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Nutrition Knowledge Gaps Matter for Older Cancer Patients

Nutrition for older cancer patients

Experts note people who aren’t able to meet their nutrition needs during cancer treatment have worse side effects and decreased survival compared to well-nourished patients.

These nutritional challenges may be of particular concern for older patients.

Because a mesothelioma diagnosis often comes at an older age, it is especially important that dietary goals be a part of every treatment plan.

Experts don’t yet have all the answers on how to address older individuals’ nutritional challenges during cancer treatment.

But they do know ignoring the problem can harm patients and worsen outcomes.

Weight Loss Not Helpful

If you’re like a lot of people, you may carry a few extra pounds. After a mesothelioma diagnosis, it may seem like a blessing in disguise to be able to lose weight without trying.

However, cancer places stress on the body, and weight loss will make you feel worse, not better.

Research demonstrates people who lose weight during treatment tend to lose muscle, not fat. This can worsen fatigue and weakness.

The body also may draw on other important tissues for energy, including red and white blood cells and platelets.

Studies show weight loss can lead to worsened treatment toxicities, decreased immune function and a harder time recovering after therapy.

Malnutrition More Common Among Older Cancer Patients

A 2016 paper published in the Journal of Geriatric Oncology highlighted how the combination of older age and a cancer diagnosis may increase the risk of malnutrition far more than either of these factors on its own.

According to the experts, malnutrition is underdiagnosed in older individuals, because there is no agreed-upon definition of what malnutrition looks like in older adults and most patients are not screened for it at regular doctor visits.

Combine this with recent findings presented at the June 2018 American Society of Clinical Oncology Annual Conference, and it is clear why malnutrition matters for mesothelioma patients.

In a study of lung cancer patients receiving cutting-edge cancer therapies, patients who were in the obese category did better.

“Underweight BMI is associated with shorter OS [overall survival] and obese BMI is associated with longer OS,” the authors wrote.

Many Side Effects of Cancer Treatment

Cancer specialists recommend the health care team always ask about and address each of the following issues for older cancer patients:

  • Fatigue or lethargy
  • Functional dependence
  • Anemia
  • Dry mouth
  • Impaired mobility
  • Nausea and vomiting
  • Poor vision
  • Cognitive and mental health issues
  • Social support
  • Diarrhea and constipation
  • Already taking many medications (polypharmacy)
  • Dental issues, such as ill-fitting dentures or poor tooth and gum health
  • Lack of appetite (anorexia) and feeling full after just a bite or two (early satiety)
  • Altered sense of taste (dysgeusia) and smell (dysosmia)

The list highlights challenges older cancer patients may face that younger patients do not. This includes lack of social support, poor vision, impaired mobility and dependence on others for daily living tasks.

These things can combine to make malnutrition one of the top concerns for older people with mesothelioma.

Health Effects of Obesity for Cancer Survivors

For the general population, experts identify obesity as a public health threat and recommend steps to curb the rising rate of excess weight gain.

For cancer patients undergoing treatment, it is less clear that lowering weight should be a priority. A health issue called sarcopenia complicates the picture.

Health experts define sarcopenia as a loss of skeletal muscle and function. This occurs with age, but also because of other chronic health conditions, including cancer.

The Journal of Geriatric Oncology publication raises an important issue all health care providers need to understand.

“Among older adults, weight gain and obesity can occur in the presence of age-related decline in muscle mass, sarcopenia, and an overall nutritional deficient state,” the authors wrote. “This paradox requires targeted research to understand the presence of common geriatric syndromes such as anorexia, malnutrition, and sarcopenia with respect to obesity, specifically among older cancer survivors.”

While focusing on weight loss for obese cancer patients with less aggressive tumors and earlier stage disease may be beneficial, this is unlikely to be the case for mesothelioma patients.

If you’re overweight and receive a mesothelioma diagnosis, the extra pounds may be a blessing in disguise. You should not focus on losing weight at this time.

If you are losing weight without trying, ask your doctor for a referral to a registered dietitian. They can develop a nutrition plan for before, during and after treatment.


Suzanne Dixon is a registered dietitian, epidemiologist and experienced medical writer. She has volunteered with the National Cancer Policy Forum, Oncology Nutrition Dietetic Practice Group, American Institute for Cancer Research, American Society for Clinical Oncology, The National Academies of Sciences, Engineering, and Medicine. The New York Times and Time Magazine also have reviewed her cancer patient resources. Read More

Sources
  1. Presley, C.J. et al. (2016, July 5). Gaps in nutritional research among older adults with cancer.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969118/
  2. Wells, J.L. and Dumbrell, A.C. (2006, March). Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682454/
  3. Paillaud, E. et al. (2014, ). Geriatric syndromes increased the nutritional risk in elderly cancer patients independently from tumour site and metastatic status. The ELCAPA—05Cohort Study. 00153-2/fulltext
    Retrieved from: https://www.clinicalnutritionjournal.com/article/S0261-5614(13)
  4. Cancer.Net (2017, July). Mesothelioma: Statistics.
    Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/statistics
  5. Santilli, V. et al. (2014, December 10). Clinical Definition of Sarcopenia.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269139/
  6. Zhi, J. et al. (2018, June 2). American Society of Clinical Oncology Annual Conference. Association of baseline body mass index (BMI) with overall survival (OS) in patients (pts) with metastatic non-small cell lung cancer (mNSCLC) treated with nivolumab (N) and pembrolizumab (P).
    Retrieved from: https://meetinglibrary.asco.org/record/158492/abstract
  7. International Society of Geriatric Oncology. 2015 Annual Conference. Geriatric Oncology and supportive care: a global approach to advance the science. Retrieved from: http://www.siog.org/content/siog-2015-prague

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