Examining the Benefits of Integrative Oncology, Nutrition in NETs

“Integrative oncology is patient-centered, evidence-informed cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside convention cancer treatment,” explained Kathleen Sanders, ARNP, MSN, MPH, Seattle Cancer Care Alliance Integrative Medicine Program, during a session at the North American Neuroendocrine Tumor Society annual meeting held October 4-6 in Seattle, Washington.

“The goal is to have people have tools that can improve their quality of life from time of diagnosis, during treatment, and following treatment,” she added.

As patients with cancer look to increase survival, increase the efficacy of conventional cancer therapies, prevent and treat side effects of conventional therapies, and improve quality of life, use of integrative oncology has started to gain traction nationwide. These modalities include stress management, acupuncture, meditation, and music therapy.

However, patients and providers want to see the research behind these modalities, explained Sanders. In order to align the clinical practice guidelines with those used in conventional medicine, integrative oncology follows United States Preventive Services Task Force criteria. The guidelines characterize modalities as A to I, ranging from suggestions to offer/provide the modality to offer/provide the modality for selected patients depending on individual circumstances to discouraging the use of the modality.

Based on the guidelines, recommended modalities for anxiety and stress, chemotherapy-induced nausea and vomiting, depression, and quality of life include meditation, stress management, yoga, acupressure, and electroacupuncture.

“There is a large enough body of evidence to use these techniques within conventional practice,” said Sanders. “It offers patients tools and offers clinicians tools and other modalities that can help when they have patients that really aren’t responding to medications or just need something extra to help them with their symptom management.”

Building off of Sanders’ presentation, Greta Macaire, MA, RD, CSO, dietitian, UCSF Helen Diller Family Comprehensive Cancer Center, discussed the role of nutrition for patients with neuroendocrine tumors.

More than one-third (35%) of adult cancers are attributed to obesity, poor diet, physical inactivity, and excess alcohol intake, and recent studies indicate that 40% of NET patients are malnourished or at nutritional risk, Macaire explained.

A 2016 meta-analysis looking at risk factors for NETs found that high body mass index was the second highest risk factor for NETs, falling just behind family history, she added. Based on these findings, guidelines were created in order to mitigate risk, focusing on behaviors such as being a healthy weight, being physically active, and eating more of a plant-based diet.

“Thinking about up to 70% of NET patients that have nonfunctioning tumors, that may be in the early stages of their disease, that maybe don’t have to deal with a lot of the symptoms that come later on after surgeries and treatments, or if they have a functional tumor, these are the guidelines that we can really have them focus on,” said Macaire.

With malnutrition and nutritional risk being associated with poorer clinical outcomes, including significantly longer hospital stays and reduced long-term overall survival, the American Cancer Society recommends a registered dietician assessment, preferably from a Certified Specialist in Oncology Nutrition, as soon after diagnosis as possible.

Components of the nutritional assessment include diagnosis/medical and surgical history; biochemical data; physical assessment; and a patient interview that inquires about unusual weight and recent weight changes, stool patterns and symptoms of carcinoid syndrome; current diet and diet history; and medications and supplements.

From there, a nutritional plan should be constructed, based on: individual needs, nutrient rich, whole foods diet, timing of meals and snacks, optimal fluid intake, food preferences, and ease of preparation.