Recipes help patients put theory into practice
Recipes help patients put theory into practice
Cookbook helps cancer patients with side effects
A cookbook is not usually a tool for patient education. However, "Goes Down Easy" was created to help cancer patients put into practice the lessons they learn about using dietary means to control certain symptoms that result from their cancer or its treatment.
The cookbook, which was produced by the Princess Margaret Hospital Foundation in Toronto, is a collaboration between six registered dietitians at the hospital and cookbook author Elise Mecklinger.
"When we were approached by the foundation about putting a cookbook together as a fundraiser, we thought this was a great opportunity to do something different. Instead of just putting recipes together, we would provide an educational tool that would benefit people with cancer, their caregivers, friends, and family," says Daniela Fierini, RD, the lead dietitian on the project.
Fierini says all six dietitians on staff provide people with strategies on diet changes when they experience treatment challenges, but often patients and families want recipes to help them implement the suggestions.
"It wasn't enough that we could provide them with the strategies; they wanted to know practical ways of either preparing the food themselves at home or if they were a caregiver to find new recipes that would help their loved ones," says Fierini.
For example, a person experiencing diarrhea would be told they could develop temporary lactose intolerance and therefore should use soy products or lactose-free dairy products. Also, they would be told to avoid caffeine, which could stimulate the gastrointestinal movement, and to use fewer spices. Lower-fat foods would be a better choice because fatty foods could aggravate the stomach and certain types of fiber could also make the problem worse.
"Once we gave the patient all that information, they weren't sure what to eat," says Fierini.
Using "Goes Down Easy," cancer patients experiencing diarrhea would find such recipes as lactose-free baked custard or a main dish that is familiar to most but has less fat and fiber then usual. In addition, cooking methods are selected that keep the fat amount low.
The cookbook covers most common eating problems associated with cancer and its treatment, including loss of appetite, nausea, taste changes, a sore mouth or swallowing problems, and diarrhea. Each chapter includes advice from dietitians, a sample meal plan as well as suggestions to maintain weight and strength and to keep well hydrated. Its purpose is to ensure meals include enough calories, protein and fluid.
"Research shows that about 50% of people who undergo cancer treatment will develop nutritional deterioration and about one-fifth of those will die of malnutrition; so it is important to try to maintain adequate intake of protein and calories to make it through the treatment. Nutrition will not cure the cancer, but it certainly is helpful to get people to maintain their strength, stamina, and energy to get through the treatment that is planned for them," says Fierini.
Recipes perfected
Each of the dietitians at Princess Margaret Hospital took a symptom and wrote strategies a patient would be given to address the problem. For example, with loss of appetite the patient would need small portions and food that is visually appealing and does not have a strong smell.
Once the dietitian provided the guidelines, Mecklinger would create about 20 recipes addressing the symptom. The team would then meet to review the recipes. Once the recipes were agreed upon, they were sent to professional home economists to review and also to prepare in their own homes to determine whether the product could easily be reproduced.
Many of these recipes were then tested by cancer survivors. In addition, chefs were used to produce the recipes. Some of the dishes were served at a restaurant to see if people liked them.
This testing helped uncover flaws in recipes. For example, the rice pudding in the chapter on sore mouth and swallowing problems became sticky once it sat an hour and was therefore not appropriate for someone with swallowing difficulties and had to be revised.
A dietitian also did a nutrient analysis for each recipe.
Other factors, in addition to dietary concerns, were considered when creating the cookbook. These included varying levels of cooking skills, financial constraints, time constraints, fatigue and stress, physical limitations, a compromised immune system, variable literacy level, and a multicultural population.
"We tried to use ingredients that were easy to find so people didn't have to run around to gourmet stores," says Fierini.
Also the cookbook is meant to trigger ideas on how to revise recipes at home so people can modify their favorites.
The side effects of cancer and its treatment can impact patients in many ways. Loss of appetite can result in weight loss and nutritional compromise, nausea can lead to dehydration especially if vomiting is a factor, and foods can taste "off" or metallic.
In addition to helping patients meet their nutritional needs regardless of symptoms, "Goes Down Easy" helps fund research, education and the enhancement of patient care at Princess Margaret Hospital and the Ontario Cancer Institute.
(Editor's note: To purchase "Goes Down Easy" visit www.pmhf.ca.)
Sources
For more information about "Goes Down Easy," contact:
- Daniela Fierini, RD, clinical dietitian, University Health Network/Princess Margaret Hospital, 610 University Ave., Rm 15-613, Toronto, Ontario M5G 2M9. Phone: (416) 946-4501. Ext. 5546. E-mail: [email protected].
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