What do you enjoy most about your role?
What I have always enjoyed most about my role is being involved with patients at the most vulnerable part of their lives. I love developing trust with patients by helping them pick a few small goals that we can achieve together to show them they do have some control over their situation. As my role has changed over the years I enjoy being at the forefront of developing programs for our patients and marketing our services to new markets.
What does a typical day for you look like?
Most of my teammates aim to see roughly eight patients per day, but sometimes as many as 16 on a busy clinic day! In most of our clinics, the dietitians work closely with Social Workers and the Nurse Navigators to identify patient needs. In my role as manager, I work with the Supportive Oncology team to develop collaborative projects, work on research, and develop metrics to ensure we are meeting patient needs. As Levine Cancer Institute has grown in recent years, we have worked to develop strategic plans to ensure that when new sites or clinics are added we have the staffing to manage those patients ahead of time.
What are the most common nutritional issues in your cancer patients?
Poor appetite, taste changes, and changes in bowel habits are the most common problems we deal with. The dietitians can spend up to an hour with patients to really get to the source of the patient’s problems. For instance, if we can tell dry mouth is causing their taste changes, we can provide them with very specific tricks and tips to address the root of the problem. Often these problems start before diagnosis and patients lose significant weight before we see them. Early identification is key to helping our nutritional interventions work.
Many of our patients experience early satiety as well, and medications may change how well their stomachs empty. Chronic constipation is common and can make patients feel like they can’t take another bite.
What types of nutritional therapies do you most commonly use with your patients?
We look at what side effects they are having and try to address them very specifically. If someone has a poor appetite we will give tips on increasing calorie and protein intake to help every bite count - often recommending Oral Nutrition Supplements or high-calorie snacks to replace the calories patients are missing at meals. We address hydration a lot as almost no one is drinking enough fluids, so we discuss ways to increase fluid intake with high moisture foods and high calorie/protein drinks, as well as creative ways to make water more palatable.
For patients with taste changes, we may look at the type of change (metallic, flat, salty) and then provide tips to overcome that particular flavour sensitivity. However, many of our surgical patients will require feeding tubes to get them through their treatments. We work closely with them to make sure they are tolerating these feedings and adjusting the formula, rate, and total volume as needed to make sure they get their full-calorie and protein needs met.
In your palliative care patients, what is most important from a nutritional, and also a holistic perspective?
In our palliative clinic, patients are often struggling with pain management. This can lead to chronic constipation. Constipation can really become a quality of life issue for our patients, and sometimes an issue they are reluctant to discuss. We try to make it a safe space to talk to the dietitians about all those digestive issues they might be embarrassed to talk about. For all of our patients, nutrition is a great way to empower them in their own care- often chemotherapy, radiation, and surgery feel very outside their control. Giving them tips to manage their own nutritional status gives them the power to be equal partners in their care and helps them feel like they are doing everything they can to take care of themselves. Seeing nutrition as part of their treatment plans really helps patients feel like they aren’t just along for the ride.
Prior to treatment (and during), we are really working to keep patients nourished to withstand the treatments and the side effects. After treatment we are working on that “new normal”, helping patients to maximize their nutrition and manage their risk through healthier eating, which may be challenging as taste changes or bowel habits can be slow to resolve. Sometimes the real work begins after treatment, helping patients find healthy choices they enjoy and can use to develop a new lifestyle.
What is the biggest misconception in nutritional cancer care?
I think the biggest misconception and challenge in nutrition for cancer patients right now is the perception that weight loss is good in our overweight patients. Often patients are pleased with their weight loss and don’t fully disclose to their care team how much weight they have lost. Often patients do not realize that this weight loss impacts their ability to withstand treatment and can even impact how well the treatment works. Early intervention can help patients understand the importance of weight maintenance during treatment so it gives us the chance to maximize how well the treatments work.