A Dietitian's Cancer Story Newsletter: Summer 2005

Greetings from Diana Dyer, MS, RD, author of A Dietitian's Cancer Story I would like to take this opportunity to thank all of you who responded to my request in the Spring Newsletter to write your US Senators and House Representative asking for their support and sponsorship of The Medical Nutrition Therapy Act of 2005 (Senate Bill 604 and House Bill 1582). Support for this legislation continues to grow. As of July 26, 2005, there are now 19 sponsors in the Senate and 36 House sponsors. This bill, which has bipartisan support and is considered “revenue neutral”, is a necessary step in order to increase the inclusion of professional services by Registered Dietitians (RD), which is called medical nutrition therapy or MNT, into true comprehensive cancer care. More information about this bill can be found on my web site at http://www.cancerrd.com/faqs/faq74.htm along with links to web sites where you can find the names and contact information for your senators and representative and even a sample letter to thank or ask for their support of this important bill. I recently read this Chinese proverb: “When a question is asked ceremoniously, the universe responds” As ceremoniously as possible via an Email newsletter, I ask you for two things: (1) Please write your senators and representative in Washington today expressing your support for The Medical Nutrition Therapy Act of 2005 and asking or thanking them for theirs (2) Please send me a short email message at newsletter2@CancerRD.com (put MNT in Cancer Centers as your subject) describing a situation in which professional services from an RD helped with the outcome of your cancer treatment and/or recovery or if such professional expertise was not included as a component of your cancer care and how you believe nutrition services would have been of benefit to your cancer care. I think this proverb means when someone “really” asks, we “really” respond. Thank you for “really”, i.e. wholeheartedly, responding to my request! Diana Dyer, MS, RD *************************** Newsletter Contents: I. Autographed books and past newsletters II. Spanish edition of my book III. Tidbits of helpful information IV. New clinical trial for people with chemotherapy-induced nausea V. Research Updates VI. Book Ordering Information VII. Newsletter forwarding guidelines VIII Newsletter sign-up instructions IX. Removal Instructions *************************** I. Autographed books and past newsletters Just as a reminder, personally autographed copies of my book A Dietitian’s Cancer Story are now available through Nicola’s Books in Ann Arbor, Michigan. It’s easy to order the book directly from her web site at http://www.nicolasbooks.com, which has a space to indicate how you would like the book inscribed. They will mail the book anywhere in the world. It has been fun to see where all the books have been sent. All previous newsletters are now archived on my web site. Just click the Newsletter button on the Homepage to find them. Of special interest, all the information contained in these newsletters is also searchable with the search function available to use on my web site. *************************** II. Spanish edition of my book – Historia De Cáncer De Una Dietista "This book is so helpful and inspirational that I volunteered to translate it into Spanish in order to share this valuable information with the Spanish-speaking community." – Maria Duarte-Gardea, PhD, RD, LD, Assistant Professor Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA The estimated Hispanic population of the United States is nearly 40 million people, with the following states having the highest proportions of these Spanish-speaking communities: California, Texas, New York, Florida, Illinois, Arizona, New Mexico, and New Jersey. No matter where you live, please consider ordering the Spanish edition of my book to donate to your cancer center’s patient library or resource center, or your local public library. Copies may be ordered from any bookstore, Amazon.com, or directly from AICR by calling 1-800-843-8114. Please help me reach this population of cancer survivors with both “information and inspiration”. I appreciate your help. Thanks very much! *************************** III. Tidbits of Information (A) Recurrent Cancer – The National Cancer Institute is developing a new booklet to address questions and concerns of people with recurrent cancer. They would like to hear your reactions to the booklet. If you have been diagnosed with recurrent cancer within the last year, and would be willing to read the booklet and then spend about 30 minutes on the phone to let NCI know your opinions, please call NCI toll-free at 1-888-249-0029. All eligible participants will be paid for their time, and this study will only involve a total of 1-2 hours. (B) Cancer survivor movie - http://www.thesurvivormovie.com/ Don’t plan to whip through this short movie or read your mail at the same time. Make yourself a cup of green tea to sip while watching this brief tribute to cancer survivorship. You’ll be glad you gave yourself the opportunity to pause and reflect on what you have accomplished thus far, still have to do, or appreciate the significance of the journey being taken by your friends, loved ones, or patients. (C) The NCI Cancer Advocates E-News – an Email newsletter for cancer advocates and the general public interested in cancer news from NCI and other federal agencies, clinical trials and new treatment updates, NIH video casts, press releases, and opportunities to become involved. The newsletter comes every other week. To subscribe: send an Email to listserv@list.nih.gov, type the following command in the body of the message: subscribe cancer-advocates. (D) Zonya’s Health Bites: The Show for Food, Fitness, and Fun – My own PBS television station is finally going to start airing the new 30 minute show called Zonya’s Health Bites: The Show for Food, Fitness, and Fun by Zonya Foco, RD, CSP. You can check her web site at