Expert Explains Nutrition and Weight Loss Challenges in Gastric Cancer

Gastric cancer treatment can be especially challenging because patients often struggle with eating, maintaining weight, and managing nausea, vomiting and fatigue, as discussed by Dr. Raghav Sundar in an interview with CURE.

Sundar explained that difficulty eating is caused not only by the tumor filling the stomach and leading to early satiety, but also by reduced stomach motility. These issues, combined with treatment side effects, can result in abdominal discomfort and significant weight loss. Nutrition support is critical, and he emphasized that restrictive or low-calorie diets can be harmful rather than helpful for patients with cancer.

Sundar is an associate professor of internal medicine in medical oncology and hematology at the Yale School of Medicine. He noted that the growing number of clinical trials in gastric and gastroesophageal cancers is giving patients earlier access to newer treatment options and should be an essential part of care discussions.

Transcript

What are some of the most common challenges patients face during treatment, including side effects, nutrition concerns and emotional well-being, and how can these be addressed throughout treatment?

Having cancer and going through cancer treatment is not easy, and everyone experiences their own set of challenges. Gastric cancer is particularly difficult because the inability or difficulty in eating is not only due to the tumor filling the stomach and causing early satiety, but also because it reduces stomach motility. As a result, patients often experience a fair amount of general abdominal discomfort, nausea and vomiting, which can come from both the drugs we give and the tumor itself, as well as the general fatigue they face from treatment.

Patients often struggle to maintain their weight, so nutrition is extremely important. Almost all patients diagnosed and treated at Yale are referred to a nutritionist to help them maintain weight. One challenge we face is the myth that high-calorie diets will feed the tumor and allow the cancer to grow. In reality, the cancer is already causing weight loss, and low-calorie or sugar-deprivation diets can be more harmful than helpful, as patients may lose even more weight.

If the tumor metastasizes to other organs, gastric cancer commonly spreads to the peritoneum, or the lining of the abdomen. This area is difficult to treat because chemotherapy typically does not penetrate the peritoneal lining. Tumors there can block the intestines, leading to bowel obstruction, difficulty with bowel movements and vomiting, and in some cases intestinal perforation, which can be fatal. This is a major challenge we face. At Yale we have a highly specialized program for patients with peritoneal metastases, involving not only medical oncologists and chemotherapy, but also surgeons who specialize in treating peritoneal disease. We also offer additional approaches through clinical trials. There is a growing understanding worldwide that peritoneal metastases need to be treated differently than cancer that has spread to the liver or lungs.

Another important point is that the drug development space for gastric and gastroesophageal cancers is expanding rapidly. We now have multiple clinical trials available across the United States and at Yale that give patients access to newer and potentially better treatments earlier in their disease course. Highlighting the importance and value of clinical trials is essential for patients with these cancers.

Transcript has been edited for clarity and conciseness.

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