Nutrition Surveillance and Counselling for Cancer Survivors
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The document discusses the importance of nutritional surveillance and counselling for cancer survivors from diagnosis through survivorship to improve outcomes. It emphasizes performing regular nutritional assessments to identify deficiencies, excess weight, and diet quality issues in survivors. The role of nutrition in cancer prevention, treatment side effects, and chronic disease prevention is also examined.
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Nutrition Surveillance and Counselling for Cancer Survivors
- 1. Nutrition Surveillance and counselling for cancer survivors Dr Paul C Rogers BC Children's Hospital & University of British Columbia Vancouver, Canada
- 2. Survivors
- 4. Objectives • Nutrition from a cancer control perspective • The importance of continuous longitudinal nutritional assessment from diagnosis through survivorship • ABCDs of nutritional assessment • The role of nutrition on the well being of cancer survivors
- 5. Objectives • Prevention: The role of nutrition in cancer and chronic disease prevention • Counselling survivors on importance of good nutrition • Incorporating nutritional research in survivorship research • Nutrition from a cancer control perspective – a modifiable prognostic factor
- 6. Cancer Control & Nutrition • Prevention • Epidemiology • Biology • Therapy • Supportive care • Therapy of toxicity • Psychology • Delayed effects • Survivorship • Palliative Care
- 7. Survivors Nutritional Surveillance, Education & Counselling • Obesity • Underweight • Quality of Life (QOL) • Long term sequelae of disease and treatment- • Cancer & Chronic Disease Prevention
- 8. Nutritional Deficiencies/Insufficiencies or Excess Calories Cause Pathology • Growth- stunting • Cognitive impairment • Impaired physiology • Organ dysfunction • Immunity-Increased risk of infections • Micronutrients- specific pathologies • Obesity & Comorbidities
- 9. Nutritional Assessment in Survivors • Should be a routine evaluation at long-term follow up clinics • ABCDs of assessment Anthropometric Biochemical Clinical Dietary
- 10. Anthropometric measurements • Height • Weight • BMI • Waist circumference, Waist/Height ratio • MUAC (Muscle) • TSF (Fat)
- 11. Anthropometric Body Composition- sarcopenic Obesity • DEXA Scan (Fat , muscle & bone) • Bioelectrical impedance • CAT scans
- 12. Biochemical • Visceral protein – affected by infection, over-hydration, renal/hepatic function, decreased synthesis, & protein in diet – Serum albumin (half life of 20 days) – Serum pre-albumin (half life of 3-4 days) • Specific vitamin and mineral levels (Micronutrients)
- 13. Clinical • Physical examination • Signs of protein and/or calorie deficit • Signs of micronutrient deficit Hair Skin Mouth Eyes Bones
- 14. Dietary • Nutritional intake : Macro intake of calories & protein Micronutrient intake • Dietary History- Quantity & Quality of nutrition (HEI) • Nutritional diary for those at risk • The need of RD in LTFU clinics
- 15. Nutritional intake of CCS • 80% of young CCS had an inadequate intake of fruit and vegetables • 50% have excessive energy intake (HIC) • Up to 95% have inadequate Vitamin D intake • Deficiency in micronutrients:B6, B12, Folate, Vit A, Vit E, iron, Cu, iodine, selenium • Poor dietary habits continue into adulthood • Low HEI scores Ref: Zhang 2016, Cohen 2020
- 16. Vitamin D Status: Proposal for Definitions Measurement of vitamin D status 0 20 40 60 80 100 120 Deficiency Insufficiency Optimal Serum 25(OH)D nmol/L Figure 2: Relationship between serum 25(OH)D levels and vitamin D status. Vitamin D insufficiency has not yet been defined but resides between deficiency and optimal status.
- 17. Utilising 50 nmol/l as the cut-off globally, it has been estimated that over 1 billion people would be classified as being vitamin D deficient
- 18. Obesity • Prevalence Overweight or Obese in 40-50% of CCS • Sarcopenic obesity • Obesity: increase prevalence of adult cancer • Obesity: results in poorer prognosis of cancers
- 19. Obesity • Increased cardiac mortality & morbidity – Cardiovascular – Metabolic syndrome – Blood sugar, hypertension, visceral fat, cholesterol • Type 2 Diabetes • Diminished QOL, depression & anxiety • Obesity in childhood and adolescence is the strongest predictor of obesity in adulthood
- 20. Prevalence of obesity in survivors of childhood ALL in studies using BMI
- 21. Adverse Effect of Obesity on OS and EFS in ALL 35% reduction of event free survival Am J Clin Nutr. 2016 Mar;103(3):808-17
- 22. Prevention through Nutrition • Cancer prevention • Chronic disease prevention • Primary prevention • Secondary prevention
- 23. Why consider diet? • Epidemiologic Studies – Doll and Peto ( JNCI 1981)- 35% of adult cancer risk was attributed to diet alone
- 24. Selected Cancers Related to Dietary Factors Cancer Estimated percent attributed to dietary factors Breast 33-50% Prostate 10-20% Stomach 66-75% Colorectal 66-75% All Cancers 30-40% Source: Young and Le Leu (2002)
- 25. Primary Prevention- Nutrition • Prevention of obesity Optimal physiological health Optimal macro and micronutrient intake. • Treatment of obesity • The influence of nutrition on epigenetic changes that may upregulate or down regulate genes relevant to cancer development: Bioactive foods
- 26. Nutrigenomics and Nutrigenetics • For personalized nutrition: • effects of diet on body- metabolism • influence of genotype on nutritionally related diseases Mutch, FASEB 2005
- 27. Bioactive Food Components N U T R I G E N O M I C S Nutrigenetics Nutritional Epigenetics Nutritional Transcriptomics Proteomics Metabolomics DNA RNA Protein Metabolite Phenotype Trujillo, E. et al. J Am Diet Assoc. 2006 Mar;106(3):403-13.
