Oncology Nutrition needs uniform clinical practice guidelines

09 June 2021 | Opinion | By Prabhat Prakash

To win the battle against cancer, it isn’t just the treatment but also proper nutrition that patients and caregivers need to focus on. Research indicates that diet plays a very crucial role in determining the positive outcomes in cancer patients. Cancer-specific nutrition, needs to be very in-depth and needs to be mostly individualistic. To that end, there is definitely a major scope for oncology nutrition products in the Indian market as it is largely an untapped market Image credit- shutterstock.com Image credit- shutterstock.com

Over the years cancer treatment has improved by leaps and bounds. Cancer a few years ago was a dreaded disease as mortality rates were high. With time oncology treatment methodologies, technologies and outcomes have improved, which has helped quash the notion that an individual with any form of cancer was going to succumb to the disease. Today with better treatments available, millions across the globe have been able to get back to leading normal lives. Cancer treatment outcomes are only going to improve with time with newer breakthrough technologies and methodologies.

To win the battle against cancer, it isn’t just the treatment but proper nutrition that patients need to adhere to. The National Cancer Registry Programme Report 2020, released by the Indian Council of Medical Research (ICMR), estimates that there will be 13.9 lakh cases of cancer in India in 2020, and that this number is likely to rise to 15.7 lakh by 2025.

Cancer burden isn’t going to decrease anytime soon due to factors like sedentary lifestyle, consumption of processed foods, alcohol intake, smoking and various other factors which are still being researched. These factors also highlight the need to lead a healthy lifestyle along with a healthy balanced diet.

 

Buoyant Onco-nutrition market

During the course of treatment, diet is an important factor that helps patients recover better during treatment. Oncology nutrition which is relatively new, is a fast growing market across the globe. The oncology nutrition market was valued at $1.34 billion in 2017 and is expected to reach $2.21 billion by 2023 (Oncology Nutrition Market report: Markets and Markets). According to Mordor Intelligence report on Oncology Nutrition Market- Growth, Trends, COVID-19 impact, and Forecasts (2021 - 2026), Asia Pacific is seeing the fastest growth in oncology nutrition.

Samara Mahindra, CEO & Founder, Carer, Bengaluru is of the opinion that there are indeed some supplements that help a cancer patient with nutrition, who are unable to ingest orally or are facing major nutritional deficiencies, but they aren’t really helpful in the long run. She states, “The entire oncology nutrition market is negating a very imperative element of cancer nutrition, and that is the dietary regimen the patient is indulging in on an everyday basis. While nutraceuticals and nutritional formulas are great products to sell and have beneficial impacts on the nutritional status of the patient, only a few are interested in helping patients understand the importance of a healthy dietary regimen to follow for the long-run. Nevertheless, this is a two-way street, the suppliers are providing what is required for short term gains and the patients want a quick fix. Although both go hand in hand- neither is going to have a long-term impact on the patient’s recovery or well-being.”

In the last few years the nutrition market as well as the nutraceutical market has made splashes across the globe. People are more health conscious than they have ever been. There is a plethora of information available across forums. There are new nutritional/nutraceutical products cropping up in the market on a regular basis, but the information that is available, is either unclear or there is just no evidence of the effectiveness of the products. Products are pushed into the market with strong marketing strategies that have a psychological impact on consumers as they are hammered into the minds. 

“Cancer- specific nutrition, needs to be very in-depth and needs to be mostly individualistic. Cancer might be the same, as in the name, but every patient's body deals with it differently. There are various different parameters to be considered. Also there are various stages too. Hence we don't find cancer specific foods or supplements easily. Also taking into consideration the preservatives etc that might get added, which might be a minus point for cancer patients. Drug-nutrient interaction also needs to be looked into.

But recently there have been companies coming up with specific onco products and we can hope for the best, so that some more come in and we can give the best nutrition treatment to all cancer patients,” shares Suvarna Sawant, Chief Dietician, HCG Cancer Centre, Mumbai. She further adds, “We just can't prescribe a high protein and high calorie diet to them and leave it at that point. We, as  dieticians, have to pay special attention to the likes and dislikes of the patient, which is done through a thorough dietary recall. Based on this, individualistic diets are planned and given. Also in most cases, patients' appetite goes for a toss, hence we have to give them small portions of food with max calories and proteins, nutritionally dense meals.”

