"What Should I Eat?"-Addressing Questions and Challenges Related to Nutrition in the Integrative Oncology Setting

Promising Roles of Phytocompounds and Nutrients in Interventions to Mitigate Chemotherapy-Induced Peripheral Neuropathy

OBJECTIVES

Provide an overview of scientific reports and literature related to the role(s) of phytocompounds and nutrients in neuroprotection. Discuss how these properties may inform nutrition- and dietary interventions to mitigate chemotherapy-induced peripheral neuropathy (CIPN), for which there are no effective treatments.

METHODS

A literature search (2010-2023) was conducted in PubMed and Google Scholar where search terms-diet, nutrition, neuroprotection, neurodegenerative diseases, and social determinants of health-were used to narrow articles. From this search, manuscripts were reviewed to provide an overview of the neuroprotective properties of various phytocompounds and nutrients and their observed effects in neurodegenerative conditions and CIPN. Social determinant of health factors (SDOH) related to economic stability and access to nutritious foods were also reviewed as potential barriers to dietary interventions.

RESULTS

Twenty-eight publications were included in this literature review. Phytocompounds found in green tea (EGCG), turmeric (curcumin), cruciferous vegetables (sulforaphane), as well as certain vitamins, are promising, targeted interventions to mitigate CIPN. SDOH factors such as economic instability and limited access to nutritious foods may act as barriers to dietary interventions and limit their generalizability.

CONCLUSION

Dietary interventions focused on the use of phytocompounds and vitamins with known antioxidant, anti-inflammatory, and neuroprotective properties, hold promise and may provide patients with natural, non-pharmacological therapeutics for the management and/or prevention of CIPN. However, rigorous clinical trial research is needed to explore these effects in humans.

IMPLICATIONS FOR NURSING PRACTICE

Nurses support cancer survivors at the point-of-care, particularly during and after neurotoxic chemotherapy treatments. If future research supports dietary interventions to mitigate CIPN, nurses will ultimately be positioned to help translate this knowledge into clinical practice through educating patients on how to infuse nutrient-rich foods into their diets. Further, nurses will need to be conscious of SDOH factors that may impede access to these foods.

Establishing an Integrative Oncology Service: Essential Aspects of Program Development

PURPOSE OF REVIEW

Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors.

RECENT FINDINGS

Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service's foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences.

Associations Between Health Behaviors, Gastrointestinal Symptoms, and Gut Microbiota in a Cross-Sectional Sample of Cancer Survivors: Secondary Analysis from the Chemo-Gut Study

BACKGROUND

Health behaviors, such as diet and exercise, are actions individuals take that can potentially impact gastrointestinal (GI) symptoms and the gut microbiota. Little is known about how health behaviors impact GI symptoms and the gut microbiota after anti-cancer therapies.

METHODS

This is a secondary analysis of a cross-sectional study that investigated relationships between GI symptoms, gut microbiota, and patient-reported outcomes in adult cancer survivors. Gut microbiota was assessed from stool samples using 16 S rRNA gene sequencing. GI symptoms and health behaviors were measured via self-report. Descriptive statistics, multiple regression, and correlation analyses are reported.

RESULTS

A total of 334 cancer survivors participated, and a subsample of 17 provided stool samples. Most survivors rated their diet as moderately healthy (55.7%) and reported engaging in low intensity exercise (53.9%) for ≤5 h/week (69.1%). Antibiotic use was associated with more belly pain, constipation, and diarrhea (P < .05). Survivors consuming a healthier diet had fewer symptoms of belly pain (P = .03), gas/bloating (P = .01), while higher protein consumption was associated with less belly pain (P = .03). Better diet health was positively correlated with Lachnospiraceae abundance, and negatively with Bacteroides abundance (P < .05). Greater exercise frequency positively correlated with abundance of Lachnospiraceae, Faecalibacterium, Bacteroides, Anaerostipes, Alistipes, and Subdoligranulum (P < .05).

CONCLUSION

Results provide evidence for associations between antibiotic use, probiotic use, dietary health behaviors, and GI symptoms. Diet and exercise behaviors are related to certain types of bacteria, but the direction of causality is unknown. Dietary-based interventions may be optimally suited to address survivors' GI symptoms by influencing the gut microbiota. Larger trials are needed.

