Written by Foteini Konstantinou, clinical biologist, Dr of Naturopathic Medicine (Canada), specialized in the treatment of cancer patients.
“Let food be thy Medicine, and let Medicine be thy food”
Hippocrates, 460-370 BC
How often have we heard this phrase? And yet how often do we put it to daily use?
There was a reason Hippocrates made such a bold statement, he could see relationships between food and disease states. Today, we can go one step further, we can say that we know in cancer, that diet is responsible for about 20% of cases. We can now even discuss the process that nutrition plays on pathogenesis. We can even talk about genetics and how food influences our genes.
Food is information to every single cell in your body, so you want to ensure that you provide the best information possible. It is the foundation of health.
Food as medicine is not a quick fix. The protective effects of food take effect after long periods of time, it is not a Depon/ Aspirin that you swallow and miraculously, 20 minutes later, your pain is thankfully gone. No, nutrition influences health over long periods of time…every day acting on every single cell in your body, over hours, days and years.
Fortunately, we live in a country where the ideal diet is easy to achieve. The ‘original’ Mediterranean diet – one which is based on WHOLE PLANT foods (and no, the tomato piece in your souvlaki does not count BUT your yiayia’s plate of lentils does) has been shown over and over to provide protection against disease; which disease? Just about every disease.
The complex interactions of phytochemicals, anti-oxidants, phytates and other compounds in whole plant based foods act together synergistically to protect you against:
- inflammation (protection against promotion cancer)
- improve insulin sensitivity (minimize risk of diabetes)
- resist oxidation (protection against cancer and auto immune disease)
- protect your genes (1 cup of berries will activate over 200 genes that protect you against cancer), therefore, eat your fruit!
- improve your immune functioning
- target stem cells (broccoli’s active ingredient Sulphoraphane targets cancer stem cells)
- decrease your blood pressure (celery and flax seeds are very good at doing this)
- decrease your cholesterol
- and increase your telomeres (protection of DNA against damage which may promote cancer)
There is no drug that can do all of this, there is no supplement or vitamin pill that can replace good nutrition.
Because cancer development is such an extended process—it can take decades to grow, you need cancer preventive agents that you can take long-term, like you would in your diet, and the Mediterranean diet is full of these protective phytochemical agents. Your health is in your control to a large degree. FOOD IS POWERFUL, make sure every bite counts.
Written by Kanella Kousiouri, medical resident in the A' ENT University Clinic “Hippocratio”, candidate Doctor of National and Kapodistrian University of Athens.
As malnutrition we define the condition which is the result of deficiency in food’s intake and absorption. This leads to loss of our body’s muscle mass and fat composition.
Malnutrition adversely affects the patient’s physical and mental condition and deteriorates the clinical result concerning his disease.
Cancer patients display a higher rate of malnutrition compared to general population due to their disease and treatment.
The prevalence rate of malnutrition to cancer patients fluctuates from 20 to 70%, according to international studies, with differences related to patient’s age, type and stages of cancer.
Patients with gastrointestinal, head and neck, liver and lung cancer display really high rates of malnutrition. It is estimated that from all patients’ deaths, about 10-20% is attributed to malnutrition rather that malignancy. That’s why nutrition plays a crucial role and ιs included in the interdisciplinary approach of a cancer patient.
It is ascertained that cancer patients’ negative energy balance and loss of skeletal mass originate from a combination of reduced intake of food and metabolic changes (higher catabolism, endurance in insulin, lipolysis, proteolysis).
Quality of life
Apart from the symptoms related to the reduced intake of food and weight loss, cancer patients also mention symptoms such as reduced physical activity, tiredness, pain and depression. These symptoms are associated with poor quality of life and reduced life expectancy mostly for patients of an advanced cancer stage. According to researches, there is an association between symptoms and systematic presence of inflammation, as well as immunological patient’s response.
The interdisciplinary approach and support of a cancer patient is going to contribute to the reduced danger of the disease appearance and impacts of malnutrition.
 Ferlay J, Shin HR, Bray F, Forman D, Mathers C, ParkinDM.Estimates of worldwide burden of cancer in 2008: GLOBOCAN2008. Int J Cancer 2010;127:2893–917.
 Pressoir M, Desne S, Berchery D, Rossignol G, Poiree B, Meslier M, et al.Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 2010;102:966e71.
 Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 2016;57:58–67. http://dx.doi.org/10.1634/ theoncologist.2016-0066.