- 28. Disruption of Gene Function in Cancer DNA Mutations Gene Deletions Chromosome rearrangements Hypermethylation of CpG islands Hypomethylation bulk genomic DNA and transposons Increased expression of DNMT GENE FUNCTION IN CANCER Epigenetic alterations Genetic alterations
- 29. Mechanisms • Evidence indicates that aberrant methylation patterns are involved in cancer • Disturbances during early development in methylation of imprinted genes can predispose individuals to cancer • Folate is a necessary nutrient in the DNA methylation process • Evidence indicates that folate can modulate genome-wide methylation levels
- 30. Epidemiology-Prenatal Multivitamins with Folic Acid • Meta Analysis-seven studies • 47% protective effect for neuroblastoma • 39% for leukemia • 27% for CNS tumors Goh YI et al. Clinical Pharmacology & Therapeutics 81, 2007; 81:685-91.
- 31. LTR Hypomethylated LTR Hypermethylated Maternal Supplements With zinc methionine choline folate B12 Yellow Mouse Agouti Mouse •High risk cancer, diabetes, obesity •Reduced lifespan •Lower risk of cancer, diabetes, obesity • Prolonged life Cooney et al. (2002) J Nutr. 132:2393S
- 32. Epigenetics • “You are what you eat” • “You are what your mother ate”
- 33. Secondary Prevention-Screening • Family history of cancers : Screening e.g. colorectal cancers • Dietary history that places a survivor at risk for cancer and other chronic diseases • Evaluation of micronutrient intake and status e.g. Vit D • Other risk factors related to secondary malignancies
- 34. Survivors
- 35. Nutritional Counselling of Survivors • Risk taking • Activity • Nutrition • Understand food components that improve health or that which is detrimental to health • Guidelines of WCRF/other nutrition resources • Involve family and/or partners in interventions • Follow up !!
- 36. Prevention
- 46. Microbiome / Microbiota • Increased understanding of its importance • Role in cancer pathogenesis and other comorbidities especially GI disorders • Role of prebiotics and probiotics
- 47. Conclusions • Nutritional assessment and counselling should be a fundamental component of long-term follow up (LTFU) of cancer survivors of paediatric and adolescent cancer • Potential impact on improving QOL • Potential impact on ameliorating some long- term side effects of cancer therapies
- 48. Conclusions • Potential impact of nutrition on prevention of adult cancers and other non communicable chronic diseases • Nutrition is relevant to all aspects of CANCER CONTROL • Research should be imbedded into LTFU when possible
- 49. Acknowledgements/ Publications • SIOP Nutrition Network • Pediatric Blood & Cancer (PBC) Nutritional Supplement: Volume 67, Issue S3, June 2020 Nutritional Concerns of Survivors of Childhood Cancer: A “First World” Perspective Jennifer Cohen, Laura Collins, Laura Gregerson, Joya Chandra Richard J Cohn • JNCI Monographs: Obesity and Pediatric Malignancies: Issue 54 September 2019
- 51. It's bizarre that the produce manager is more important to my children's health than the pediatrician Meryl Streep
- 52. Contacts Nutritional Network • Paul Rogers progers@cw.bc.ca • Ronnie Barr rbarr@mcmaster.ca • Maya Prasad maya.prasad@gmail.com • Karina Viani ka_viani@yahoo.com.br • Ligia Fu Carrasco ligiafucarrasco@yahoo.com • Erin Gordon erin.Gordon@childrens.Harvard.edu • Wim Tissing W.J.E.Tissing@prinsesmaximumacentrum.nl • Elena Ladas edj14@cumc.Columbia.edu
- 53. Canadian Cancer Survivor Network Contact Info 1750 Courtwood Crescent, Suite 210 Ottawa, ON K2C 2B5 Telephone / Téléphone : 613-898-1871 E-mail: jmanthorne@survivornet.ca or info@survivornet.ca Website: www.survivornet.ca Twitter: @survivornetca Facebook: www.facebook.com/CanadianSurvivorNet Instagram: @survivornet_ca Pinterest: http://pinterest.com/survivornetwork/