Bladder tumors, what to eat to overcome the heat and the side effects of therapies

Plunging temperatures, high humidity and long days: a mix that especially knocks out the most fragile people including cancer patients in therapy, exhausted by the disease but also by the inevitable side effects of drugs. nutrition can play a strategic role both in helping to combat the summer heat and in contrasting the consequences of treatments. It was discussed during the event “Gourmeet – Multidisciplinarity in comparison for people with bladder cancer” what is it? recently held in Rome at the Citta? del Gusto by Gambero Rosso Academy, with the patronage of SIUrO – Societa? of Uro Oncology, AIOM Italian Association of Medical Oncology, PaLiNUro Patients Free From Urothelial Neoplasms and SIU – Society? Italian of Urology. The event, organized by Pharmalex – formerly MAPCOM and with the unconditional contribution of Astellas.

Heat and side effects

Bladder cancer is in fifth place among the most frequent in the Italian population. More than 90% of bladder tumors (distinguished between those in superficial forms and those that infiltrate the muscular tunic) consist of urothelial carcinomas. In patients affected by this pathology and who are being treated with oncological drugs, the side effects associated with these treatments can reduce the patient’s quality of life and decrease their therapeutic adherence. Added to this is the exhaustion caused by the high temperatures of this period which worsen the fatigue. “To face the treatment path in the best possible way and try to prevent or control these adverse reactions – he explains Salvatore ArtaleSC Director of Medical Oncology Hospitals of Vimercate, Desio, Carate Brianza, ASST Brianza – it is important that the patient adopts a healthy lifestyle that includes a personalized diet designed together with a specialist”.

Taste perversion and diarrhea

We are used to thinking of the typical effects of chemotherapy such as nausea and vomiting, but with the arrival of new therapies, the potential contraindications also change. “Today we have new drugs, such as, for example, conjugated antibodies, which have specific cytotoxicity, i.e. they do not have the typical side effects of chemotherapy but sometimes tiredness or dysgeusia, i.e. taste alteration, and diarrhea appear unexpectedly”, specifies Artale who is also the creator of the portal www.oncologiaecucina.it. “These drugs have just entered clinical practice and we are using them in our hospitals realizing that the side effects are managed very well. Naturally, in the heat, patients who are in therapy may have more tiredness and less appetite”.

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The ingredients of health

Precisely to counteract these side effects and those caused by the heat, during the event ‘The ingredients of health’ was presented, the recipe book describing the dishes and nutritional advice created by Salvatore Artale and his Team and by Domenico Stile, a of the youngest Chefs with 2 Michelin stars in Italy. “We have devised ad hoc recipes to try to encourage patients’ adherence to therapy because in the face of an important advantage from the point of view of therapeutic efficacy, we need the patient to adhere to the treatment and therefore we have provided some useful advice about what to eat”.

The menu to fight fatigue

The continuous feeling of tiredness and lack of energy is also partly due to the loss of muscle mass (sarcopenia). What to put on the table? “We need foods that are sources of vegetable or animal protein, preferably fish. For example, you can opt for soy as it has a high amount of protein. Alternatively, it is possible to use other legumes such as lentils, chickpeas, broad beans, beans, peas to be cooked, all peeled as they are more digestible”. The recipe book also suggests the use of vegetable proteins as well as dark chocolate in small quantities.

For patients with renal insufficiency

Patients presenting with urothelial carcinoma are often elderly and with comorbidities such as renal insufficiency. In these patients, a high amount of protein could create problems. How to adjust? “Some nutrients such as protein and sodium, potassium and phosphorus intake need to be kept under control. Two simple dishes to prepare for this type of patient can be wholemeal pasta in 5 tomato and basil sauce: a dish rich in fiber thanks to the wholemeal component of the flour, vitamin E present in EVO oil and beta-carotene contained in tomatoes or a greek salad with yellow and red peppers, red onion, tomatoes and cucumbers what? the right amount of nutrients also based on the degree of renal insufficiency”.

The menu to fight diarrhea

One of the most annoying and disabling side effects is mild diarrhea with two or more stools per day. “When the patient is in this condition – explains Artale – the body is unable to absorb the nutrients and water in a sufficient manner. If left untreated, diarrhea can lead to serious consequences: stomach cramps, weakness, weight loss, dehydration, poor appetite and electrolyte disturbances. For this, the recipe book offers a first course with white rice which is? rich in complex carbohydrates and with a minimal portion of fiber and almost free of lipids. “Consumption in the form of a cream – continues the oncologist – is recommended in case of inflammation of the digestive tract and in the presence of diarrhea. Furthermore, this first course can be useful in buffering the excess liquids of the irritated intestine, reducing diarrheal discharges. AND? important to pass the cream of rice with the vegetable mill because this step allows you to eliminate part of the fiber, contraindicated in case of diarrhea or inflammation of the digestive tract”. Instead, the following should be avoided: dairy products, fried, fatty and spicy foods, sweets and foods that contain large amounts of sugar, raw fruit and vegetables, legumes, all types of seeds, coffee and alcohol.

How to make the urge to eat come back

Dysgeusia, i.e. the alteration of taste, is not an effect to be overlooked both because it could cause a reduction in the patient’s adherence to treatments already tried by the heat, and because it could cause loss of appetite, leading to weight loss and a condition of malnutrition. “You need strong flavors like cuttlefish and short cooking like blanched to bring out the flavor even more. AND? recommended to add aromatic herbs such as mint, chives and basil”. Hydration is also essential in patients with bladder cancer after surgery who must drink as much as possible.

Hydration with drinks and food

The heat and the consequent fatigue must be tackled first of all with hydration. “Patients have to make up for the loss of minerals by choosing foods that contain a lot of water, such as zucchini. For those who lose their appetite, some precautions can be taken, for example fruit popsicles or smoothies with fruit and vegetables which are refreshing and also caloric and therefore useful for combating fatigue”, suggests Artali who instead advises against carbonated drinks and even those that contain artificial sweeteners: “Some sweeteners are not good because they can cause gastrointestinal disorders and then select bacteria that in bladder cancer is better not to select such as Escherichia choli responsible for urinary tract infections”.

How important is multidisciplinarity

Nutrition therefore enters fully into the treatment strategies of the oncological patient. In particular, the complex management of bladder cancer, despite the latest therapeutic advances, shows how this disease remains aggressive and very difficult to cure. Precisely for this reason we need a treatment path managed by a multidisciplinary team made up of oncologists, urologists, nutrition experts, hospital pharmacists and psychologists. During the event, ample space was reserved for the impact on the quality of life of patients affected by this pathology, especially in moments of greater fragility and vulnerability of the patient. “We consider bladder cancer as a complex and orphan disease. Is there? a poor awareness of the pathology among patients and caregivers who are often poorly informed and poorly supported in the various phases of the treatment path. Events like this, together with the constant work of the Association, are fundamental for spreading awareness of the disease”, declares Laura Magenta, assistant president of the PaLiNUro Association. “At the same time they support people in a treatment path that increasingly looks at their well-being at 360°. As repeatedly stated and supported by extensive scientific literature, the link between healthy and correct nutrition and therapeutic pathways is increasingly cohesive, also from the point of view of prevention”.