The main speaker at a seminar on 'Breast Cancer' held on Friday at Aga Khan University, Dr Shaista M Khan, called for prevention rather than cure.
Highlighting the importance of awareness about the basic health sectors among the general masses, she said that "we, specially women," must increase knowledge about the health programmes.
All speakers emphasised the need to get awareness how to control or handle the situation created by the sickness or cancer.
Dr Shaista, Chief of General Surgery Department, Aga Khan University, said that cancer prevention "is an important public health issue" and chemo-prevention of breast cancer is a very promising area that has already achieved significant objectives during last several years.
She said that cancer prevention has improved significantly over the last decade, including breast cancer. "We must take simple and proper diet to keep away from dangerous diseases."
Role of Nutrition in Cancer Prevention: Sadia Zubair, Nutritionist, AKU, discussed the role of diet and life style in prevention of breast cancer. She emphasised that maintaining appropriate weight in childhood and adulthood has been shown to be protective against cancer.
Related to this are the findings that physical activity is also reported to be protective. Whether physical activity has an independent effect or through its impact on body weight is not clear. Unfortunately, the urban environment provides very little opportunities for women to engage in physical activity outside their home.
The second emphasis was on consuming the right kinds of fats. Excessive intake of fats from animal origin, that is saturated fats, increase risk of breast cancer but it is not enough to switch to vegetable oils.
TOPIC: Optimizing Nutrition During and After Cancer Treatment.
Speaker Ayesha Zahid Khan Nutritionist AKU/CHS, focussing on the topic, said that 'Cancer Survivorship' begins at the time of diagnosis and lasts for the balance of life. Adequate nutritional status is of utmost importance in all phases of a cancer survivor's life.
Not only the disease but also its treatment has a negative effect on the patient's food intake and therefore their nutritional status. During treatment the patient may suffer from nausea, vomiting, food aversions where some foods that are previously liked are disliked and the patient will refuse to eat them. However, a good nutritionist can counsel patients and their families regarding ways in which these side effects of treatment can be minimised.
Ayesha emphasised the importance of family support if cancer patients are to eat enough to maintain adequate nutritional status. Family members must realise the importance of the eating environment in encouraging the patient to eat such as a pleasant environment that is free from noise and distraction, pleasant company while eating, and attractively served meals.
PHASES OF CANCER SURVIVORS
1- Active Treatment Phase
2- Recovery Phase
3- Health Maintenance Phase
4- Living with advanced cancer
GOALS OF NUTRITION SUPPORT
-- Repletion or preservation of nutritional status prior to or during treatment.
-- Management of food related discomfort due to cancer and its treatment.
-- Improvement of strength, wellbeing and /or quality of life.
-- Reducing chances of recurrence.
ASSESSMENT OF NUTRITIONAL STATUS
-- Identify the subset of patients who might benefit from dietary counselling
-- Determine the cause and severity of malnutrition
-- Identify patients at risk of complications of chemotherapy, radiation therapy or surgery
-- Assess the efficacy of nutritional support
SUBJECT GLOBAL ASSESSMENT (SGA)
MEDICAL HISTORY
-- Weight change
-- Dietary intake change
-- GIT symptoms > 2 weeks
-- Functional capacity
PHYSICAL EXAMINATION
-- Loss of subcutaneous fat
-- Muscle wasting
-- Ankle/sacral edema
-- Ascites
SGA-SCORING SCALE
Score 0-1: no intervention required
Score 2: indication for nutrition education
Score 3-8: requires intervention
Score 9: critical need for intervention and /or symptom management
EFFECTS OF TREATMENT
-- Decreased Appetite
-- Nausea/Vomiting
-- Taste changes
-- Early Satiety
-- Dry Mouth swallowing Difficulties
-- Mouth Sores Reflex Constipation
-- Diarrhea Lactose Intolerance
-- Pain/Fatigue Depression
DECREASED APPETITE
-- Eat small, frequent meals and snacks.
-- Eat solid foods first; avoid beverages at mealtime.
-- Light exercise may stimulate appetite.
-- Consume nutritious drinks or nutritional supplements between meals.
-- Add foods high in calories and protein eg nuts to maximise nutrient density.
-- Create a relaxed eating atmosphere.
NAUSEA/VOMITING
-- Avoid foods with strong odours or flavours.
-- Eat dry, bland foods.
-- Eat and drink small amounts slowly and often.
-- Avoid overly sweet, greasy, and spicy foods.
-- Avoid lying down immediately after eating.
-- Drink beverages cool or chilled and cat foods at room temperature or cooler.
TASTE CHANGES
-- Use herbs, spices, and marinades to enhance taste
-- Serve food cold or at room temperature.
-- Sour foods may be refreshing.
-- Try alternative protein sources if meat has an unpleasant taste.
-- Avoid very sweet foods.
EARLY SATIETY
-- Eat small, frequent meals and snacks.
-- Avoid beverages with meals.
-- Minimise intake of low caloric dense foods.
-- Drink small sips of nutrient dense beverages or supplement throughout the day.
DIARRHEA
-- Increase fluid consumption.
-- Avoid carbonated beverages and caffeine.
-- Avoid raw veg. And fruits with skin or seeds.
-- Avoid gas-producing foods.
-- Avoid highly spiced foods and fatty foods. Bland foods may be better tolerated.
-- Eat foods and drink liquids rich in sodium and potassium.
-- Lactose-free products can be used where feasible.
FOOD SAFETY
-- Special concern for cancer survivors.
-- Immunocompromised
-- Immunosuppressive cancer treatments
GENERAL GUIDELINES FOR FOOD SAFETY
-- Wash hands thoroughly before eating.
-- Keep all aspects of food preparation clean.
-- Wash hands before food preparation, and wash fruits and vegetables thoroughly.
-- Use special care in handling raw meat, fish, poultry and eggs, and thoroughly clean all utensils, countertops, cutting boards, and sponges that have contacted raw meat; keep raw meats and ready-to-eat foods separate.
-- Cook to proper temperature; meat, poultry and seafood should be thoroughly cooked.
-- Milk and juices should be pasteurised.
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