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Meredith Barwin knows food provides more than just nutrients.
"It's social and it's emotional, too," says Meredith, a registered dietitian at the Princess Margaret Cancer Centre. "It connects people on so many different and important levels."
When a patient is diagnosed with head and neck, lung, esophageal or gastric-esophageal cancer, the multidisciplinary team at the Princess Margaret knows nutrition is going to be a challenge.
Radiation or chemotherapy can dramatically reduce a patient's appetite, change how foods taste, cause digestive disturbance and result in painful or troubled swallowing. The location of a tumour might also impact the ability to ingest food by mouth.
Preventing and treating malnutrition is key.
"Cancer takes a huge amount of a person's energy," says Meredith, who joined the Princess Margaret last year after completing her bachelor of science in Applied Human Nutrition at the University of Guelph and a dietetic practicum at Toronto Metropolitan University through St. Michael's Hospital and Unity Health Toronto.
"Early intervention with cancer patients can help to prevent severe muscle wasting and weight loss, and improve outcomes."
March is Nutrition Month in Canada. At UHN, the Clinical Nutrition team of about 70 registered dietitians and eight clinical diet technicians work with multidisciplinary care teams and members of UHN Nutrition Services to contribute to the overall health and quality of life for patients.
The UHN Nutrition Services team includes six administrative registered dietitians as well as 225 staff and supervisors. Nutrition Services play a key role in ensuring not only meals and snacks, but nutrition supplements and formulas are delivered to the inpatient units each day.
In 2021, Health Standards Organization and the Canadian Malnutrition Task Force released a new standard on Malnutrition Prevention, Detection and Treatment. This is geared to improve inpatient outcomes by providing standards of care for multimodal nutrition care, screening, assessment and treatment across acute care hospitals.
UHN is in the process of rolling out a standardized malnutrition screening tool for the registered dietitians across all sites. This will further support the screening, diagnosis, treatment and monitoring of malnutrition for patients.
'Food is a very personal thing'
At the Princess Margaret, patients undergoing cancer treatment face changes in their metabolism. That often means they need to get more protein and other nutrients into their diet.
"The earlier we get involved, the more time we have to adjust what's working and what's not working," Meredith says. "The body is like a car, if you don't put fuel into it, it's not going to go."
The nutritional interventions for the patients she works with vary. For some, a modified texture diet such as pureed or minced food or a fluid diet alone is the best option. For others, insertion of a gastric tube or G-tube – a feeding tube directly into the stomach – is the preferred choice.
Janet, who was diagnosed with esophageal cancer last summer, says Meredith has been an integral part of her care team at the Princess Margaret.
"At the beginning, I had no idea of the implications of radiation and chemotherapy on my nutrition," says Janet, noting Meredith made frequent visits to her hospital room to discuss food and medicine intake through a G-tube. "She's always so helpful, upbeat and cheerful."
Since returning home, Janet says Meredith has continued to be "a lifeline," advising on the transition away from a G-tube to an orally-consumed diet of liquid, pureed and soft foods. Janet says the young dietitian has connected her with a speech-language pathologist to help monitor swallowing and also liaised with her care team to ensure Janet got needed supplies of nutrition and medicine.
"Knowing I was going home from the hospital but would still be talking to her regularly has been a blessing," says Janet, who recently celebrated her 80th birthday and has resumed walks and some social engagements. "She makes herself available and always calls back."
Meredith says the key is to determine with patients what works best for them.
She recalls the positive impact of a simple suggestion to a patient that they pour their Ensure nutritional drink over ice to improve the taste. Another was finding their G-tube schedule was interfering with outings, so they worked together to alter the timing to increase convenience.
"Food is a very personal thing," Meredith says. "We work together with patients to help figure out what's going to make them feel the most comfortable at this difficult time."