Supporting the

Neuroendocrine Cancer Community

The role of a dietitian

Oct 31, 2021

Food is a basic need of the body. 

How the body uses food, changing it into energy and using it to provide us with the essential nutrients we need is amazing!

For many of us, food is also an essential part of our social lives.

For those diagnosed and living with cancer, the relationship with food and eating can change – and our body’s ability to process food can be disrupted.

This can happen due to where the cancer (or tumour) is or how it may change your appetite. 

Sometimes, the treatment for cancer can cause symptoms that put you off eating. 

These changes in appetite and eating can be distressing for both you and your family or friends. 

Even if you don’t have symptoms, you may still be concerned about ensuring that you are eating the ‘right’ foods.

Some cancers within the digestive tract or in other parts of the body may alter your normal hunger and fullness signals : you no longer feel hungry even when you haven’t eaten in a while or you may feel full even after eating only a small portion. 

Neuroendocrine Cancer can alter function due to:

  • the impact of the tumour (physically and mentally)
  • the presence of a tumour
  • the function of the tumour (e.g.excess gut hormone secretion)
  • the treatments of the tumour (surgery, medications, interventions)

There are a number of diets and online recommendations as to how you can utilise diet (food and drink) to improve general health and cancer – how to use food to address symptoms you may be experiencing due to cancer or its effects.

Getting the right information is vital.

We talked yesterday about how to check for misinformation, to ensure you get the right information for you.

But, you don’t have to go it alone – your specialist team / specialist nurse / specialist dietitian can help.

We are aware that not all specialist teams have a dietitian as a core member of the team, however many do have access to a dietitian – you may just need to ask.

 A dietitian is a qualified, registered, allied healthcare practitioner. 

He/she has learned from and, often, contributed to the science of nutrition, applying that knowledge, in practice, to improve health, alleviate symptoms, empower self-management and positively benefit overall survival.

However, it can be a bit confusing – there are a number of titles, that may, at first glance, appear to be roles (people) that do the same thing. Not so.

  1. Dietitian
  2. Nutritionist
  3. Nutritional therapist or Diet Expert

 

1. Dietitian : are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public health level. 

Their role is regulated by law and governed by an ethical code to ensure that they always work to the highest standard. The term dietitian is a protected title in the UK 

This regulatory oversight means that dietitians have extended authority to work on evidence-based recommendations. This means they can work with clients within medical treatment programmes or with existing severe medical illnesses.

You can check whether your dietitian is registered on the HCPC online register.

2. Nutritionist : are qualified to provide information about food and healthy eating.

Anyone can call themselves a nutritionist, however only registrants with the UK Voluntary Register of Nutritionists (UKVRN) can call themselves a Registered Nutritionist (RNutrs). 

Registered Nutritionists are not permitted, by law, to call themselves dietitians. The term “nutritionist” is not a protected title in the UK.

Nutritionists can only work to provide general diet and healthy lifestyle advice to private clients (adults and children) who are outside of medical treatment.

You can check whether your nutritionist is registered on the AfN website.

 3. Nutritional therapist or ‘Diet Expert’ : Anyone can use these titles, however, they are not permitted, by law, to call themselves dietitians.

Nutritional therapists are not eligible to register with either UK Voluntary Register of Nutritionists (UKVRN) or the Health & Care Professions Council (HCPC). However, they are able to register with the Complementary and Natural Healthcare Council – though this is not compulsory.

“Diet Experts’ have no registration or regulatory authority. BDA (The UK Association of UK Dietitians)

During the initial assessment of a cancer patient, a dietitian will assess nutritional status which involves asking about a patient’s weight changes, appetite and food intake. They will also consider and interpret relevant previous medical history, current test and scan results, and any issues that may be happening as a result the cancer and/or it’s treatment – both physically and mentally.

They will work with you, your specialist team and primary care to address any nutritional concerns. 

Further information about the role of the dietitian and what they do is available from the BDA.

You can listen to NCUK CEO Catherine Bouvier chat with Tara Whyand (expert dietitian) here discussing many of the topics we have covered this week – including myth busting, dietitian v nutritionist role, vitamins.

Impact of dietitian input 

Reported in an abstract presented at ENETs (European Neuroendocrine Tumor Society) more than 10 years ago :  Neuroendocrine Cancer “can have a negative impact on patients’ nutritional status.” 

The study, carried out at the Royal Free Hospital Centre of Excellence, looked at the impact dietitian input had on those experiencing nutritional problems and weight loss. 

137people were referred to the specialist dietitian – more than half completed the user feedback survey (76 people = 56%): of these 88% (67 people) said they benefited from seeing the dietitian – with 45 people reporting that the specialist dietary advice received improved their problem – all but 2 patients reported that they were able to follow the advice. Schnaid et al. :  Abstract #39: 7th Annual ENETS Conference (2010)

Dowd et al (Cardiff Neuroendocrine Cancer Service) abstract presentation at UKINETs (UK & Ireland Neuroendocrine Tumour Society) last year, echoed these findings:

 “There are a range of gastrointestinal issues which can be related to the NET (Neuroendocrine Cancer), treatment, surgical intervention, or pre-existing diseases. Many of these can … be improved through altering diet with the support of a specialist dietitian.”

They concluded that

“dietetics should be a core member of the MDT to improve patients’ outcomes, quality of life and to allow specialist dietetic intervention”.

Kikut et al (2020) support this conclusion and, looking at digestive tract Neuroendocrine Tumours (GEP-NETs) in particular,  go a step further in recommending the development of consensus guidelines for care :

Dietetics support and the development of official nutritional standards seem to be a necessary element in the therapy of GEP-NET patients.”

NCUK has been supporting the collaboration of a group of specialist dietitian, with experience and expertise in Neuroendocrine Cancers, to develop guidelines for care – we hope to be able to announce, in the very near future, the publication and sharing of this very important piece of work.

  Further information on Diet and Nutrition – and Neuroendocrine Cancers –  can be found on our website – www.neuroendocrinecancer.org.uk 

Around 36,000 people are affected by Neuroendocrine Cancer in the UK, with over 5,000 people newly diagnosed each year. That is more than 13 people a day. 

For many the first time they will have heard about Neuroendocrine Cancer will be the day they receive their diagnosis.

In 2020 we launched Faces of NCUK & Voices of NCUK. 

These campaigns provide a platform for those who wish to share their journey and experiences and are a source of support for those who have just started their journey.

We’re always looking for people to share their experiences of Neuroendocrine Cancer.

By raising awareness of Neuroendocrine Cancer (NC), we can reach and help more people. Personal stories highlight so many relevant aspects of living with NC, provide important insights that support education of healthcare professionals, raise awareness of possible signs and symptoms pre diagnosis, raise awareness of NC in the general public arena and encourage and inspire other people who have just started on their journey. 

You can share your story here.