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Non-Small Cell Lung Cancer and Nutrition

Salina Judd, Ashley Newcomer, & Abigail Mendenhall

02 March 2016
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Introduction

Cancer is a very prevalent disease. The second most common type of cancer among men and

women is lung cancer (Key Statistics for Lung Cancer, 2014). Unfortunately, there is no cure

for lung cancer and it has a very low 5-year survival rate of 49% when diagnosed in the earliest

stage (Key Statistics for Lung Cancer, 2014). One of the most common treatments used to

reduce the cancer and to prolong the life of the patient is chemotherapy. Nutrition plays an

important role in maintaining the patients strength and well-being during these treatments and in

prolonging their survival. More research is needed to determine specific foods and supplements

that may be beneficial during chemotherapy treatments for non-small cell lung cancer patients.

Cancer

Although prevalent, many people do not understand what cancer does to the body. The

American Cancer Society explains that cancer is developed when new cells that the body does

not need, or when old or damaged cells do not die as they should (Lung cancer non-small cell,

2014). This leads to a buildup of extra cells, forming masses of tissue called growths or tumors.

Cancer spreads by breaking away from the original tumor, entering the blood vessels or lymph

vessels, attaching to other organs and forming more tumors or growths (Judd, 2008, p. 465).

Lung cancer is one of the most common forms of cancer, and is characterized by two different

types: small cell and non-small cell. Lung cancer can be diagnosed through a physical exam, a

chest x-ray, or a CT scan. Treatment may include radiation therapy, surgery, chemotherapy, or

targeted therapy (Judd, 2008, p.472-475).

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Non-small Cell Lung Cancer

Non-small cell (NSC) lung cancer is a type of cancer that affects epithelial cells of the lungs.

87% of lung cancer patients suffer from non-small cell lung cancer (Bellenir, 2007, p.313).

Symptoms include a cough that doesnt go away or gets worse; difficulty breathing or shortness

of breath; constant chest pain; coughing up blood; a hoarse voice; frequent lung infections, such

as pneumonia; fatigue; and weight loss (Judd, 2008, p. 468). Since symptoms of non-small cell

lung cancer are common symptoms of other less serious diseases, it is often found through

procedures such as X-ray, physical examination, and/or CT scan. The results are then analyzed

through invasive procedures such as biopsies (Bellenir, 2007, p.326-327).

Causes and Risk Factors

Each case of non-small cell lung cancer is different and due to many different genetic,

individual lifestyle, and environmental factors. However, there are known ways to increase a

persons risk for developing NSC lung cancer. One of the established leading causes is smoking

tobacco. Smoking tobacco contains a mixture of chemicals, many of which are known to be

carcinogenic, causing damage to the epithelial cells lining the lungs (Lung cancer non-small

cell, 2014). Alternative smoking habits such as smoking cigars, smoking e-cigarettes, or

smokeless tobacco products may reduce the likelihood of developing NSC lung cancer, but still

contain dangerous carcinogenic materials, and are not recommended (Lung cancer non-small

cell), 2014).

Genetic predisposition, air pollution, age, and previous radiation therapy can contribute to

the development of NSC lung cancer as well. Those with family members who had lung cancer

may be at a slightly increased risk, even if the person does not smoke. Air pollution may slightly
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increase the risk of lung cancer, because it damages lung cells. Those who have been diagnosed

with lung cancer tend to be over the age 65, indicating that the risk of developing lung cancer

increases with age. Those who have had lung cancer are a risk for relapsing and developing a

second lung tumor (Judd, 2008, p. 467).

Nutrition may also play a role in the risk of developing lung cancer. One study found that

for chronic smokers, those who ate a high amount of fresh vegetables and fruits were less at risk

than those who didnt for developing lung cancer (Gnagnarella, 2013).

Chemotherapy and Nutrition

As stated previously, one method of treatment for NSC lung cancer is chemotherapy; a cancer

treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by

stopping the cells from dividing. The anticancer drug can either be taken by mouth or injected

into a vein or muscle. The drug then enters the bloodstream and can affect cancer cells all over

the body; however, if it is placed directly into an organ or body cavity, then the drug mainly

affects cancer cells in those areas (Bellenir, 2007, p. 331-332). The side effects of chemotherapy

depend on the kind of drug(s) and the quantity of the drug. However, some side effects are

common for most of the chemotherapeutic drugs, which include hair loss, weak immune system,

fatigue, poor appetite, nausea and vomiting, diarrhea, and mouth and lip sores. These symptoms

are results of the anticancer drug harming normal cells that divide rapidly: blood cells, cells in

hair roots, and cells that line the mouth and digestive tract (Judd, 2008, p. 475).

