It’s important to have an oncology dietitian on your treatment team. A cancer diagnosis for you or a loved one can feel completely overwhelming. While you may understand that nutrition is important for the prevention and treatment of many types of cancer, you may also feel confused about what nutrition options are right for you. Oncology dietitians specialize in helping patients diagnosed with cancer by providing personalized nutrition recommendations that support optimal health from diagnosis to treatment to remission.
During my dietetic internship at St. Agnes Hospital in Catonsville, Maryland, I had the unique opportunity to work one-on-one with oncology dietitian Emelie Buell, MS RD LDN. Emelie practices both in an inpatient and outpatient setting at the hospital, and sees many of her patients from the time of their initial diagnosis through the end of their treatment course(s). I was consistently impressed with her level of compassion and empathy for her patients, as well as her extensive knowledge of cancer-related nutrition. This month, she and I sat down to talk more about the role of the oncology dietitian on the care team, some useful recommendations she has for cancer patients, and what she enjoys most about her position.
Kristin: Oncology is a very specialized area of dietetics. How did you decide to pursue this career path in particular?
Emelie: I knew I wanted to study nutrition due to my love of cooking and learning about new ingredients. I’ve been practicing in dietetics for 6 years and in that time have seen and helped patients with a wide variety of conditions. I was drawn to oncology because of the unique connections I made with those patients working on the inpatient cancer wing. After one day of training I knew that this [oncology] was going to be a good fit for me. I see patients on their good and their bad days and no matter what, I leave feeling like I’ve made a positive impact on their day, even if it’s just by lending a listening ear.
K: How would you describe your role on the patient’s care team?
E: As a dietitian, I am responsible for helping patients stay healthy and strong for their treatments with proper nutrition. I do this through encouragement, education, symptom management, and simply trying to help a patient feel more comfortable during this stressful time. I also interact with nurses and doctors as a part of the care team. I make myself available for consults where I generally meet patients in the treatment room or one-on-one in a conference room for a more private session.
K: What are some of your patient’s common nutrition concerns and how do you help address them?
E: Most commonly, patients are concerned with how to gain back weight they’ve lost and how to maintain consistent intake when they are not feeling well. For those patients that need to gain or maintain weight, I often recommend high calorie/high protein foods and provide examples of recipes to try that are in line with their taste preferences. Weight gain can be frustrating for patients. I remind them to be patient, that it isn’t going to happen over night. It could take months especially if they’re experiencing a mixture of good days and bad days in terms of appetite.
When a patient isn’t feeling well, it’s extremely difficult to maintain adequate intake. It’s important to me to understand what they are able to tolerate given their symptoms so I can make recommendations for foods that might be helpful to them. I also promote small, frequent meals as those can be easier to tolerate. Sometimes all a patient can manage is drinking water and maybe an Ensure. I remind them that eating something is better than eating nothing which helps take the pressure off the “eat, eat, eat” mentality that can feel stressful to patients.
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K: Do you have any “secret” tips and tricks to share that might make eating easier if a patient is experiencing nausea or loss of taste?
E: The best advice I have for nausea is to stay consistent with your anti-nausea medications recommended by your doctor. Sometimes putting a little bland food in your stomach can help settle it too. One of my favorite “secrets” to combat loss of taste is to suck on hard lemon candy or drink lemon water before eating. The lemon helps wake up taste buds and makes food taste more like it should.
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K: Why is maintaining or gaining weight so important during cancer treatment?
E: Risk of malnutrition! Many side effects from treatment can lead to a patient not wanting to eat. Some patients enter into their first treatment already below their normal body weight. If weight loss progresses, the patient risks the dosage of their treatment needing to be decreased and therefore prolonging their course of treatment. As their dietitian, part of my responsibility is to monitor and address weight changes as soon as they’re documented. I work hard to educate patients on how to manage their weight, sometimes as early as their first appointment. Being proactive about weight changes is the best thing to do to support their overall health during treatment.
K: What tips do you have for caregivers of someone with cancer? How can they best support their loved ones’ nutrition efforts?
E: First of all, be patient. It’s easy for an outsider to tell someone to eat or make their favorite meal and expect a patient to eat 100% of it. Second, encourage without being pushy. Often, especially with chemotherapy, patients experience side effects for a few days directly after receiving their treatment. After those days pass, patients may find their appetite increases back to their baseline. Give them this time and encourage small sips/bites of food and beverages. This may also be a good time for a nutritional supplement such as Ensure.
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K: Do you have any advice for patients that are struggling with preparing healthy meals on their own?
E: Prepping large portions of food on days when patients have more energy is key. Using a crockpot or an instant-pot is a great way to make more food without putting forth a lot more effort. When possible, patients can freeze individual portions to reheat later. Having quick, convenient options available on-hand is great too. I like to recommend the frozen steam-in-a-bag vegetables and 90-second rice packets. Stay stocked up on snacks like granola bars, yogurts, nuts, and peanut butter crackers (just to name a few). Hydration often gets overlooked as a part of a healthy meal too. I typically suggest that patients keep a reusable water bottle by their side throughout the day as a reminder to drink. Some water bottles now have fruit diffusers attached, which is great for making lemon water to assist with taste changes.
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K: What are the benefits of continuing to see a dietitian once cancer treatment has concluded?
E: Just because treatment is done does not mean that side effects are gone overnight. It can take weeks or months for patients to feel back to normal. Continuing to see a dietitian can help with symptom and weight management going forward. Patients also benefit from ongoing support in terms of deciding what foods to eat and executing meal prep. There’s a lot of information and misinformation out there about what foods to eat to prevent cancer, and dietitians are uniquely qualified to make evidence-based nutrition recommendations that are appropriate for the patient.
Emelie works as a part of the St. Agnes Hospital cancer care team, providing support to patients currently receiving inpatient and outpatient care at their facility. If you’re looking for nutrition support during your cancer diagnosis and treatment course, our qualified dietitians are ready to meet you. Schedule an oncology dietitian consultation with one of our experienced providers today and learn more about how having an oncology dietitian on your care team can support your long term health and recovery goals.
Kristin Jenkins is a dietitian nutritionist based in Maryland. She has been involved in the field of eating disorders and disordered eating for over 6 years and brings both personal and professional experience to her work serving clients who struggle with their relationship with food and their bodies.
