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Michelle Morrisey
Nutrition 409
Professor Joan Rupp
21 April 2015
Field Trip Reflection: Oncology
Cancer treatment is a long and vigorous process, and can be extremely difficult on
the patient. About 60% of patients with cancer receive radiation therapy at some point in
their treatment course (1). The acute side effects of therapy are related to the site being
treated and can include dysphagia, taste changes, pain, xerostomia, mucositis, nausea and
vomiting, diarrhea, and the appearance of anorexia or cachexia (1). Those side effects can
impede the ingestion and absorption of food, therefore negatively impacting a patient’s
nutritional status. Impaired nutritional status affects quality of life, frequency of emergency
room visits and hospitalizations and ultimately, morbidity and mortality of the patient (1).
The doctor’s job is to treat the cancer, but who then is to treat the treatment? Lori
Thacker does, at the UC San Diego Moores Cancer Center. Every Tuesday and every other
Thursday she sees out-patients and talks with them about ways to maintain normal eating
patterns even with such an awful disease. Thanks to Dr. Oz, Lori sees a lot of patients who
are looking to make dramatic changes in their diet in an attempt to “cure” their cancer.
Lori’s job is to straighten out the facts, and ensure the patients that there is no need to
make any dramatic changes to their diet. Some of her more serious patients have
dysphasia, nausea and vomiting, and other side effects that make eating extremely difficult.
When this is the case, the primary concern is making sure the patient is not malnourished.
High calorie plant based foods like nuts and nut butters are often prescribed, but if eating is
too difficult, patient may have to start on enteral nutrition.
Maintaining adequate nutrition status in head and neck cancer patients is
challenging, but dietetic intervention can improve clinical outcomes. Unfortunately, many
patients are non-compliant with dietary advice when it is provided. Behavior Change
Counseling, a patient centered approach that incorporates motivational interviewing and
behavioral strategies, is an empirically supported approach for promoting behavior change
(2). When dietitian integrate behavioral change counseling into standard consultations,
they can greatly improve patient compliance outcomes (2). This improves the patient’s
nutrition status as well as their overall quality of life.
I really enjoyed this visit to the Moores Cancer Center. Similar to our other
excursions, Lori explained the need for patients to see dietitians, but the hospital’s lack of
scheduling them. The room we toured was a very small examination room, but Lori told us
that is where she sees patients on Thursdays. It really goes to show how much Lori believes
in what she does, even if the hospital does not prioritize her work. It was also interesting
hearing about her other jobs. Her work with ALS and Huntington’s patients seemed a little
more fast-paced, due to the nature of the diseases, but also extremely rewarding.
Lori’s description of her job really emphasized that being an expert in nutrition is
only the first thing to being a good dietitian. This field requires so much patient interaction
it is necessary to also have a good personality. When speaking with her oncology outpatients, she always checks for non-verbal cues. Cancer treatment is so draining, patients
exhaust easily sometimes. If she senses a patient getting tired, Lori invites them to leave a
little early. Additionally, it’s not just about counseling with the patient, but with the
caregiver as well. This disease can be almost just as difficult on the patient’s loved ones
sometimes. Because they’re often the ones preparing the food, it is important to give them
the same nutrition education and counseling.
The UC San Diego Moores Cancer Center is a prominent leading institution in the
nation dedicated to scientific innovation and clinical excellence (3). It has one of the highest
achievements in cancer research, clinical care, and education, and prides itself on its
contributions to the community. The Moores Cancer Center’s mission includes creating
personalized cancer medicine by creating, translating and disseminating exceptional
cancer science and medicine (3).
Works Cited
1. Gosselin, TK, L Gilliard, and R Tinnen. "Assessing the Need for a Dietitian in
Radiation Oncology." Clinical Journal of Oncology Nursing, 12.5 (2008): 781-787.
2. Beck, AK, AL Baker, B Britton, G Carter, J Bauer, C Wratten, L Wolfenden, P McElduff,
and L Thornton. "Therapeutic Alliance Between Dietitians and Patients with Head
and Neck Cancer: Relationship to Quality of Life and Nutritional Status Following a
Dietitian Delivered Health Behaviour Intervention." Asia-pacific Journal of Clinical
Oncology, 8 (2012): 340.
3. "Moores Cancer Center." UC San Diego Health Sciences. N.p., n.d. Web. 21 April.
2015. <http://cancer.ucsd.edu/about-us/Pages/center.aspx>