If you’ve been diagnosed with cancer, you will interact with a number of different members of the health care team at various times during treatment. When you walk into a doctor’s office, hospital, or cancer center, you may encounter nurses, physician assistants, social workers, doctors—the list goes on. In the Spotlight On series, we talk with some of these health care professionals to learn more about their jobs and the role they play in providing high-quality cancer care.
Proper nutrition is essential for living well during and after cancer treatment. Dietitians are the nutrition experts who can help people understand proper eating for their specific conditions. To get an inside look at how nutrition and oncology work together in cancer care, Cancer.Net talked with two oncology dietitians. Maureen Gardner, MA, RDN, CSO, is a Clinical Dietitian at Moffitt Cancer Center and an Executive Committee Member of the Oncology Nutrition Dietetic Practice Group (a dietetic practice group of the Academy of Nutrition and Dietetics). Annette M. Goldberg, MS, MBA, RDN, LDN, is an Outpatient Dietitian at Boston Medical Center Cancer Center.
1. Why did you become a dietitian, and how did you end up working in oncology?
Maureen Gardner (MG): My mother is a registered dietitian who worked in hospitals and nursing homes when I was growing up. So that played a huge role in my decision to become a dietitian. My first job at Dana-Farber Cancer Institute 20 years ago ignited my interest in oncology nutrition, and after hearing the then-director of nutrition at Moffitt, Dr. Nagi Kumar, speak at a local dietitian meeting, I knew I had to work at Moffitt. That was 14 years ago!
Annette Goldberg (AG): Nutrition and dietetics were not my first career. Previously, I was working in technology management. In 2007, I was diagnosed with breast cancer. During my treatments, my weight loss was dramatic and nutritional support was not readily available within the cancer center. As I recovered, I decided I wanted to devote the remainder of my career working in an area where I had passion. After some soul searching, I realized that passion was nutrition—nutrition for the cancer patient.
2. What is the role of a dietitian on the cancer care team?
AG: My primary role is to work with the team to identify patients who are at high risk for malnutrition or significant weight loss and to work with those patients to maintain their nutritional status during treatment. I’m also a resource for aiding with tube feeding, nutritional supplements, diet education, community activities, and general counseling.
MG: A registered dietitian is a liaison between the medical team and patient and helps translate nutrition goals for the best possible treatment outcomes. We give the patient solutions to problems, which range from hints for taking food when you are nauseated or have a poor appetite to assisting with feeding tubes.
3. What are some of the most important things you do for people with cancer on a daily basis?
AG: It is important for me to be an advocate for the patient. Many times, families don’t understand why the patient won’t eat and, consequently, food becomes a battle. I assure the patient that I understand their challenges and provide suggestions on the easiest way to consume increased calories based on their side effects or individual challenges.
MG: We support patients by making sure they meet their goals for calories, protein, and fluid in order to assist them with completing their planned treatment. Our goals include preventing treatment interruptions, helping to ease side effects, and improving their overall quality of life.
4. What are the best or most rewarding parts of your job?
MG: When I can help patients feel comfortable with their nutrition plan and empowered to make a difference, it is so rewarding! I love it when patients see results and improvement and start to feel better after meeting with a dietitian. The very best part is hearing from a patient when they have completed treatment and are feeling better, and then they write, call, or return to visit the team.
Our patients’ courage is inspiring.
AG: The best and most rewarding part of my job is helping people feel better and successfully recover. Patients are always so grateful for my help and that is extremely satisfying.
5. What are some common concerns your patients have, and how do you help address them?
MG: Poor appetite is really frustrating for many patients and their families and is very common. We often try behavioral hints, such as smaller meals and milkshakes. If these solutions don’t work, then the medical team may have ideas for medications that can help.
Staying hydrated can be challenging too, so we make lists of fluid-rich foods that patients enjoy as well as fluids to help prevent dehydration. It’s all about individualization and meeting the patient where they are.
AG: A majority of patients battle with weight loss, decreased appetite, and taste changes. Patients’ reactions are different. Therefore, I spend time understanding a patient’s preferences, what foods they find appetizing, and so forth. Then, we work on suggestions and build a meal plan that is tolerable and calorie dense.
6. What are the most challenging aspects of nutrition for patients with cancer?
AG: Patients have to think of nutrition as a form of medication. I reinforce the need to eat every few hours and encourage the patients to ensure they consume the proper amount of nutrition every day. It is a difficult time: the body requires additional energy and the patient has no appetite.
MG: Nutrition plays a huge role in the prevention of cancer, but there is a lot we still don’t understand. We use nutrition as a tool, but it’s important to use it for support and to understand it’s just one of many tools we use to treat cancer.
7. What is one thing that most people should be aware of when it comes to nutrition and their cancer?
AG: My biggest concern is the misinformation patients hear from media snippets or read on the Internet. Sugar feeding cancer, special diets, supplements, etc., create confusion and extra expense for the patient. Dietitians spend quite a bit of time reassuring and educating the patient that the basics of nutrition will serve them well.
MG: Internet myths! Every day I meet a patient who has fallen prey to an e-mail or a post on social media that a well-meaning family member or friend has sent. Many of these scare patients and make them feel that food is the enemy instead of one tool (of many) to help them get through treatment or recovery. Just because it is written on the Internet does not make it true!
8. Do you have any tips to help patients better communicate with their cancer care team?
MG: Make a list of questions with a checkbox and room for answers before you visit your health care team member, so when you get to your appointment, you don’t forget to ask. You may want to bring someone with you to your appointments, too. They can help you take notes!
AG: Before your appointments, write down your questions or concerns. During conversations with your providers, refer to your list of questions. Doctor and treatment visits can be stressful, and it is easy to forget questions or to become confused. And if it is possible, it is always best to have a friend, relative, or advocate with you for every visit.
9. How can someone find a dietitian for their care team?
MG: Patients can request a nutrition consult from their physician at our National Cancer Institute (NCI)-designated Comprehensive Cancer Center. For patients outside of Moffitt, I’d recommend asking the physician who is directing the patient’s care for a referral to a registered dietitian. If patients wish to find a dietitian in their area, they can go to the website of the Academy of Nutrition and Dietetics and click on “Find an Expert” in the top right of the page. Another great resource is the website for the Oncology Nutrition Dietetic Practice Group, which has lots of information for patients and caregivers as well as dietitians.
AG: I would first recommend that the patient ask a member of their cancer care team for a referral. Professional organizations such as the Commission on Cancer (CoC), Academy of Nutrition and Dietetics, National Comprehensive Cancer Network (NCCN), and the Association of Community Cancer Centers (ACCC) recommend that a dietitian be available for consultation. The Academy of Nutrition and Dietetics certifies oncology dietitians with a CSO (Certified Specialist in Oncology) credential.
Annette and Maureen talk more about the role of nutrition and dietitians in oncology in the following podcast.A transcript of this podcast is also available.