 Laird BJ, Fallon M, Hjermstad MJ, Tuck S, Kaasa S, Klepstad P, et al. Quality of life in patients with advanced cancer: differential association with performance status and systemic inflammatory response. J ClinOncol 2016;34:2769e75.
Written by Sofia Paspaliari, dietologist – dietician, MSc in Clinical Diet, Charokopio University, supervisor of Diet Department, Hippocratio Hospital
Malnutrition is defined by a noticeable weight loss, at least 10% the last six months.
Head and neck cancer and its role in malnutrition
There is a high risk of malnutrition in patients with head and neck cancer
Both the head and the neck play a crucial role in the process of digestion because they permit food’s transition to mouth and stomach.
The nature of the head and neck cancer in conjunction with multiple treatments (chemotherapy, radiotherapy, surgery) as well as the main dental processes in the oral cavity before the treatment, could negatively affect this procedure contributing to the appearance of malnutrition. The poor nutritional habits and the way of living of patients with head and neck cancer could also deteriorate the problem significantly.
Nowadays, the patients with head and neck cancer can possibly be overweight or obese at their first appointment with the doctor but there is still a high risk of malnutrition if they have had significant weight loss during the last period of time.
The percentage of malnutrition, early from the first diagnosis, to these patients, fluctuates from 30% to 90%.
Impacts and problems related to malnutrition in head and neck cancer
Malnutrition leads to a wide range of problems for patients with head and neck cancer. For example it can lead to complications (infections), reduced response to the treatment, treatment interruptions, unplanned admissions to the hospital, increased time of hospitalization, reduced quality of life and increased mortality.
In addition, according to the guidelines, if a patient suffers from malnutrition, the surgery should be postponed up to 14 days in order to make sure that his diet is appropriately supported.
Nutritional support for malnutrition cases
The main goal of nutritional intervention for patients with head and neck cancer is to deal with malnutrition and other nutritional symptoms.
The common symptoms, which are observed, include mucositis, mouth sores, pain or difficulty in swallowing, dry mouth, thick saliva and a lot of discharges, changes in taste and/or sense of smell, nausea and/or vomit, constipation as well as reduced appetite. All the above, can lead to a reduced intake of food and unintentional weight loss.
The nutritional consultancy aimed at the personal needs of patients with head and neck cancer, during the radiotherapy and chemo-radiotherapy, has positive effect on nutritional intake, nutritional condition, side effects of the treatment and patient’s quality of life.
Types of diet
For the nutritional support of the person, the dietician can suggest a change in food’s composition, according to the needs. As a result, he can suggest one of the following types of diet:
- Soft diet
- Pulped diet
- Full liquid diet.
For example, someone can proceed from a full liquid diet to a pulped diet, if it is tolerable.
If there are problems related to the maintenance of an appropriate diet, the dietician can suggest the transition to another diet which is going to include nutritional supplements.
There are liquids with different fluidity which can be suggested if there is a safety problem in swallowing. This is usually determined by a speech therapist.
In case of a difficulty in maintaining an appropriate diet, the dietician can suggest the addition of supplements in patient’s everyday life. There is a variety of products which provide people with nutritious ingredients and energy in a small amount of food and liquid. Some well-known supplements include protein powder which can be added in milkshakes or smoothies and liquid products which are high in proteins and calories.
Food supplementation with feeding tube
Patients, who can’t cover their estimated nutritional needs from their mouth for a prolonged period due to the side effects of cancer and its treatments, may need artificial nutritional support. The most common evidence for artificial nutritional support is dysphagia.
There are a lot of types of tubes which can be placed and the most suitable is going to be determined. These tubes can be permanent or temporary. The best penetration of intestinal nutritional support can be achieved via a gastrostomy tube, if the patient still has a functional gastrointestinal tube.
Some patients with head and neck cancer can simultaneously use a feeding tube while consuming soft food and liquids from their mouth. Liquids are suggested because they can be spilled via tube to stomach- usually, either via a pump or manually. This liquid diet is going to replace the nutritious ingredients which can’t be covered by oral intake throughout the period need. With the above modern alimentation, a sense of a natural alimentation is provided to the patient while a partial function of swallowing is maintained and helps the prevention from muscle atrophy.
Observation after the treatment
When the treatment is completed, patients start a new journey of rehabilitation and return to normal eating habits.
The transition from feeding tube to liquid diet and solids can be a time consuming procedure with challenges. The help of a speech therapist and pathologist is essential in order to determine which food is essential for the patient, as far as his readiness for swallowing is concerned.
The transition to a normal diet starts with liquids. The patients often use a supplement for their nutritional reinforcement some weeks after the end of the treatment. After that, they proceed to soft and liquid diet. They are also encouraged to consume food according to their preferences.
