Cancer patients have a lot of special dietary needs. Treatments like radiation therapy and chemotherapy tend to wreak havoc on the digestive faculties. Appetite is often reduced and simple acts like swallowing and eating can become very painful. Patients with cancers of the gastrointestinal tract are especially affected.
“Well,” you might say, “lots of people lose weight when they’re sick. It’s not too bad, right?”
Karen Wagner can tell you in many words exactly how wrong you are. As a dietician counseling cancer patients at the Abramson Cancer Center, she knows for sure that weight maintenance is paramount. Let’s say you’re receiving radiotherapy. To put it simply: if your size changes, the way you fit into the machine changes. The doctors treating you have to run measurements and simulations all over again to recalculate the proper dose you receive. And if you’re suddenly much smaller and can’t take on as much radiation as it would take to kill your tumor, the sudden dose reduction does you no favors.
That’s just one example. Chemo patients tend to lose weight as well, and the dehydration and diarrhea that accompany the rapid weight loss often reduce the efficacy of the drugs.
The message is simple: maintain the patient’s weight. Karen has plenty of tricks up her sleeve to help her do it. Among them: avocadoes, peanut butter, Ensure, enzyme supplements, and, if absolutely necessary, feeding tubes.
Most dieticians make a living telling people to consume high-fat foods in moderation. Karen just hopes the extra butter will prevent pancreatic cancer patients’ internal organs from deteriorating.
This is the guerrilla warfare of nutrition counseling. She really does whatever is necessary to get patients through their harrowing treatments. Some patients actually gain weight. She can curtail that. Some patients come in very overweight, and it would actually be appropriate for them to lose some weight very slowly, in a healthy way. She can make sure that happens.
What she had to tell me was this: “Food should not be an additional source of guilt and stress while people are going through their cancer treatment.” It is often her job to make sure people don’t get obsessed with eating right, since no dietary choice will reverse the production of malignant cells (if there were such a choice, she would know it and recommend it often.) While food does fascinate her, and she recognizes that a healthy diet is a source of vitality, when somebody has cancer she finds herself needing to be very pragmatic.
For the most part, the best she can do is make sure the patient stays hydrated, stays at a stable weight, and is not experiencing horrible symptoms. Everything else is gravy (sometimes it is actually gravy.)