What is an Oncology Dietitian?

When you have cancer, your body needs proper nutrients and calories to recover from treatment. Yet, eating well can be difficult when you feel nauseous or don’t have the energy to cook. That’s where an oncology dietitian comes in.

An oncology dietitian (also called an oncology nutritionist) is a key member of your cancer care team. Typically, your oncologist will refer you to an oncology dietitian.

With their extensive background in nutrition, oncology dietitians help you create a meal plan that promotes healing and minimizes side effects while undergoing cancer treatment.

With the help of Melinda Pundt, RDN, LDN, senior dietician nutritionist at the Levine Cancer Institute, we provide more insight into what an oncology dietitian does and how they can support you on your journey to recovery.

An oncology dietitian works with cancer patients and their families to develop a diet during radiation.

This medical professional helps patients adjust their nutritional intake to optimize health and minimize side effects caused by cancer and cancer treatments.

After gathering more information, your oncology dietitian will develop a nutrition plan with specific food-related goals. This plan will likely include lots of fruits, vegetables, and lean proteins. But it may also include surprising foods like gravy or milkshakes.

Some of the food-related goals within a meal plan are specific to the patient.

For example, if you have experienced dramatic weight loss during chemotherapy, your goal may be to gain 20 pounds. To increase your body mass, your oncology dietitian may offer specific calorie and protein benchmarks.

Your oncology dietitian may also offer:

• Simple, practical tips and advice to help you achieve your nutritional needs
• Advice on ways to deal with weight loss, fatigue, and nausea brought on by illness or treatment side effects
• Personalized guidelines based on your biological needs and unique circumstances
• Plans for families or caregivers in support of your nutritional needs
• Recipes, lists of foods, dietary supplements, and vitamins

Good nutrition in cancer patients has been linked to better chances of recovery and lower incidences of remission.

A well-rounded diet can also:

• Prevent or combat malnourishment
• Mitigate the deterioration of lean body mass
• Help the patient recover from treatment
• Reduce complications and related illnesses
• Bolster strength and energy
• Increase quality of life

“Your body is constantly having cells damaged from treatment and having cells repair after treatments,” Pundt offers.

“A balanced diet helps provide your body with the vital vitamins, minerals, protein, and energy to help it repair and heal after every treatment.”

Pundt says that creating a nutritional guide for cancer patients is a delicate balance.

Though the patient needs to consume a diet full of nutrient-dense foods, they also need to eat what tastes good to them.

“Overall, we want the majority of our diet to come from nutrient-dense sources, including whole grains, lean protein, healthy fats, vegetables, and fruits,” Pundt says.

“But this does not mean every single meal and snack has to be perfectly balanced. Our comfort foods still provide us with nutrients and joy.”

Many cancer patients are intimidated by oncology nutritionists. They worry that the dietitian will be overly critical of their current diet or suggest they stop eating their favorite foods.

However, your oncology nutritionist is here to support you. Just like how you have a say in choosing your cancer treatment plan, you also have a say in what you eat.

“There are no bad or off-limit foods,” adds Pundt.

“During treatment, your body is using more energy than it would normally. The foods that bring you joy can help with getting in some extra nutrients to support your body during treatments so you can finish treatment on time.”

During your first consultation, your oncology nutritionist will perform a physical assessment. Since 85% percent of cancer patients experience malnutrition at some point during treatment, your dietitian will look for fat and muscle loss, thinning hair, brittle nails, and other tell-tale signs of a nutritional imbalance.

The nutritionist will also ask you lots of questions about your diet, like:

• How many meals do you eat per day?
• When do you eat each meal?
• Do you drink soda and other high-sugar beverages?
• What side effects or symptoms are you experiencing?
• Do you experience these symptoms after eating certain foods?
• What are your favorite foods?
• When you feel sick, what do you crave?

“We like to get a feel for our patients’ baseline or normal diet. This can help us identify changes in their diet during treatment,” says Pundt.

“We also like to review any possible nutrition-related side effects that patients may experience while undergoing treatment and address these as needed.”

To get the most out of your first dietitian consultation, Pundt suggests that patients:

• Make a list of medications, supplements, and vitamins. If you can’t bring all of your bottles with you, take photos.
• Note any side effects you are experiencing and when you experience them (e.g. nausea after eating breakfast). Your dietitian may be able to recommend certain foods that will ease symptoms.
• Keep a food log for at least a week ahead of time. “Sometimes we aren’t eating as balanced as we may think,” says Pundt. “Food journaling can help you and your dietitian identify if there is anything missing in your diet.”
• Any questions you may have. “We want you to be active and present in the management of your health and nutrition,” Pundt says.

Eating a balanced diet can be difficult for anyone. But many cancer patients experience treatment side effects or symptoms related to their disease that make it less pleasant to eat the right way. Download our free Guide to Diet & Nutrition During Radiation Therapy for more information.

Below are some of the common nutrition challenges many oncology patients experience.

Cancer can alter your metabolism or the way your body turns food into energy. As a result, your appetite may change.

