How should nutrition and diet be in patients with hematological cancer?

The importance of nutrition in cancer treatment has been better understood with each passing day. Saying that one of the first few questions that patients usually ask after diagnosis is ‘what should I eat now, how should I eat’, Assist. from Eskişehir Osmangazi University Faculty of Medicine Adult Hematology Department. Assoc. Dr. Neslihan Andıç, Ankara Representative of Medical Academy and ONCOLife on nutrition in cancer patients and diets applied in patients with hematological cancer Hatice PALA KAYAAnswered the questions of…

What are the general nutritional problems during the treatment of hematological cancers?

Assist. Assoc. Dr. ANDIC: Our patients are generally those with compromised immune systems, which can easily become infected. They need to be fed with clean food. In addition, mouth and throat sores are common and make eating painful. Intestinal infections, diarrhea or constipation can disrupt food intake. Many drug treatments cause nausea, vomiting and loss of appetite. In addition, special diets should be applied for those who have esophagus, stomach, bowel surgery or those whose organs are affected by radiation therapy. Anxiety about the treatment and illness of the patients and the state of depression are also an important problem. Finally, who helps with nutrition, that is, who prepares and serves the food, is also important. A knowledgeable and dedicated caregiver is very helpful in this regard.

In cancer treatment, patient and ‘target-oriented’ nutrition regime should be applied.

What information about nutrition do patients with hematologic cancer need most?

Assist. Assoc. Dr. ANDIC: One of the first few questions that our patients usually ask after diagnosis is what should I eat and how should I eat. They are asked about the type of food, its preparation, and whether there are foods that can affect cancer treatments positively or negatively.

What is clean food, what is its importance for cancer patients?

Assist. Assoc. Dr. ANDIC: It means a low microbe diet. All patients, especially those with low neutrophil counts, should be fed this way. Raw meat should never come into contact with cooked meat. Here the knife and cutting board should be separate. Hands should be washed thoroughly after touching raw meat. Meat and eggs must be very well cooked. Milk and dairy products must be pasteurized. These should be stored in small portions. It shouldn’t sit in the fridge for a few days. Meals should be cooked quickly, either in a pressure cooker, in a preheated oven, or cooked in boiling water. Cooked food should not stay at room temperature for more than 2 hours. Small portions should be placed in the closet as soon as possible.

When it comes out of the fridge and is eaten, it should be eaten by boiling again or by heating it very well. Frozen foods should be thawed in the refrigerator, not at room temperature. If foods such as bread and pastries are to be purchased from outside, vacuum packed ones should be preferred. Nuts sold in the open should not be eaten. Even if it is packaged, especially the ones without shell should be preferred. Hard fruits that can be peeled from fruits should be preferred.

For example; apples but not grapes. No raw vegetables and fruits are recommended for patients with very low neutrophil counts (below 1500). For these patients, drinking and brushing water must have passed through a filter that can filter ≥1µ particles either from bottled water or at home. Beverages with added ice from outside should not be drunk. Moldy foods should not be eaten, even hands should not be touched.

Could you tell us about the other diets you follow in patients with hematological cancer?

Assist. Assoc. Dr. ANDIC: Different diets can be given according to the needs of the patients. If nausea-vomiting is at the forefront, it is necessary not to force the patient until the vomiting is over; It should be ensured that he takes fluids little and often, and solid foods should be tried gradually if he can take the liquid. Fragrance-free foods should be preferred. We do not recommend starting with the patient’s favorite food so that he does not associate vomiting with this food in the future.

Foods that relax the stomach should be tried at the forefront for these patients. Examples of these are: Foods that are not very cold or hot, soups (beans, beans, etc.) pea, broccoli, no cabbage), boiled potatoes without skin, meats without oil – boiled without skin, plain pasta, noodles, eggs, cheese, saltine crackers – biscuits, white bread-toast, rice, yoghurt can be given. If the patient has a mouth ulcer, it is appropriate to cook the food until it is very soft, eat it as a puree, drink the liquids with a straw, use a baby spoon and not give hot, bitter, sour, salty, tomato paste, tomato and hard foods.

Nutritional mistakes made during cancer treatment harm patients

If he has diarrhea, he can drink carbonated drinks and drink sports drinks. Broth soup with broth meets the need for sodium, potatoes and bananas are sources of potassium. Low-fiber foods (yogurt, white bread, white rice, cooked carrots, chicken, eggs, saltine crackers) should be preferred. In case of constipation, it is recommended to drink plenty of fluids, drink hot drinks after meals, and consume high-fiber foods (whole wheat bread, wholemeal foods, pasta, apples, corn, cabbage, peas, spinach).

Patients with hematological cancer and bone marrow transplant patients especially need a protein-rich diet. In order to make foods rich in protein, it is appropriate to grate cheese on top of it, to cook it with milk instead of water, to add eggs, to cook dishes and soups with meat. Protein powders can also be added to foods. If the patient has difficulty in taking these foods orally, there are ready-made mixtures produced in a balanced way. These can be drunk or given with the help of a tube to be released from the nose to the stomach if the patient is unconscious. In addition, if there is a situation where the gastrointestinal tract cannot be used or should not be used, nutrition can be provided completely through the vein.

How do nutritional problems seen in patients during treatment affect their treatment processes and quality of life?

Assist. Assoc. Dr. ANDIC: There is no doubt that providing nutritional support improves the patient’s quality of life. Our stomach and intestines are important parts of our immune system. There is strong evidence that oral nutrition reduces the risk of infection. Therefore, oral feeding should be supported as much as possible. It is necessary to remind that there will be some special food-drug interactions during the treatment process. For example; Mercaptopurine should not be taken with milk and dairy products, grapefruit juice increases tacrolimus and sirolimus levels.

Proper nutrition in cancer treatment improves chances of survival

Yoghurt is recommended, but other probiotics-fermented products known to improve intestinal flora are inconvenient in patients with very low white blood cell count; bowel infection—and can lead to serious blood infections. Existing studies have not shown that a particular diet accelerates cancer recovery or increases treatment success. Improving nutrition helps patients get through this difficult process more easily. Apart from this, it would not be appropriate to create an expectation that it will cure cancer.




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