Addressing Patient Requests to Add Dietary Supplements to Their Cancer Care-A Suggested Approach

Dietary supplements are widely utilized by cancer patients as part of a complementary and integrative approach to their healthcare. However, a significant portion of patients refrain from discussing their supplement use with their physicians, often due to the perceived indifference or negativity of their healthcare providers. This communication gap exposes patients to unreliable information sources and potential risks associated with uninformed supplementation. As the healthcare landscape evolves, there is an increasing recognition of the pivotal role that physicians play in guiding patients' healthcare decisions. A patient-centered perspective prioritizes the provision of evidence-based information tailored to the individual's needs. It advocates for open discussions about potential risks and fosters shared decision making, respecting patient autonomy. Additionally, this approach involves offering alternative options, documenting patient preferences, and ensuring ongoing support while coordinating with the healthcare team. To address these evolving needs, healthcare providers must adopt a transformative perspective, becoming expert guides who engage with their patients as informed and empowered participants. This revised approach emphasizes an open dialogue that balances presenting facts and acknowledging uncertainties surrounding dietary supplement use. Our narrative review of the literature underscores the importance of a practical approach, centered on transparent discussions and respect for patient autonomy. By following this approach, healthcare providers can empower patients to navigate the complexities of dietary supplement use within the context of cancer care, thereby safeguarding patient safety and overall well-being. Notably, our proposed tool highlights the utilization of reliable sources, the risk stratification of supplements, specific recommendations, and subsequent monitoring, providing a structured framework for informed decision making.

Kidney Cancer Integrative Oncology: Possible Options for Care

PURPOSE OF REVIEW

This study aims to review how complementary and integrative medicine (CIM), defined as therapies utilizing nutrition, physical activity, herbs, supplements, mind-body therapies, homeopathy, and other non-traditional therapies, can address the prevention, treatment, side effects, and recurrence of kidney cancer. This review discusses advances and discoveries in research, gaps in research, current debates on the subject, and directions for future research. We queried Ovid MEDLINE and PubMed databases using the search terms kidney cancer, integrative medicine, integrative oncology, nutrition, supplements, treatment, prevention, and therapy. Searches were limited to integrative medicine and integrative oncology. We reviewed CIM therapies related to prevention, treatment, side effect mitigation, and recurrence of kidney cancers.

RECENT FINDINGS

Search results yielded 211 studies, of which 87 were relevant to this review. Studies related to CIM and kidney cancer were clustered into themes, including nutrition, physical activity, supplements, mind-body therapies, and alternative therapies. This review provides a foundation for utilizing the principles of integrative medicine in the prevention of and care for patients with kidney cancer and the need for further focused research on the effectiveness of CIM in kidney cancers.

Complementary and Integrative Medicine in Pancreatic Cancer

PURPOSE OF REVIEW

Pancreatic cancer has high mortality and morbidity rates, associated with the issues of typically late diagnosis and the limited effectiveness of current treatments. Patients tend to experience multiple symptoms that can include anxiety, fear, depression, fatigue, weakness, peripheral neuropathy, and abdominal pain, which reduce quality of life (QoL) and may compromise the treatment continuum. Many of those symptoms are amenable to complementary and integrative medicine (CIM) therapies as a part of supportive and palliative care. This article reviews research findings on the beneficial effect of use of CIM modalities in regard to pancreatic cancer, with emphasis on pancreatic ductal adenocarcinoma (PDAC).

RECENT FINDINGS

Given the often-poor prognosis of the disease, patients with PDAC often seek integrative therapies to help manage the disease itself, to provide support through cancer treatment and its symptoms, and to provide emotional stress relief. Data is accumulating in the past few years on the potential benefits of CIM to the management of pancreatic cancer symptoms and treatment side effects, in order to augment supportive care. This data reveal that nutrition counselling; digestive enzyme therapy; microbiome support; dietary supplements; lifestyle interventions (physical activity and circadian health/sleep hygiene) appear to improve QoL of these patients through reduced symptom burden and meeting psychological needs, such as distress and fatigue. Acupuncture, mindfulness, yoga, reflexology, massage, and homeopathy may also contribute to symptom reduction, both physical and psychological, in all stages of the disease. There is supporting evidence that some CIM modalities may alleviate side effects and symptoms related to pancreatic cancer and its treatment, suggesting that practitioners might consider integrating these modalities in certain situations encountered in the treatment of pancreatic cancer. Further investigation is needed to define the optimal integration of CIM into the treatment and supportive care of patients affected by pancreatic cancer.