If you don’t feel hungry or get full too quickly, your oncology dietitian may suggest:

• Eating five to six small meals throughout the day
• Keeping an eating and drinking schedule with an alarm set on your phone
• Storing snacks on your bedside table
• Making mealtime an experience – set the table, put on music, gather friends and family

“Eating less than what your body needs due to decreased appetite can lead to complications when receiving cancer treatment,” says Pundt.

“Eating less than what your body needs can lead to unintended weight loss, increased side effects of treatment, unplanned treatment breaks, decreased energy and weakness, and, in more serious situations, malnutrition.”

Some patients experience the opposite problem: they are always hungry. Though food is key to maintaining strength and energy levels, overeating can lead to unneeded weight gain.

If you can’t seem to curb your appetite, your oncology nutritionist may suggest:

• Limiting high-calorie foods like pizza, fried chicken, ice cream, and baked goods
• Eating higher-fiber foods like fruits, vegetables, and whole grains
• Including lean proteins (e.g. chicken, turkey, fish, beans) in each meal
• Drinking tea, decaffeinated coffee, seltzer water, or water with lemon between meals

Constipation is very common among patients receiving cancer treatment. In some cases, the backup is due to decreased water consumption and inactivity. In other cases, chemotherapy drugs are to blame.

If you are experiencing constipation, your oncology dietitian may suggest:

• Choosing high-fiber foods like whole grains, fruits and vegetables, and nuts
• Drinking prune or apple juice
• Keeping track of your fluid consumption
• Drinking hot drinks like tea and decaffeinated coffee

If you are receiving radiation to the abdomen or pelvic area, you may be facing a different issue: diarrhea. Though both constipation and diarrhea can be dangerous, loose stools can quickly dehydrate an oncology patient.

“Dehydration and electrolyte abnormalities are serious complications that can result from untreated diarrhea,” says Pundt.

“It is important to tell your provider right away if you begin to experience watery bowel movements. Diarrhea can also lead to inadequate nutrition because foods move too quickly through the system.”

To ease your gastrointestinal discomfort, your oncology nutritionist may suggest:

• Sticking to the BRAT diet: bananas, rice, applesauce, and toast
• Drinking fluids with electrolytes (e.g. coconut water, diluted fruit juices, Pedialyte)
• Avoiding fatty and greasy foods
• Limiting high-fiber foods like fruits and vegetables

Fatigue is one of the most common side effects of all cancer treatments. Though fatigue doesn’t necessarily affect the appetite, it does affect a patient’s ability to cook healthy, nutritious food for themselves.

If you are experiencing fatigue, your oncology nutritionist may suggest:

• Cooking freezable soups or stews on days you have more energy
• Asking friends and family to start a meal train
• Purchasing convenient – but still healthy – pre-made foods
• Splurging on a meal delivery service

Pundt recommends turning to your network of friends and family for help creating a “survival kit” that includes easy-to-prep foods like microwaveable rice, canned beans, tuna, frozen microwavable veggies, peanut butter, canned fruits/veggies, single serving yogurts or cheese sticks, or anything else that requires little to no cooking.

If you are receiving chemotherapy or radiation therapy, you may notice symptoms of dry mouth. You may be excessively thirsty, for example, or have thick saliva.

To combat dry mouth, your oncology dietitian may suggest:

• Avoiding alcohol and limiting caffeinated drinks
• Chewing on sugar-free gum between meals
• Adding lemon or lime to water
• Incorporating citrus into salad dressings
• Keeping track of your water consumption

Most patients who receive chemotherapy experience nausea and vomiting. These uncomfortable side effects are also common among patients receiving radiation to the brain, gastrointestinal tract, and liver.

“Your oncology dietitian can work with you to come up with foods that may be better tolerated when you are not feeling well,” says Pundt.

“Be sure to talk to your provider about medications that can help ease nausea and vomiting if it is an issue for you!”

To ease your nausea, your oncology dietitian may suggest:

• Eating a small amount every one to two hours
• Choosing bland foods like crackers and rice
• Drinking ginger tea or chew ginger candies
• Limiting greasy or heavy foods

During your consultation, your oncology dietitian will also discuss food safety. Since cancer and cancer treatment can weaken your immune system, it’s important that you avoid food-borne illnesses like salmonella and norovirus.

“Food safety is especially important for those that may have a weakened immune system, like oncology patients. Certain cancer treatments can make it harder for your body to fight off infection so it is important to follow basic food safety rules to lower your risk of getting a foodborne illness,” offers Pundt.

To keep your food safe, your oncology dietitian will recommend:

• Washing your hands before eating
• Keeping surfaces that come into contact with food clean
• Keeping hot foods above 140°F and cold foods below 40°F
• Avoiding cross-contaminating meats and vegetables
• Washing raw fruits and vegetables before consumption
• Avoiding high-risk foods like sushi, undercooked eggs, raw milk or cheese, raw sprouts, and self-serve buffets

The cancer journey is full of uncertainty. As you cope with this uncertainty, it’s important to have a team of expert medical professionals who can provide guidance and support.

At SERO, our cancer care team consists of oncology dietitians as well as radiation oncologists, dosimetrists, physical therapists, social workers, and other skilled individuals. When you partner with us, you will be backed by a team of compassionate and knowledgeable professionals who want nothing more than to see you healthy.

To learn more about SERO and the services we offer, call us at 704-333-7376.