Chronic Fatigue in Cancer Survivors can be Fought With a Healthy Diet

Highlights:

Long-term, persistent fatigue is the most commonly reported side effect in cancer survivors
Cancer-related fatigue reduces the quality of life, and treatments are limited
A healthy diet including eating at least one high vitamin C fruit, one yellow or orange vegetable, one tomato serving, one leafy green serving, 3 servings of whole grains a day; and 2 servings of omega-3 fatty acid rich foods a day, whether plant or seafood-based has shown to decrease fatigue in cancer survivors

Cancer survivors are in a state of chronic fatigue because of treatments and the disease itself. A new study shows that intentionally modifying their diet can reduce chronic cancer-related fatigue.

Chronic fatigue is the most widely reported lingering side effect of cancer treatment among all cancer survivors. Research has shown that persistent fatigue has been linked to depression, anxiety, and an overall reduced quality of life ().

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‘In a recent study, healthy diet has been shown to decrease chronic fatigue in cancer survivors’

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Lymphoma Survivors and Chronic Fatigue

“This is especially prevalent for lymphoma patients, where up to 60% of survivors specifically report fatigue that lasts beyond treatment completion. We believe that there are some foods rich in specific nutrients that may help reduce inflammation in the body and help improve fatigue,” said Tonya Orchard, lead author of the study and an associate professor in the College of Education and Human Ecology.

For this research, the investigators wanted to know if it was feasible to recruit and retain lymphoma survivors in a remotely delivered nutrition counseling intervention that focused on nutrient-rich whole foods to improve fatigue symptoms. The Ohio State research team recruited 10 patients with diffuse large B-cell lymphoma to participate in a pilot study of a 12-week dietary intervention to reduce fatigue and improve overall diet quality.

Previous studies have suggested that dietary interventions with an intentional focus on increasing levels of lycopene and other carotenoids from colorful foods, certain B vitamins, and omega 3 fatty acids, which are obtained from whole foods and not supplements, can result in significant change that dramatically increase quality of life.

In this study, all participants had completed chemotherapy and been in remission for at least two years.

Patients received one-on-one nutrition counseling from a registered dietitian nutritionist over four weekly and four bi-weekly sessions. Participants were asked to incorporate whole grains, vegetables, fruit, and fatty fish or plant-based foods with high levels of dietary omega-3 polyunsaturated fatty acid (n-3 PUFA) in their diet.

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Diet for Cancer Survivors

Participants were given goals for the various groups and could choose whichever specific foods they liked. The overall goal was to improve diet quality. Specific food goals included: eating at least one high vitamin C fruit a day; one yellow or orange vegetable a day; one tomato serving a day; one leafy green serving a day; 3 servings of whole grains a day; and 2 servings of omega-3 fatty acid rich foods a day, whether plant or seafood-based.

The dietary pattern was based on previously published research from one of the study co-investigator, Dr. Suzanna Zick, suggesting that foods rich in carotenoids, lycopene, certain B vitamins, and omega 3 fatty acids improved fatigue in breast cancer survivors.

“It may be the synergistic effect of the nutrient-rich foods that create healthful changes in our bodies long term. There is much that we don't understand about this process yet,” said Anna Maria Bittoni, a dietitian with the OSUCCC – James and study coauthor.

Participants were given a dietary intervention booklet with specific food lists to fit each category and suggested ways to use them in sample recipes. Dietitians then worked with cancer survivors to provide counseling on making sustainable dietary changes and addressing potential barriers to implementation of these dietary changes, such as taste preferences, cooking skills, and time limitations. The intervention was tailored to the individual to address both dietary preferences and behavioral barriers.

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Role of Telehealth in Helping Cancer Survivors Choose Healthy Foods

Results of the study suggest that this remote “telehealth” format was feasible and acceptable for this group of lymphoma survivors. Researchers were able to retain 90% of the participants in the 12-week intervention and adherence to study goals was high. By the end of the intervention, participants were able to meet goals for intake of specific food groups on an average of 4.8-6.1 days of the week.

The vast majority of study participants were able to meet targeted food goals by study completion. Participants increased whole fruit consumption by 1.28 cups per day, with consumption of non-juice fruit including citrus, melon, and berries increasing by 0.83 cups per day. Their vegetable intake increased significantly from 2.05 cups per day to 3.76 cups per day. The consumption of omega-3 PUFA fish increased from 1.76 serving per day to 3.75 servings per day. Whole grain consumption also increased from 1.2 servings per day at baseline to 3.65 daily.

The pilot study also showed that participants significantly increased their Healthy Eating Index 2015 score, which is an established metric for an overall healthful eating pattern based on U.S. Department of Agriculture dietary recommendations.

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Healthy Diet Decreases Fatigue

Participants reported their fatigue through a self-reported system called the PROMIS (patient reported outcome measure information system) fatigue score. This score was seen to dramatically reduced after the intervention. The researchers also note that this is encouraging preliminary data and suggest that the dietary intervention may be effective in reducing cancer related fatigue. However, since the study had no control group, additional research is needed to test this.

“More patients are surviving and living well beyond cancer. As we look at the bigger picture of survivorship, it is so important that we acknowledge and address long-term side effects of cancer and cancer treatment, such as chronic fatigue. Diet is an accessible and realistic opportunity to make a positive impact on the quality of life for cancer survivors, and is worthy of further investigation,” said Orchard.

Reference:

A remote Whole Food Dietary Intervention to Reduce Fatigue and Improve Diet Quality in Lymphoma Survivors: Results of a Feasibility Pilot Study - (https://pubmed.ncbi.nlm.nih.gov/36755357/)

Source-Medindia