrition status group. It was concluded that “severely malnourished patients had worse outcomes among patients and nutrition status improvement may improve chemotherapy response”. (13)

Another study published in Nutrition and Cancer in 2015 looked at nutrition status in 262 patients with diffuse large B cell lymphoma (DLBCL) being treated with R-CHOP chemotherapy (rituxan, cyclophosphamide, doxorubicin, vincristine and prednisone). In this study body mass index (BMI) was found to be predictive of overall survival. The study concluded that, “nutritional insufficiency encountered in DLBCL patients might influence the occurrence of treatment-related toxicity and poor survival outcome”.  (14)

A patient can find nutritional advice by reading articles and searching the internet. However, the general information may not be adequate to address the full scope of concerns that are unique to each patient undergoing lymphoma treatment. CSO’s are trained and have the skills and expertise to understand each patient’s medical information and work in close collaboration with his or her health care team. They use evidence-based guidelines considering each patient’s personal preferences, needs, and abilities to develop individualized nutrition plans. CSO’s are able to follow each patient through treatment and recovery making nutrition recommendations as needs change.

The study of nutrition for cancer survivors is an evolving science. Until more is known, it is suggested that after treatment has been completed, cancer survivors should follow the recommendations for cancer prevention.

Both the American Institute of Cancer Research (AICR) and The American Cancer Society recommend a plant-based diet, balanced with physical activity, to maintain an ideal body weight.

AICR in partnership with the World Cancer Research Foundation published a comprehensive report in 2007 identifying guidelines for cancer prevention. The process to develop these guidelines was “transparent, objective and comprehensive”. Studies were independently reviewed and presented to an expert panel of twenty-one world-renowned scientists, who analyzed the accumulated evidence to develop the 10 Nutrition Recommendations for Cancer Prevention. The Continuous Update Project is an ongoing review of the scientific literature, to capture new research, as it is published, to ensure that the evidence, on which the 10 recommendations are based, continues to be up-to-date and the most comprehensive available. (15)

To see a Certified Specialist in Oncology Registered Dietitian at the New York Presbyterian Weill Cornell Medical Center Ambulatory Care Network call (212) 746-0838. A physician referral is required.

AICR’s Recommendations for Cancer Prevention

  1. Be as lean as possible without becoming underweight.
  2. Be physically active for at least 30 minutes every day.
  3. Avoid sugary drinks. Limit consumption of energy-dense foods.
  4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
  5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
  6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
  7. Limit consumption of salty foods and foods processed with salt (sodium).
  8. Don’t use supplements to protect against cancer.
  9. It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods.
  10. After treatment, cancer survivors should follow the recommendations for cancer prevention. (15)

References

  1. Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980; 69:491.
  2. Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998; 34:503.
  3. Senesse P, Assenat E, Schneider S, et al. Nutritional support during oncologic treatment of patients with gastrointestinal cancer: who could benefit? Cancer Treat Rev 2008; 34:568.
  4. Jagoe RT, Goodship TH, Gibson GJ. The influence of nutritional status on complications after operations for lung cancer. Ann Thorac Surg 2001; 71:936.
  5. Rey-Ferro M, Castaño R, Orozco O, et al. Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition 1997; 13:878.
  6. Barret M, Malka D, Aparicio T, et al. Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter study. Oncology 2011; 81:395.
  7. Salas S, Deville JL, Giorgi R, et al. Nutritional factors as predictors of response to radio-chemotherapy and survival in unresectable squamous head and neck carcinoma. Radiother Oncol 2008; 87:195.
  8. Aslani A, Smith RC, Allen BJ, et al. The predictive value of body protein for chemotherapy-induced toxicity. Cancer 2000; 88:796.
  9. van Eys J. Effect of nutritional status on responses to therapy. Cancer Res 1982; 42:747s.
  10. Hammerlid E, Wirblad B, Sandin C, et al. Malnutrition and food intake in relation to quality of life in head and neck cancer patients. Head Neck 1998; 20:540.
  11. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Cancer: disease and nutrition are key determinants of patients’ quality of life. Support Care Cancer 2004; 12:246.
  12. Tian J, Chen JS. Nutritional status and quality of life of the gastric cancer patients in Changle County of China. World J Gastroenterol 2005; 11:1582.
  13. Chen KL, Liu YH, Li WY, Chen J, Gu YK, Geng QR, Jiang WQ, Huang HQ, Lin TY, Xia ZJ, Cai QQ. The prognostic nutritional index predicts survival for patients with extranodal natural killer/T cell lymphoma, nasal type.  Ann Hematol. 2015 Aug;94(8):1389-400.  Epub 2015 Apr 15.
  14. Park S1, Han B, Cho JW, Woo SY, Kim S, Kim SJ, Kim WS. Effect of nutritional status on survival outcome of diffuse large B-cell lymphoma patients treated with rituximab-CHOP. Nutr Cancer. 2014;66(2):225-33. Epub 2014 Jan
  15. http://www.dietandcancerreport.org/cup/report_overview/index.php, accessed July 20, 2015

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