Briana Galiardo, RDN, CDN, Director of Nutrition at New York Cancer & Blood Specialists, discusses the integral role nutritionists play on the wellness team at the facility.
Patients recovering from or who are at high risk for cancer can have unique and critical nutritional needs. That is why nutritionists are an important part of the cancer-fighting team at New York Cancer & Blood Specialists.
“New research findings support theories that patients who have quality nutrition and hydration actually experience better outcomes and fewer side effects from their chemotherapy and radiation treatments,” Galiardo says. “Nutrition has taken on a vital role at our facility, not only for getting patients through their cancer treatments, but also for preventive and post-cancer recovery purposes.”
Depending on the type of cancer a patient has, the side effects and how far along he or she is in the treatment process, specific nutritional needs may vary.
“Every patient’s care is individualized here,” Galiardo says. “We do not offer generic meal plans.”
After a patient’s cancer diagnosis, a nutritionist first focuses on boosting the patient’s immune system and overall health to ensure he or she is ready for treatment. The patient may be asked to consume more antioxidants, as antioxidant supplements are not recommend during treatment, as well as vitamins and minerals. The nutritionist will also ensure the patient is well hydrated and at a healthy body weight.
“If patients start their chemotherapy treatments with poor nutrition or malnutrition, they are at an increased risk for developing more side effects from treatment as opposed to those with proper nutrition,” Galiardo says. “They typically will experience more lethargy, weakness and fatigue and have a more difficult time getting through their treatments.”
Once treatment begins, optimal nutrition depends on the patient’s chemotherapy regimen and resulting side effects.
“When patients are on a specific chemotherapy regimen that causes diarrhea or constipation, for instance, or have a cancer that affects their gastrointestinal tract, we are going to work with foods that will not exacerbate GI distress,” Galiardo says. “For patients who have any type of esophageal or lung cancer that affects their ability to swallow, we can use a tube-feeding regimen that is designed to ensure patients receive adequate nutrients. We may also modify the textures of the foods they consume to make eating easier.”
Malnutrition and Dehydration
While symptoms vary, malnutrition is a common and dangerous concern for many patients during and immediately following treatment. Eating inadequate nutrients, the wrong type of nutrients, or eating too little or not at all due to treatment side effects, can cause malnutrition.
Nutritionists at New York Cancer & Blood Specialists look for signs of malnutrition by reviewing a patient’s protein levels, kidney function, hydration, weight and BMI. Assessing these nutritional lab values, in addition to weight and BMI, is important because someone can be overweight yet malnourished if he or she is not getting enough nutrients. Careful evaluation of these numbers signals to the nutritionist what the patient is lacking. If, for example, the patient is malnourished due to a low BMI (below 18.5), the primary goal would be weight gain. The nutritionist may increase the patient’s caloric intake and introduce more protein and amino acids, which are important to the recovery process, as well.
Dehydration, one of the most crucial signs of malnutrition, is also a key focus for nutritionists.
“Patients must be properly hydrated during cancer treatments, or they will experience worse side effects,” Galiardo says. “Their kidneys will not function properly. They may have greater respiratory side effects, dry mouth, irritability, poor appetite, fever, muscle cramps, and even experience dizziness or confusion.”
If a patient is dehydrated, a nutritionist will work with the patient to develop nutritional strategies to help him or her replace fluids and electrolytes lost from diarrhea, fever or a lack of consumption.
“We utilize nutrition to increase hydration first, but IV hydration is readily available for patients who require it,” Galiardo says. “If patients are unable to receive fluids by mouth, they are still able to get the hydration they need.”
The nutritionists at New York Cancer & Blood Specialists support patients’ dietary needs as long as necessary. While the average duration of patient care is three to six months, Galiardo says they often support patients long into the recovery process, at which point nutritionists focus on replenishing what was lost during treatment.
“We never let a patient go after the first visit,” Galiardo says. “Many patients tend to follow up with us even after their treatments are over or until we are able to get them back to a healthy body state.”
The Wellness Team
When patients visit New York Cancer & Blood Specialists, they first meet with an oncologist and develop a treatment plan. That plan can involve an entire wellness team, including nutritionists, psychologists and social workers.
“I have to say it is very unique for a cancer center. We are a tight-knit community that really cares about our patients, and we work hand in hand with each other,” Galiardo says. “Our care does not stop at chemotherapy and medications. We focus on wellness as a whole, which positively affects the treatment outcome. I think that is going to spark more places to develop wellness teams, but I think we are really at the forefront of that.”
To learn more about cancer-related nutrition, visit nycancer.com/services/Nutrition.