Sniffing out a healthy menu of eating habits

Science Article

Nutrition Services helps patients, families learn concepts that may help prevent future illness

Patient Philip Orvis (right) of Liberty, Mo., takes a smell test during a class taught by dietitian Sarah Washburn (left). Accompanying Orvis were his wife Susan and brother Paul, of Imperial, Neb. Photo by Theresa Naujack

The hour-long nutrition class for Seattle Cancer Care Alliance patients and families ended just before lunch.

"Any more questions?" asked dietitian Sarah Washburn.

Patient George Unguren looked around the table with a grin. "We're hungry," he said.

Although the dozen or so patients and caregivers in the room laughed at Unguren's joke, food is a serious topic for cancer patients. With treatment often wreaking havoc on their ability to eat, patients want all the information they can get about healthy eating.

In addition, awareness of the strong association between cancer and diet draws patients to learn more about nutrition that may help prevent future illness.

Performing medical nutrition assessments and providing patients with nutrition information are the responsibilities of Nutrition Services. It's a big job - and it recently got bigger.

Formerly a department of the Hutchinson Center, Nutrition Services is now part of the Alliance. And instead of catering only to transplant patients, it has expanded its services to all persons treated in the Alliance Ambulatory Clinic.

While much of the information disseminated by Nutrition Services consists of general guidelines for healthy eating, different forms of cancer may require that a patient receive more specific and individualized guidelines and counseling.

Menu of assistance

As a result, Nutrition Services continually expands its menu of assistance. Dietitians specialize in one or more areas of cancer and nutrition to address the needs of specific patients. The goal is to provide the patient with the most reliable and accurate information based on up-to-date scientific findings.

"We're really proud of our expanded service and excited about it," said Saundra Aker, manager of Nutrition Services.

The department recently completed a new brochure describing its services. Throughout March - National Nutrition Month - the nutrition staff distributed nutrition quizzes and question-and-answer flyers to patients and caregivers. And that's just the beginning.

"We would like to develop more materials and classes to better serve the needs of the general oncology patients," said dietitian Jean Stern, nutrition education coordinator.

"We're seeking input from people about what they would like and need, whether it's information about weight control, general wellness or use of supplements."

A cornerstone of Nutrition Services is a book initially published 25 years ago entitled "A Guide to Good Nutrition During Cancer Treatment."

95-page book

Aker and former Hutch dietitian Polly Lenssen manager of Clinical Nutrition Services at Children's Hospital and Regional Medical Center, edited the 95-page book, which features contributions from nutritionists from the Alliance, Hutch, Children's and the University of Washington.

"It was one of the first books in the country that dealt with nutrition and cancer," Aker said.

Since 1976, more than 30,000 copies have been distributed by Nutrition Services, and a German edition was published in 1985.

Shortly before the Alliance clinic opened, the book underwent its fourth revision, to make it more applicable to general oncology patients and to provide more overall information.

Another key offering is a pair of weekly classes.

Washburn, one of six staff registered dietitians, typically opens a nutrition-overview class with a smell test. Participants receive a card with three different scratch and sniff patches and are asked to identify each odor. This exercise is designed to illustrate the important role that smell plays in one's ability to taste.

Washburn points out that chemotherapy, radiation and other medications may influence a patient's ability to taste and smell, which ultimately influences a patient's interest in eating.

As a recent class continued, Washburn talked about the percentages of fat, protein and carbohydrate contained in a healthy diet and what foods provide the most of each.

She also distributed packages of food and described how to look at their labels to determine nutritional content.

"Ever heard of the food pyramid?" Washburn asked, describing the five food groups shown in the Food Guide Pyramid.

"It's the fruits and vegetables that most people don't eat enough of in their diet. If you get five or more fruits and vegetables a day, you're ahead of the game, because there are so many proven healthy components found in fruits and vegetables."

Along with basic nutrition guidelines, Washburn offered practical advice for coping with side effects related to cancer treatment. For instance, patients with dry mouths who want to eat pasta or rice may tolerate those foods better if they are moistened with a broth or sauce.

And patients should think twice about forcing themselves to eat their favorite foods if they're feeling ill. Otherwise, Washburn said, they may forever associate that food with being sick.

The classes are free and registration is not required. Although the sessions target patient and caregiver issues, Alliance staff are invited to attend. That way, they can better answer diet-related questions patients may ask or can refer patients to Nutrition Services for further assistance.

While transplant physicians have long relied on Nutrition Services to assist their patients, the department's presence in the Alliance clinic building is an expanded resource for oncologists and patients.

Besides teaching classes and distributing written materials, Nutrition Services provides individual counseling services.

High nutritional risk

Such sessions are routinely scheduled for transplant patients, whose treatment puts them at high nutritional risk. The risk for general oncology patients depends on the type of cancer and form of treatment.

General oncology patients are referred to Nutrition Services by their physician or can make an appointment themselves by calling 206-288-1148. Appointments are the norm, but same-day referrals are accommodated as well.

"It's very challenging for people to eat well during treatment," Stern said.

"Additionally, patients must sort through the potentially confusing nutrition information from the media and their friends and family. Ultimately, the goal of what we do is to provide reliable information so that patients can make appropriate diet choices."

Aker agreed. "Good nutrition is more important than ever when fighting cancer," she said. "Food provides the essential nutrients that not only help us heal, but also give us the strength and energy to remain active in all aspects of our everyday lives. That's the bottom line."

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How to get the book

The latest edition of "A Guide to Good Nutrition During Cancer Treatment" can be purchased from Nutrition Services. To order a copy, call the Nutrition Office at 206-288-1148 or e-mail jsalmons@seattlecca.org.

When are the classes?

The two weekly nutrition classes are held in room 1006 of the Alliance clinic building. The details:

• Food safety, 11:30 a.m. to 12:30 P.M. Tuesdays.
• Overview of nutrition and managing side effects during treatment, 10:30 to 11:30 a.m. Thursdays.

More info: 206-288-1148.

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