Consider the dietary needs of Breast Cancer patients
Breast cancer is the most common cancer diagnosed among women in Australia. Approximately 2.3 million people are diagnosed with breast cancer globally with approximately 57 Australians diagnosed each day. That equates to around 20,000 people diagnosed each year and is the second most commonly diagnosed cancer behind prostate cancer. Of those diagnosed, they have a 92% change of surviving five years (87% for males and 92% for women). Around 1 in 15 by the age 85 will be diagnosed with breast cancer. (https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics
Among people who have cancer, the ingestion of complementary medicine is very common and these people may seek out options that they believe may make a difference to their prognosis (Seely D et al. 2008). Naturopaths, nutritionists and herbal medicine practitioners can assist these people during their surgery, chemotherapy and/or radiation by a number or ways:
1. Reduce side effects, especially long-term side effects
2. Increase effectiveness of medical treatment
3. Increase quality of life of the patient
4. Potential anti-cancer activity in their own right
It’s important when looking at complementary therapy that it is not only one profession, but many, of which pilates can be considered a complementary medicine or allied health professional. Either way, it is important for the person to have a group of professionals working together as a team to best assist the individual. Each profession brings a different aspect which can help the healing and the experience of the person through their treatment and to then thrive post treatment.
Diagnosis of Cancer and During Treatment
The diagnosis of breast cancer or any cancer can be extremely stressful and generate a lot of anxiety for the individual and their family and friends. Being supportive and creating a safe environment for person with cancer is extremely important so they feel safe, relaxed and open to hearing any help they might receive. Each stage of treatment is very different and creates different stressors on the patient. Being aware of what is going on for the patient and hearing them, holding space is a vital component of assisting them.
Each stage of the treatments are addressed differently, and each person reacts to each one individually therefore patient centred care is paramount. In naturopathy and nutrition, diet plays a major component, but so does stress management, sleep, exercise suggestions, lifestyle suggestions and social engagement. For diet, chemotherapy can cause some major issues for patients including taste changes, smell enhancement, mucositis (mouth ulcers or ulcers along digestive tract), constipation and or diarrhoea, lack of appetite or increased appetite, not enough energy to cook, aversion of certain foods and beverages (even water can taste bad) and difficulty digesting certain foods. Being aware of what that patient is going through and making suggestions to assist can help them through.
General suggestions during chemotherapy its important to increase protein intake (normally 1.3grams of protein per kilo of body weight a day), eat more cooked foods than raw foods, have frozen meals ready to heat up and snacks at hand to consume and ensure complex carbohydrates for slow release energy. If they are feeling nauseous, somethings people find helpful include hot chips, ginger tea or ginger tablets, soft drink particularly coke cola (something I would never normally suggest) and eating on a regular basis. Most patients go off of coffee, meat, alcohol and many other foods as they don’t taste the same. Again, everyone is different, so it will vary greatly.
Diets and Breast Cancer
There have been numerous studies conducted on diet. One of more controversial studies was published in 2020 from a longitudinal study conducted on 52,795 North American women for 7.9 years (Fraser GE, et al. 2020). What they identified from this study was that the American dietary guidelines for milk which was 3 glasses a day was statistically significant with an increased risk of breast cancer. Additionally, higher total intakes of dairy calories and more than 1 glass of milk a day had been found to be associated with an increased risk of developing breast cancer [hazard ratios 1.22 [95CI:1.05-1.40] and 1.50 [95%CI:0.55-0.85]. Alternatively, cheese, yoghurt and soy were not associated at all with the development of breast cancer. To add to this data, in 2013, a paper was published that showed people diagnosed with hormone receptive tumours should drink low fat milk, rather than high fat milk (Kroenke CH, et al. 2013). The basis behind this is that all milk contains hormones as the animal must have given birth to lactate, and that the fat component contains most of the hormones.