http://www.zonya.com/healthbites.htm to see if your local PBS station has it in their line-up. If not, call the station to request it! (E) New book – Over 140 Things you need to know about your Autologous Bone Marrow or Stem Cell Transplant by Mark Patton, MGC Publications, Bayside, Wisconsin, ©2005. Ordering information is at www.BMTresources.org, and a portion of the proceeds are donated to the Bone Marrow Foundation to help patients in need of financial assistance for their transplants. A wealth of practical advice from a very experienced patient. I especially liked Tip #74 – utilize the expertise of the transplant centers “outstanding dietitians”. *************************** IV. New Clinical Trial A new clinical trial funded by the NCI and National Center for Complementary Medicine is comparing different doses of ginger in patients with chemotherapy-induced nausea and vomiting. The study is currently recruiting patients. Study sites are in Michigan, New York, Indiana, and Puerto Rico. Further information regarding the study design and objectives, eligibility, and study sites contact names and phone numbers can be found at the following web site:http://www.cancer.gov/clinicaltrials/CCUM-0201 *************************** V. Research Updates (A) Women’s Intervention Nutrition Study (WINS) was finally presented at The American Society of Clinical Oncology’s annual meeting in May 2005. Further information can be found at the following web site:http://www.cancer.gov/clinicaltrials/results/low-fat-diet0505 In a nutshell, this large research study showed that post-menopausal breast cancer patients given intensive nutrition education and on-going support from a Registered Dietitian (RD) in order to achieve and maintain a low-fat diet (target was 15%, actual intake ~20%) had a lower rate of breast cancer recurrence than women who were asked to follow their regular diet. The overall risk reduction for recurrence was 24% but the subgroup of women with ER-negative tumors had a 42% risk reduction for recurrence during the 5 year follow up time period. This research has not yet been published, and combing the data with a fine-tooth comb may still show that other factors also helped reduce the risk of recurrence, such as weight loss, increased exercise, increased consumption of fruits and/or vegetables, etc, even though these lifestyle changes were not the primary interventions or variables being studied. Take home message – If you are a breast cancer survivor (either in treatment or after treatment completion), don’t wait for your oncologist or surgeon to suggest that you see an RD as part of your comprehensive cancer care. Ask for a referral today for the RD at your cancer center or seek out the professional expertise of an RD in private practice in your locality by going to the web site for the American Dietetic Association (http://www.eatright.org) and typing in your zip code. Look for an RD with expertise in oncology and/or weight management. (B) Two recently published studies show that patients who received concurrent individualized dietary counseling while undergoing radiation therapy for either colorectal cancer or head and neck cancer had improved nutritional and quality of life outcomes. These well-designed research studies will likely prove to be classic, landmark studies leading to the increased provision of proactive nutritional care for cancer patients. 1. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Ravasco P, et al., J Clin Oncol. 2005 Mar 1;23(7):1431-8. This study compared three groups of colorectal cancer patients, all undergoing radiation therapy: (1) the first group received individualized dietary counseling as directed by their food preferences and symptoms of the disease or radiation side effects, (2) the second group did not receive any counseling but received 2 cans/day of a high protein and calorie liquid supplement to drink in addition to their usual food intake, and (3) a third group consumed only their usual food intake the best as possible during radiation therapy without any counseling or liquid dietary supplements. The results showed that individualized dietary counseling was the most effective means leading to improved nutritional intake, nutritional status, and quality of life during radiation, at the end of radiation, and particularly 3 month after radiation therapy had been complete. 2. Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Ravasco P, et al., Head Neck. 2005 May 26;27(8):659-668. With an identical study design to the colorectal study already mentioned, again, only the group of head/neck cancer patients who received the individualized dietary counseling during radiation therapy had the most improved nutritional intake, nutritional status, and quality of life indicators at both the end of radiation therapy and even more significantly 3 months after radiation was complete, even overcoming the usual nutritional deterioration seen with radiation therapy for head/neck cancer. Quality of life outcomes like physical and cognitive functioning have traditionally been considered *soft* results by the research community. However, these authors state that they should be the “gold standard” in any clinical trial. Ask any cancer survivor if quality of life is important, and even as important as the more commonly used endpoints that involve some measurement of tumor response. Which group would you want to be in? The time is rapidly approaching, if not already here, when patients at high risk of nutritional decline during cancer therapy plus those for whom nutritional intervention may impact disease progression will benefit by receiving medical nutrition therapy from RDs as a proactive component of comprehensive cancer care. Take home message from both of these studies – speak up and insist on having an RD be part of your oncology health care team in a proactive role (i.e., not just receiving a consult after you have lost or gained 30#). I have heard from cancer survivors across the country that “shopped around” to