Diagnosis cancer. This is bad for those affected and their relatives. Therapy is often stressful and exhausting. Some patients may find it good to lose a few kilos. "Cancer is often accompanied by a reduced appetite and unwanted weight loss," says Andrea Jaworek, head of the nutrition team at Klinikum rechts der Isar. Stop! Don’t lose weight! Cancer patients need their strength in the fight against cancer. A stable weight alleviates the side effects of chemotherapy or radiotherapy and maintains the quality of life and performance. With an optimally adapted diet, the immune system can work better, cancer patients have more energy and spend less time in the hospital. "The main goal of nutrition in cancer is to provide the body with sufficient energy and nutrients, to alleviate discomfort and to maintain quality of life to a large extent," summarizes Andrea Jaworek. Under the medical supervision of Prof. Marc Martignoni and Dr. Alexander von Werder, Andrea Jaworek and her nutrition team care for around 1,000 cancer patients a year at the Klinikum rechts der Isar.
Andrea Jaworek, head of the nutrition team at Klinikum rechts der Isar.
Avoid malnutrition in cancer at all costs
Some types of cancer, therapies and drugs, z.B. in the case of breast cancer, can lead to weight gain. But the majority of cancers are accompanied by unintentional weight loss if they are not counteracted. The tumor alters the metabolism and weakens the body. The risk of malnutrition is high. This often occurs even before the actual diagnosis. Malnutrition is when a person unintentionally loses at least five percent of their body weight within three to six months. At a weight of 80 kilos, that’s only four kilos. Many patients are happy if they lose weight along the way. But it is also an alarm sign in cases of overweight.
"Working at a university hospital means that we see a lot of severe cases and also rare diagnoses," says Andrea Jaworek. Proper nutrition is particularly tricky for patients* with tumors in the gastrointestinal tract. For these patients*, the physical and psychological stress is particularly high, especially after a serious operation where z.B. large parts of the intestine, stomach or esophagus had to be removed. In order to restore their quality of life and their enjoyment of food, nutritional therapy is a very important pillar of treatment. "Every person has a different need and different requirements," Jaworek emphasizes. Diet must be individualized, depending on diagnosis, age, energy needs and personal food preferences.
The interdisciplinary nutrition team advises inpatients, day patients and outpatients at the Klinikum rechts der Isar on nutrition-related diseases and illnesses that result in nutritional problems, z.B. with gastro-intestinal illnesses, pancreas illnesses or different cancer types. Nutrition is an important pillar of therapy for patients. The goal is to improve or maintain nutritional status, reduce symptoms such as nausea or digestive complaints, and ensure quality of life.
Special case: stomach cancer, esophageal cancer and colon cancer
"Must z.B. the stomach is removed when stomach cancer is diagnosed, in technical language this is called gastrectomy, the small intestine is connected directly to the esophagus," explains the head of nutritional counseling. With far-reaching consequences: Normally, the stomach passes the pre-digested food pulp in small quantities to the small intestine. Now this natural reservoir function is missing. The denaturation of proteins by gastric acid also no longer takes place. If esophageal cancer is diagnosed, the esophagus may have to be removed in whole or in part, depending on the tumor. The stomach is then reshaped into a narrow substitute esophagus and pulled upward. The removal of parts of the intestine also has serious consequences for food intake and digestion. "The intestine is responsible for nutrient absorption with different functions depending on the section. Some sufferers have to inject themselves with certain nutrients because they lack the special section of the intestine needed for natural absorption," explains Andrea Jaworek.
Patients with gastroenterological cancers have to struggle particularly hard with nausea, loss of appetite, diarrhea, vomiting, changes in taste, and chewing and swallowing difficulties. They often can no longer tolerate foods that are difficult to digest, such as legumes and whole grain products, as well as breaded and fried foods. "It is very difficult for these patients to meet their daily energy needs at all. Especially since the calorie requirement can be increased in cancer. One calculates, depending upon activity with approx. 30-35 kcal per kilo of body weight, which is 2100-2450 kcal at 70 kilos," says Andrea Jaworek. It’s also hard to accept psychologically that it’s suddenly over after half a pretzel, when before the illness, hunger was easily enough for a three-course meal.
- Many small portions, about five to six meals a day
- Enrich healthy foods high in calories with cream, butter or oil
- Eat meals high in calories and protein, if appropriate. Use drinking food as a supplement
- Eating in a nice ambience / in company
- Arrange food nicely on large plates
- Quickly available, tasty meals at hand
- Immediately pursue the desire to eat
- Try different consistencies and temperatures
Add high caloric value to healthy foods
"We advise our patients to eat at least five to six small meals a day. It is ideal if they enrich healthy foods with cream, butter or oil," explains the nutritionist. The extra shot of cream in the soup is wanted from now on, as is the cream yogurt or the casserole generously topped with cheese. Those who can no longer eat a whole slice of bread should spread more butter on half the bread in order to reach their calorie requirement.