Numerous other longitudinal and epidemiological studies have assessed the association with breast cancer and dairy with most finding there is no association found. Two conducted in 2018 and 2019 found no association with diary intake and adolescence and early adulthood and risk of breast cancer later on (Chen L, et al. 2019; Farvid MS, et al. 2018). Soy on the other hand, has very conflicting results which can lead to considerable confusion. Most of the confusion comes from the fact that studies in humans compared to the studies conducted on animals show different results (Shu ZO, et al. 2009). What is recommended is that if you have had soy all of your life, you can continue having it, if you haven’t, don’t start especially the highly processed soy foods or products (Qiu S, et al. 2019). What is safe to consume is small amounts of the traditional foods like tofu, tempeh, edamame or miso (Shu XO, et al. 2019: Qiu S, et al. 2019).
In 2010 an important paper was linked an anti-inflammatory diet to reduced risk of recurrence (George SM, et al. 2010.) By lowering the low-grade chronic inflammation, improved survival rates were found. This was measured by C reactive protein (CRP) levels in the blood. Another diet on the fasting-mimicking diet was conducted on triple-negative breast cancer (TNBC) which found that it lowered glucose-dependent protein kinase A signalling and stemness markers which assisted in reducing the number of cancer stem cells (Salvadori G, et al. 2021). It also helped to prevent hyperglycemia and other toxicities associated with chemotherapy.
The main diet that has been proposed for people with or post breast cancer is the Mediterranean Diet (MD). It has been shown to have a positive effect in prevention, during treatment and post treatment (Mentella MC, et al 2019: Laudisio D, et al. 2021; Hussain T et al. 2016). The diet contains naturally occurring polyphenols (olive oil, vegetables, herbs etc) which have a natural anti-inflammatory and anti-angiogenesis action that can assist in the reduction of proliferation of cancer (Mentella MC, et al 2019: Laudisio D, et al. 2021; Hussain T et al. 2016).
When it comes to exercise, its important work within the patient or client’s limitations as fatigue can be extreme for some people. If you are conducting a class for an hour, this may be too much for some, and might need to be broken down to 2 half hour sessions a week or less. There is also a wave of fatigue that can come over them at certain times and they shouldn’t push through that type of fatigue, they need to sit or lay down until it passes as that can cause major fatigue after as they do not recover as well. If they are generally feeling malaise which is not feeling great as well as tired, they can work through this type of fatigue. Checking in with them on a regular basis will assist. Additionally, paclitaxel or taxel is a chemotherapy agent that also affects the quads and they may find that walking up stairs or hills or exercises that works this muscle group maybe a lot weaker than normal and will not recover as well.
Conclusion
Overall, having a team around the patient to assist in all aspects is an imperative aspect of assisting them through this experience. It is also important for the different professionals to be in contact and update each other on what they are doing to best assist the patient. Having good referrals which you trust that you can suggest to people is also very advantageous. Ensuring that this experience for them is as easy and supportive as possible can have a big impact on how the patient travels through this phase in their life.
Dr Janet Schloss is Clinical Research Fellow at the National Centre for Naturopathic Medicine, Southern Cross University in Queensland, Australia. Janet is an accomplished researcher with extensive experience in coordinating clinical trials. In addition to her academic career, Janet is a practicing clinical nutritionist and naturopath with over 20 years’ experience. Following the completion of her doctorate in 2015, Janet has focused her research on supporting people who have cancer through studying the use of complementary medicines to assist side effects of cancer treatments.
References
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Hussain T et al. Oxidative Stress and Inflammation: What Polyphenols Can Do for Us? Oxid Med Cell Longev. 2016;2016:7432797. doi: 10.1155/2016/7432797
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doi: 10.1158/1055-9965.EPI-10-0464
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Salvadori G et al. Fasting-mimicking diet blocks triple-negative breast cancer and cancer stem cell escape. Cell Metab. 2021;33(11):2247-2259.e6. doi: 10.1016/j.cmet.2021.10.008.
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