find a cancer treatment team that included an RD. Ask up front and express your desires (do I dare say requirements?) One last note: don’t assume a center does not have an RD on staff, as some progressive cancer treatment facilities have figured out ways of including their expertise as part of the complete cancer care package. (C) Two recent flaxseed studies from Dr. Lilian Thompson’s lab in Toronto will be encouraging for those who have had concerns that the most active component of flaxseed, a phytoestrogen abbreviated SDG, may promote estrogen responsive tumors or even interfere with the anti-estrogen drug Tamoxifen. (1) Dietary flaxseed enhances the inhibitory effect of Tamoxifen on the growth of estrogen-dependent human breast cancer (mcf-7) in nude mice. Chen J, Hui E, Ip T, Thompson LU, Clin Cancer Res. 2004 Nov 15;10(22):7703-11. This mouse study clearly showed that dietary flaxseed given in an amount equivalent to the human intake of 25-50 gm per day (25 gm = approx. 2 Tbsp) inhibited the growth of human estrogen-dependent breast cancer and also increased the tumor-inhibitory effect of Tamoxifen at both low and high level of estrogen levels. The mechanism(s) for this effect is not yet clear but is likely multi-factorial in nature involving several non-hormonal pathways. In general, ground flaxseed showed more positive effects in the mouse study than the use of flaxseed oil. An additional important finding was that while Tamoxifen increased the weight of the uterus 39% in the low estrogen group (indicating an estrogenic effect) compared to the control, flaxseed alone had no effect on weight of the uterus. Note: Many women who now take another anti-estrogen drug called an aromatase inhibitor (AI) will wonder if there are data to evaluate how flaxseed might interact with the action of aromatase inhibitors. No comparable study has yet been published but additional recently published in vitro work by Dr. Thompson has shown that the active components produced from flaxseed (and also the active component of soy) greatly reduce the activity of the aromatase enzyme in estrogen-dependent breast cancer cells grown in cell culture. Further research is warranted, but these results are encouraging. (J Steroid Biochem Mol Biol. 2005 Apr;94(5):461-7) (2) Dietary flaxseed alters tumor biological markers in postmenopausal breast cancer, Thompson LU, Chen JM, Li T, Strasser-Weippl K, Goss PE, Clin Cancer Res. 2005 May 15;11(10):3828-35. Publication of this study has been long awaited. Post-menopausal women who had a breast biopsy positive for breast cancer consumed either a muffin containing 25 grams of flaxseed or a control (placebo) muffin daily during the time frame between the biopsy and breast cancer surgery with various tumor biological markers measured at the time of biopsy and later surgery. This human study very clearly showed that dietary flaxseed favorably impacted existing both ER-positive and ER-negative breast tumor cells in a short time period (32 days) by showing reduction in tumor cell proliferation markers, increased cell death (apoptosis index), decreased expression of the aggressive HER2 gene (c-erbB2 score), and the total intake of flaxseed correlated with the changes seen for both the c-erbB2 score and the apoptosis index. The author states that these results suggest that the dietary intake of flaxseed has the potential to reduce the growth and invasiveness of breast cancer. Additional research is needed, but again, these results are very encouraging. Take home message from these flaxseed research reports: Dietary flaxseed in reasonable amounts looks to be very promising as adjunctive therapy for both ER-positive breast cancer and ER-negative breast cancer. The amount used in the muffin study and the comparable amount used in the mouse study is easily achievable. One to two Tbsp. of whole flaxseed can be obtained by consuming my soy shake recipe on a daily basis (http://www.cancerrd.com/Recipes/supersoy1.htm). Other recipes on my web site that contain flaxseed as an ingredient include: * Banana Walnut Flaxseed Muffinshttp://www.cancerrd.com/recipes/banana_walnut_flax_muffins1.htm * Flaxseed Pesto  http://www.cancerrd.com/recipes/flaxseedpesto1.htm * Rice Pudding  http://www.cancerrd.com/recipes/ricepudding1.htm * Granola with Soy and Flaxseedhttp://www.cancerrd.com/recipes/granola_soy_flaxseed1.htm Sprinkle ground flaxseed on cereal or yogurt, mix it into veggie burgers, tuna or egg salad, pancake or waffle batter, etc, etc. Please write and tell me your favorite way to eat flaxseed. Send a message to newsletter2@cancerrd.com and put Flaxseed in the subject line. I’ll put some more ideas into my next newsletter along with an update about an additional study published by Dr. Thompson. *************************** VI - Book Ordering Information Both editions of A Dietitian's Cancer Story, the updated and revised 2002 edition (ISBN 096672383X) and the Spanish edition published in 2000 (ISBN 0966723821) can be ordered from any bookstore, library, Amazon.com, and directly from the American Institute for Cancer Research (AICR) by calling 1-800-843-8114 or going to their web site <http://www.aicr.org>. Discounts for orders of 10 or more copies are available for both editions by calling AICR at 1-800-843-8114 - asking to speak to Candis Navarette. Many cancer centers, health care professional offices, and places of worship have ordered books in larger quantities to have available to give as educational and support information or to resell. Bookstores and libraries may order directly from the book wholesaler Ingram. *************************** I send my best wishes to all of you for health, healing, and hope! Diana -- Diana Grant Dyer, MS, RD - Author A Dietitian's Cancer Story (English and Spanish translation) Available from AICR (call 1-800-843-8114) "Information and inspiration for cancer survivors" Proceeds donated to the Diana Dyer Cancer Survivors' Nutrition and Cancer Research Endowment at the American Institute for Cancer Research (AICR)