Head & Neck

Learning with Lillie…About Nutrition

By Lillie D. Shockney, RN, BS, MAS, ONN-CG; University Distinguished Service Professor of Breast Cancer; Professor of Surgery and Oncology, Johns Hopkins University School of Medicine; former director of cancer survivorship programs at Johns Hopkins.

Lillie D. Shockney is an active clinical researcher with a focus on quality of life issues for survivors. She is also a two-time breast cancer survivor. Her own experiences, combined with her caring approach, sense of humor and genuine concern for her patients, make her uniquely qualified to help others navigate the nuances of diagnosis, treatment and survivorship. She has written 16 books and more than 300 articles on the subject of cancer survivorship, quality of life, coping with side effects, navigation, breast cancer and metastatic disease.

 

After my patients get past the initial shock of learning they have cancer, and we have discussed what treatment will likely look like going forward, I turn the discussion to nutrition. Nutrition becomes even more important during cancer treatment and into survivorship. Once patients understand why, they are on board 100 percent to do what they can to help themselves. It’s a welcome shift from discussing treatment, and it’s empowering because, in general, they have control over what they eat. At times like that, it’s nice to feel in control of something.

I start by asking about the type of diet they followed earlier. People who may not have had the best nutrition usually ask if their eating habits caused their cancer. I assure them that a specific nutrition choice didn’t cause it. If they have concerns about their past nutrition, I encourage them to get rid of that guilt, forget about it and think about embracing the life that we plan to save. You cannot undo the past but you can get onto a healthier path going forward. Mark Twain has a wonderfully appropriate quote that sums it up: “Tomorrow is a new day with no mistakes in it.”

Then, we discuss the foods and habits they should strive for. Some people are surprised to hear there isn’t a “cancer diet” to follow that will prevent cancer or make treatment work better. It’s all about adopting an overall healthy nutrition lifestyle.

Some people with head and neck cancer may need a feeding tube for a period of time. What goes into the feeding tube is not food as we know it but a nutritional mixture to maintain strength and get the right nutrients needed to continue the healing process. During this time, dental care is still very much needed and shouldn’t be forgotten. There can be a tendency to assume if nothing is going into the mouth that the teeth and gums are fine if left alone; they are not. Brushing, flossing and caring for gums remains a priority.

Others may face challenges with the types of food they can eat. I share ways they can position themselves for better health.

  • Eat a low-fat diet. Try for 30 grams or less a day.
  • Make the plate colorful. Aim for far less white foods and a lot more orange and green ones. Liquid nutrition, in the form of soups and smoothies, may be the foundation of the diet for some time. Make them a rich source of nutrients by blending in leafy greens, milk or non-dairy options, protein powders, fruits and juices.
  • Keep a glass of water handy during mealtime to make swallowing easier. Water is one of your best friends.
  • Revisit meal times and portion sizes. Breakfast should be the biggest meal of the day, and dinner should be the smallest.
  • Prepare for dining out. One of the ways we celebrate and socialize with family and friends is over a meal. This meal might be at a restaurant. Look online at the menu and preselect your food choices. Request, if needed, to have half served to you and the other half in a take home container. If swallowing is difficult, request that your server keep your water glass full at all times. Don’t miss the joy of socializing due to anxiety about eating in public. If you have a feeding tube, consider joining the group at the end of the meal.

If lack of appetite is an issue, people should tell their doctor because it’s important to understand the cause. Appetite stimulants usually have great results, and their doctor will suggest alternate ways to get nutrition, if necessary.

We discuss roadblocks they may face along the way and how to deal with them. Well-meaning friends and family will undoubtedly show up with unhealthy comfort food or crunchy foods that can’t be eaten during head and neck cancer treatment. A good strategy is to get ahead of those visits by offering suggestions to others about the types of foods they can bring over. People want to help, and knowing that they’re bringing something that goes along with the treatment plan will make them feel even better.

Keeping up healthy habits into survivorship is essential, and it should be part of the survivorship care plan.

Eating well and practicing good dental care helps you take an active role in your own care. Remember, you’re not alone. Ask your dietitian for assistance. If there isn’t one on staff with your health care team, ask for resources available to help you adopt a healthy and nutritious lifestyle.

 

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