Nutrition is important in helping cancer patients get the nutrients they need to maintain their

body weight and strength, keep body tissues healthy, and to fight infections. This contributes to a

better chance of recovery and quality of life. There is little definitive research on the subject,
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especially for non-small cell lung cancer, but one study that looked at metastatic colorectal

cancer patients going through chemotherapy determined that the patients that consumed enough

calories and protein in their diets to maintain muscle mass were better able to withstand

chemotherapy treatments and had much higher chances of survival (Blauwhoff, Versteeg, de van

der Scheuren MA, den Braver NR, Berkhof J, Langius JA, & Verheul, 2016).

Because chemotherapy tends to harm the cells lining the digestive tract, patients often

suffer from poor appetite, nausea, and vomiting. This can make it difficult to eat in general,

especially to eat foods high in necessary nutrients. Chemotherapy patients are encouraged to

consume foods that are nutrient-dense: fruits, vegetables, protein, low fat dairy, and whole

grains. They are encouraged to limit foods that are high in sugar and trans fats, including refined

carbohydrates and red meat. However, some physicians will recommend consuming a high-

calorie snack, such as a milkshake, right after chemotherapy before the drug takes effect in order

to ensure that the patient consumes enough calories for the day. Overall, the recommendations

for nutrition are to enjoy nutrient-dense and protein-rich foods, while limiting the foods that

cancer cells may feed off of, like sugars and fats (Chemocare, n.d.).

One case study suggested that Omega-3 fatty acids might help increase the chances of

survival and recovery (Diet & Nutrition; Case of Nutritional Treatment for Cancer Reported,

2005). As this is a case study looking at one man and his experience, the results can not be

generalized however.

Some tumors may alter the way the body uses certain nutrients; for example, the body may not

be able to absorb all the nutrients from the food, even if the patient is eating enough. This can

lead to a serious risk of malnutrition, which can cause the patient to be weak, tired, and unable to
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fight infections or get through cancer treatment. Therefore, consuming plenty of vitamins,

minerals, protein, and fat is vital for the patient to heal, fight infections, and have enough energy

(National Cancer Institute, 2016).

Limited Research and Future Studies

As stated previously, there is very limited research on specific nutritional guidelines for non-

small cell lung cancer patients going through chemotherapy. Most available information is

targeted for the general cancer patient population. It is very difficult to conduct nutrition-based

research on cancer patients. There are many variables that cannot be controlled for and it isnt

feasible or ethical to subject chemotherapy patients to controlled trial experiments examining the

effects of specific foods and nutrients in their recovery and survival.

One design that could potentially be employed more extensively is a longitudinal

observational study looking at lung cancer patients specific diets going through chemotherapy

and looking for correlations in recovery rates and periods of survival after diagnosis. Even

though a causal relationship wouldnt be established through this design alone, it may lead to the

discovery of patterns. This may not be feasible however, as longitudinal studies may require a

large amount of time and resources.

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Citations

American Cancer Society. (2014). Lung cancer (non-small cell). Retrieved March 02, 2016, from

http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/index

American Cancer Society. (2014). Key statistics for lung cancer. Retrieved March 02, 2016, from

http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-

lung-cancer-key-statistics

Bellenir K. (Ed.). (2007). Cancer sourcebook (5th ed.). Detroit, MI: Omnigraphics.

Blauwhoff-Buskermolen, S., Versteeg, K. S., M. A. E. De Van Der Schueren, Braver, N. R.,

Berkhof, J., Langius, J. A., & Verheul, H. M. (2016). Loss of Muscle Mass During

Chemotherapy Is Predictive for Poor Survival of Patients With Metastatic Colorectal

Cancer. Journal of Clinical Oncology. Retrieved from http://www.ncbi.nlm.nih.gov/

pubmed/26903572

Chemocare. (n.d.). Managing nutrition during cancer and treatment. Retrieved from http://

chemocare.com/chemotherapy/health-wellness/managing-nutrition-during-cancer-and-

treatment.aspx

Diet & nutrition; case of nutritional treatment for cancer reported. (2005). Cancer Law Weekly, ,

47. Retrieved from https://ezproxy.app.willamette.edu /login?url=http://

search.proquest.com/docview/223256869?accountid=15051

Gnagnarella, P., Maisonneuve, P., Bellomi, M., Rampinelli, C., Bertolotti, R., Spaggiari, L., ...

Veronesi, G. (2013). Nutrient intake and nutrient patterns and risk of lung cancer among
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heavy smokers: Results from the COSMOS screening study with annual low-dose CT.

European Journal of Epidemiology, 28(6), 503-11. doi:http://dx.doi.org/10.1007/

s10654-013-9803-1

Judd, S. J. (Ed.). (2008). Respiratory disorders sourcebook (2nd ed.). Detroit, MI: Omnigraphics.

National Cancer Institute. (2016). Nutrition in cancer care. Retrieved from http://

www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq