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Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.

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MM Oncologists Don’t Discuss Healthy Lifestyles

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I have focused the study below on myeloma oncology. In my experience MM oncologists don’t discuss healthy lifestyles. In some cases newly diagnosed MM patients are told to eat whatever they want.

The main issue is that the FDA does not include nutrition in the standard-of-care therapy plan for all NDMM patients. I understand how and why the FDA does what it does.

But I draw the line with MM oncologists. A sentence from the study below cites an oncologist who says that there isn’t enough time in an appointment and that oncologists are not trained to discuss nutrition.

Really? Not enough time? Not trained? And oncology is asking NDMM patients to put their lives in the oncologist’s hands?

I am a long-term MM survivor and cancer coach. I have been researching and writing about anti-MM nutrition for years. While nutrition is not an FDA approved MM therapy, nutrition and nutritional supplementation and lifestyle therapies matter to MM patients.

How can nutrition support cancer patients?

  1. Maintaining Weight and Muscle Mass:
    • Adequate Caloric Intake: Ensuring patients consume enough calories to prevent weight loss and muscle wasting, which are common in cancer patients.
    • Protein-Rich Foods: Including high-protein foods to help repair tissues and maintain muscle mass.
  2. Managing Treatment Side Effects:
    • Nausea and Vomiting: Eating small, frequent meals and choosing bland, easy-to-digest foods can help manage nausea.
    • Loss of Appetite: High-calorie, nutrient-dense foods can help patients meet their nutritional needs even with a reduced appetite.
    • Mouth Sores and Difficulty Swallowing: Soft, moist foods and avoiding spicy or acidic foods can make eating easier.
  3. Supporting Immune Function:
    • Micronutrients: Vitamins and minerals such as vitamin C, vitamin D, zinc, and selenium are important for immune health.
    • Antioxidants: Consuming foods rich in antioxidants (e.g., fruits, vegetables, nuts) can help protect cells from damage.
  4. Improving Energy Levels and Reducing Fatigue:
    • Balanced Diet: A diet that includes a variety of nutrients can help maintain energy levels.
    • Hydration: Adequate fluid intake is essential for preventing dehydration, which can contribute to fatigue.
  5. Enhancing Recovery and Healing:
    • Nutrient-Dense Foods: Consuming foods rich in essential nutrients supports healing and recovery post-surgery or treatment.
    • Omega-3 Fatty Acids: These can help reduce inflammation and support overall health.
  6. Reducing the Risk of Malnutrition:
    • Nutritional Counseling: Working with a dietitian to create a personalized nutrition plan that meets the specific needs of the patient.
    • Supplementation: In some cases, nutritional supplements may be necessary to meet the increased demands.
  7. Improving Quality of Life:
    • Enjoyable Meals: Creating a pleasant eating environment and focusing on favorite foods can improve the patient’s mood and willingness to eat.
    • Routine and Consistency: Regular meal times and familiar foods can provide comfort and stability.

Specific Dietary Recommendations

  1. Proteins: Lean meats, fish, eggs, dairy, legumes, and nuts.
  2. Carbohydrates: Whole grains, fruits, vegetables, and legumes for sustained energy.
  3. Fats: Healthy fats from avocados, olive oil, nuts, and seeds.
  4. Hydration: Water, herbal teas, and clear broths.
  5. Vitamins and Minerals: A varied diet with plenty of fruits and vegetables to ensure adequate intake of essential vitamins and minerals.

Considerations for Different Cancer Types

  • Gastrointestinal Cancers: May require adjustments to avoid foods that irritate the digestive tract.
  • Head and Neck Cancers: Soft or liquid diets might be necessary due to difficulties with chewing or swallowing.
  • Breast Cancer: Emphasis on maintaining a healthy weight and including phytonutrient-rich foods.

I don’t expect elaborate nutritional counseling for every MM specialist. I’m talking about the basics. Actually, all I’m expecting is that each oncologist tells each cancer patient that their nutrition, sleep, stress, exercise, etc. matters to their health.

Are you a newly diagnosed MM patient? Did your oncologist or nurses tell you anything about nutrition? Email me at David.PeopleBeatingCancer@gmail.com 

thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Oncologists Don’t Discuss Healthy Lifestyles With Cancer Survivors

“Physicians caring for cancer survivors don’t always promote healthy lifestyle changes, and oncologists and other specialists are less likely to do so than primary care physicians (PCPs).

So suggest the results from a new survey of 91 physicians.

This included 30 PCPs, 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists who treated survivors of prostate cancer, melanoma, and breast cancer, respectively). In addition, interviews were conducted with 12 oncologists to identify barriers to promoting health behavior change.

Less than a third of the oncologists said that they discuss healthy lifestyles with cancer survivors, citing that time is an issue, that they aren’t trained for it, and that they are concerned that the extra information will overwhelm patients…

In one scenario posed in the survey, a physician had 2 minutes remaining in the visit with a cancer survivor. Only 8.8% reported that they would use that time to discuss topics related to health promotion, but PCPs were significantly more likely to do so vs oncologists and specialists (P = .02).

Similarly, if an overweight patient requested information about weight loss, 93.3% of PCPs reported that they would encourage health behavior change, while less than half of oncologists and specialists would do so (P < .001).

Oncologists perceived weight gain ambivalently, the authors note. One interviewed oncologist commented that “our goal is often don’t lose weight, because losing weight is the first bad sign that we’re heading toward progression of disease. We definitely jump on weight loss and we aren’t so jumpy on weight gain. I often use the phrase, ‘In my world, I’m not too unhappy about gaining weight.’ ”

No Adherence With Weight Loss?

Another finding was concern that the health promotion message would interfere with the use of medication regimens to prevent cancer recurrence. While most physicians believed that at least half of the patients would continue to take their medications, they also felt that patients would not do so if they were also trying to lose weight.

When looking at beliefs pertaining to adherence to drug regimens, physicians predicted that 57% would adhere to their medication regimens, but that percentage dropped to 10.7% if the patient was trying to lose weight at the same time (P < .05).

One oncologist noted that “most people are saying that patients cannot do both . . . like chewing gum and walking.”

Commenting on the findings to Medscape Medical News, Demark-Wahnefried found this surprising, especially since there are no systematic data to support it. “I don’t doubt that this is a finding that arose from this mixed method study, but it only surveyed 30 oncologists from Northwestern University,” she emphasized. “Therefore, I would be cautious on whether these findings can be generalized more broadly.”

While this was a small sample of physicians, and especially oncologists, another commentator noted that it was seen across the board for all the physicians surveyed. Colleen Doyle, MS, RD, managing director of nutrition and physical activity at the American Cancer Society, noted that “the physicians all agreed that there would be reluctance to remain on the treatment regimen, if they are trying to lose weight.”

“Studies like this certainly raise some interesting issues and help us understand things we need to delve into,” she added.

Another expert also found these results unexpected.

“That struck me as odd, unless they are talking about breast and prostate cancer, where patients can gain weight from the treatment, and that may be an issue,” said Deborah K. Mayer, PhD, RN, Frances Hill Fox distinguished professor in the School of Nursing and director of cancer survivorship at the University of North Carolina, Chapel Hill.

“But that’s not the case for all cancer patients,” she said. “And it still doesn’t mean you shouldn’t try losing weight.”

Adherence to long-term medication is an issue, Mayer added, and can be related to cost, toxicity, or other factors, “but I think it might be a stretch to link adherence to weight loss.”

Oncologist Say Cancer Control is Priority

Even though oncologists acknowledged that cancer survivors can derive both physical and psychological benefits from adopting health behavior changes, all of the oncologists interviewed stated that cancer control is their primary concern, which reduced the priority of providing health promotion advice. One oncologist said, “We’re so focused on the life-or-death aspect of cancer, everything falls through the cracks.”

Oncologists also emphasized their lack of time and resources to discuss health promotion during regular visits, and that this type of advice could be provided to cancer survivors elsewhere in the health care system.

Several suggested that “a well established survivorship clinic is the best way to [provide health-promotion advice] . . . because then all [oncologists] would have to do is say, ‘I’d like to refer you to the survivorship clinic.’

A Component of Survivorship

Commenting on the findings to Medscape Medical News, Mayer said that the paper shows that oncologists haven’t fully embraced health promotion as a component of survivorship care. “Screening and surveillance for cancer recurrence is what they do well, but at this point, most patients are also asking what they can be doing at this point to help themselves. This is a time when they may be open to messages about behavior change and health promotion.”

Previous studies have shown that roughly 10% of all survivors follow all of the recommended health behaviors, Mayer noted. “They don’t smoke, they don’t drink a lot, they eat a healthy diet, and maintain a healthy weight.”

“About 10% of patients do none of these things,” she continue, “and the rest (about 80% of patients) are somewhere in between, where there is at least one health behavior can be targeted.”

“So while oncologists may not be doing the health behavior counseling themselves, they could be doing an assessment and referring them to programs or other health professionals,” Mayer suggested.

“Importantly,” Doyle continued, “How do we educate from a communications perspective? This is a very stressful time for the patient, and you want to talk to them and help them in a way that is empowering and motivational, and not what’s going to make them feel guilty.”


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