Generally speaking, the alimentation via the feeding tube shouldn’t be interrupted before a specific point: The patient should be able to cover at least 75% of the estimated needs only via oral intake.
The feeding tubes shouldn’t be removed before the proven stabilization phase of weight and the sufficient oral intake.
The duration of the dependence usually has to do with the severity and duration of dysphagia. Approximately 10% of patients are going to need permanent intestinal diet due to the prolonged dysphagia. Risk factors for long term intestinal nutrition include growing tumors, poor function of swallowing before the treatment or type of treatment.
To the majority of patients, a lot of nutritional problems seem to insist after the end of the treatment. The pain and the difficulty in chewing torture a lot of patients even after six months, while having a strong impact on oral intake.
- A prompt diagnosis of malnutrition risk or the appearance of malnutrition play a crucial role.
- The early and appropriate intervention can reduce the malnutrition rate as well as the weight loss.
- The specialized dieticians can work with patients for the improvement of their nutritional intake and the handling of side effects in parallel to medical management from oncologists and nurses.
Written by Maria Kristaki, nurse in the Department of bone marrow transplantation, Children’s Oncology Clinic “Elpida”, “Agia Sofia” Pedon Hospital
Neutropenic patients are vulnerable to infections
The antineoplastic medicines attack the cancer cells and simultaneously hit the normal ones such as the components of blood: hemoglobin, platelets, white blood cells and other cells such as epithelial cells of mucous membrane, mostly mouth’s and gastrointestinal tube’s as well as the hair follicle.
An abnormally low level of neutrophils (white blood cells) in the blood make the patients vulnerable to infections from bacteria, viruses, funguses and protozoon.
Food may be the cause of infection for these patients. Things get worse if there is a co-existence of mucositis (stomatitis, enteritis).
During the previous years, the diet rules for neutropenic patients were stricter. Today, after the multiannual experience in care of immunosuppressed patients, a safe diet, low in bacteria focuses more on following basic rules of hygiene during the handling, preparation and storage of meals and less on exclusion of specific types of foods.
A few rules to make your diet safer, as far as the microbes are concerned:
- Choose shops that are considered trustworthy and you have already checked that they follow basic principles of hygiene and sanitation.
- Choose foods from the fridge that are found in the lower shelves and at the back, so as to maintain low temperature.
- Buy the foods that need to be kept in the fridge when you have already completed the other purchases and place them in your fridge as soon as possible (within 15-20 minutes). During the summer period you may need to carry the foods in an isotherm bag with ice packs.
- Place a priori in your trolley or basket different plastic bags for different foods such as: fruits, vegetables, raw meat and fish and other foods.
- Meticulously wash and dry your hands before you prepare your food and during the preparation, specifically when you touch raw meat, chicken, fish and raw vegetables.
- In the kitchen, carefully clean any residues of liquids and blood of raw meat and chicken or eggs, from surfaces or utensils by using paper towels instead of towels or sponges.
- Use different cutting boards for raw meat, fresh vegetables or other types of cooked food.
- Maintain raw foods such as meat, fish, eggs and vegetables in different parts of the fridge and in packages. Keep them separately from other cooked foods.
- Wash fruits with running water before you place them in your fridge. On the contrary, you shouldn’t wash eggs because their membrane is going to be removed from their surface. You should place them in the fridge with their package.
- Cook well meat, fish and eggs and for a long time.
- Avoid fresh vegetables such as lettuce, cabbage and fruits without skin (strawberries), raw nuts and cheese of Roquefort type.
- All the boiled vegetables are safe as well as the roasted nuts.
- Avoid water directly from a well or a water spring.
- The fresh cooked food shouldn’t be out of the fridge for more than two hours and the rewarmed food for more than half an hour.
- Don’t protect the cooked food in your fridge for more than two days. When you rewarm it make sure that the temperature is at least 60Ο A food which has already been rewarmed once should be thrown away. In other words, we should keep the warm foods, warm and the cool foods, cool.
- If you use a microwave oven, you should stir the food in order to rewarm all its parts at least at 60Ο
- Don’t defrost frozen foods at room temperature. Defrost them in the fridge from the previous day or in the microwave oven during the same day.
- Avoid “junk food“ such as cheese pies or foods from restaurants. If you go to a restaurant choose a fresh cooked meal rather than a precooked one.
- Don’t share food with your family members from the same plate.
- If a family member suffers from viral gastroenteritis, he/she should use and separately wash different plates and eating utensils.