There is definitely scope for oncology nutrition products in the Indian market as it is largely an untapped market. Currently the oncology nutrition market is dominated by Abbott, Nestle SA, Fresenius Kabi AG, B Braun Melsungen AG and Hormel Foods Corporation, with the US being the largest market for oncology nutrition by 2024 (Oncology Nutrition Market- Growth, Trends, COVID-19 impact, and Forecasts (2021 - 2026): Mordor Intelligence report).

           

Preventing nutritional imbalance 

Mumbai-based Esperer BioResearch has launched two health supplements Es- Fortitude (nourish, protect & recovery) and Es- Invigour (base formula) directed towards cancer treatment, which is backed by extensive research on nutritional deficiencies in cancer patients in India. Raktim Chattopadhyay, Founder & CEO, Esperer BioResearch is of the opinion that oncology nutrition is of utmost importance, which can help a patient recover better during, after the course of cancer treatment. He comments, “One of the most relevant syndromes that increase as cancer progresses is cachexia or wasting of muscles that can cause weakness and death. Hyper metabolism is correlated with clinical and biological markers of cancer cachexia and is associated with a shorter survival in metastatic cancer patients. Thus, there is a need for preparing the body for the treatment, during the treatment and during recovery stage. Nutritional imbalance has a direct impact on cancer and our quest is to mitigate the risk that stems from nutritional deficiency in cancer patients.”

Diet not only plays an important factor in mitigating cancer risks but also in better recovery from cancer. Certain diets contribute significantly to certain types of cancers. Hence, one cannot emphasise enough on a healthy diet and lifestyle. Mahindra adds, “There are some nutritional supplements or formulas that are helpful and in some cases, essential in providing the additional nutritional resources to patients who are unable to ingest orally or are facing major nutritional deficiencies. However, there are also multiple brands and concoctions that are not validated and as a result are harmful in nature. In cases of depleted protein levels, which is a common side effect experienced by cancer patients, most, if not all, are prescribed protein powders. The issue occurs with the quality and ingredients of these powders. It either has high levels of refined sugar or preservatives that are unnecessary. The unfortunate circumstance in the country is that there is a lack of reliable and natural range of nutritional formulas that can be openly prescribed to the patient and supports their essential dietary requirements. Having said that, there is a change being witnessed as smaller companies are entering the market and are creating a wider range of wholesome and natural products for the clinical nutrition fraternity in India.”

 

Nonexistent uniform guidelines

Currently there are no standard guidelines in place in India when it comes to oncology nutrition, oncologist, dieticians rely on diets that patients are comfortable with, supplements are added if necessary as a booster. Dr Trinanjan Basu, Consultant Radiation Oncologist, HCG, Cancer Care Mumbai, says, “Oncology management has always been a pandora's box. There are complex interplays between diagnostic tools, treatment modalities, rehabilitation approaches and all cumulate into quality of life. Various international guidelines like European and American cancer nutrition (ASPEN and ESPEN) have formulated various aspects of oral and enteral nutrition among cancer patients. Unfortunately, we lack standardised pan India guidelines for the same. We do have institution- specific guidelines for cancer patients and it is really the need of the hour for uniform clinical practice guidelines for cancer nutrition.” He further comments, “Cancer-specific food or supplements are a complete misnomer. There are studies which have emphasised that Indian diet is well balanced for all essential macro and micronutrients. The issue or the paradox is the inability to consume the same due to treatment related side effects. The latter becomes important while patients of enteral or parenteral nutrition (tube feeding or IV nutrition). The challenge to supplement essential nutrients becomes paramount in these scenarios. We do have availability of many nutritional supplements in India and I believe at times we as oncologists face the huge task of understanding which is superior.”

The Indian onco-nutrition market has been gaining momentum but it requires a more inclusive collaborative approach. Imported, over the counter supplements cannot fill the nutrition void that cancer patients suffer from. There is a need for more companies to invest in oncology nutrition that caters to the Indian demography as imported products that are available haven’t been made keeping Indian cancer patients in mind. The demand for oncology nutrition products is on the rise, with well rounded products being the need of the hour.

 

prabhat.prakash@mmactiv.com

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