Nutrition for the Feline Oncology Patient
AN INDIVIDUALIZED APPROACH TO NUTRITIONAL MANAGEMENT OF OUR PATIENTS
Nutrition is an important part of ensuring your cat has a good quality of life during and after receiving cancer therapy. Your cat’s nutritional needs can be affected by his/her appetite, the specific cancer diagnosis, the treatment approach used to manage the cancer, and concurrent medical conditions s/he may have. We believe that this complexity requires an individualized approach to nutritional management for each of our patients. Cancer and its treatment can be associated with side effects that influence nutritional status. The most common side effects include hyporexia (decreased appetite) or anorexia (no appetite). Hyporexia or anorexia may develop for 1-2 days or may last for a prolonged period of time. Our concerns with your cat’s nutritional status increase as the frequency of hyporexic or anorexic episodes expands.
TOPICS RELATED TO NUTRITION FOR CATS WITH CANCER
There are many sources of information that attempt to deal with the nutritional needs of cats with cancer. A one-size fits-all approach to the dietary needs of a cancer patient is not realistic. Furthermore, some information regarding the nutritional needs of cancer patients can be trusted, some are not likely to hurt, while other sources are factually flawed and potentially harmful. The following nutritional topics have received considerable attention in the field. A considered approach focused on your cat’s nutritional needs is the best approach.
CARBOHYDRATES AND CANCER
Several sources online recommend a high protein, low carbohydrate, and grain-free diet for all cancer patients. It is believed that feeding a low carbohydrate diet decreases fuel for cancer cells, and such a diet provides more energy in the form of fats and proteins for the cat. In fact, there are no good medical studies to show that feeding high, low, or medium carbohydrates have much of an effect on survival in cats with cancer. The theory behind a low carbohydrate diet is that cancer cells use glucose as their primary energy source. When cancer cells use glucose they create a compound called lactate. Lactate leaves the cancer cell and is converted back to glucose in the cat’s liver. This conversion of lactate to glucose requires energy. During this process some have speculated that the cancer gains energy but the patient loses energy. This could theoretically contribute to the condition called cancer cachexia (severe, uncontrolled weight loss). In reality, most cats with cancer will not develop cancer cachexia. Feeding a low carbohydrate diet has not been shown to improve survival or response to chemotherapy or radiation therapy. Cats are carnivores and do not require carbohydrates in their diets. Even so, studies have shown that carbohydrates are not bad for cats and most likely do not cause diabetes mellitus or obesity.
Cats with certain medical conditions, such as kidney failure or gastrointestinal disease, require a low protein or low fat diet. With these diets, carbohydrates provide an important energy source while minimizing the amount of fats and proteins in the diet that could exacerbate his condition. Feeding a low carbohydrate diet is not recommended because low carbohydrate diets are delicious to most cats and it is often difficult to change a cat’s diet from a low carbohydrate diet to a higher carbohydrate diet (low fat and/or protein) that may be required for some medical conditions. Also, if your cat is eating a low carbohydrate diet it will be very difficult to find a replacement diet if he/she becomes finicky about their food.
BALANCING FATTY ACIDS
Considerable debate and discussion has focused on the use of Omega-3 fatty acids in cats with cancer. Omega-3 fatty acid supplementation has been evaluated in single study of dogs with lymphoma. Currently there are no published studies looking at omega-3 fatty acids in cats with cancer. In most cases, fatty acids have minimal side effects and may be a consideration for your cat. A discussion with your oncologist or the nutritionist is recommended prior to starting any supplements, including fatty acids.
INTEGRATING NUTRITION INTO THE CARE OF YOUR CAT
If your cat is eating a regular diet at the beginning of therapy, we recommend that we continue feeding this diet until the end of the initial treatment cycle. This will allow us to evaluate your cat’s nutritional status and how his/her body reacts to the therapy. This assessment is used to determine whether there is a need for a diet change to fit his/her medical requirements. We encourage you to discuss all dietary concerns with your oncologist. The development of an individualized nutritional plan may be considered for your cat. In cases where your cat is not eating well a more immediate approach to meet nutritional needs may be necessary.
MANAGEMENT OF DECREASED APPETITE IN FELINE CANCER PATIENTS
For cats that are hyporexic, feeding enough calories is the most important goal. Providing a palatable diet that your cat will eat consistently is more important than providing a specialized diet.
Some cats will like therapeutic ‘recovery diets’ such as Hill’s Prescription Diet a/d, Iams Maximum Calorie, Royal Canin Recovery RS or Purina CV Feline Formula. Warming the food for 5-10 seconds can enhance the smell and may encourage him/her to eat.
Some cats want something new and different. For these cats, having a variety of foods may be beneficial.
Other cats can be particular about the type (canned vs. dry), flavor, and texture of foods. Studies have documented that cats are often affected by the shape of dry food as well as the flavor. There may be a similar effect to the consistency of canned foods (pate vs. sliced vs. shredded vs. gravy).
Make sure when you are offering a variety of food that you offer various shapes, textures, or consistencies of food as well as flavors. Knowing what your cat is used to eating may help to guide you to the type of food she may be willing to eat when hyporexic.
WHAT ABOUT “PEOPLE” FOOD?
Feeding ‘people food’ can sometimes stimulate your cat’s appetite. You can offer a variety of foods such as cooked eggs (scrambled or hard boiled) or cooked meats (i.e. roasted boneless skinless chicken, canned chicken, pan brown ground turkey or ground beef, or tuna packed in water). Chicken or beef broth can be used as gravy; however, make sure that it does not have garlic or onion in it.
What to avoid: Baby foods are not recommended because they don’t provide enough calories and may contain garlic and onion that can be toxic to cats. Dairy products are also not recommended for most cats since they can cause gastrointestinal upset.
You should never feed your cat raisins, grapes, garlic, onion, chocolate, or artificial sweeteners since these can be toxic.
MANAGING CATS WITH NO APPETITE
It is important that you do not force your cat to eat. This includes syringe feeding and continuing to place bowl of food in front of your cat even after he/she has walked away from it. Cats can develop severe food aversion, and foods that are forced on them will often not be acceptable to the cat for a long period of time and possibly for life. This obviously makes it more difficult in treating a recurrent hyporexic or anorexic cat. We recommend that you offer a small amount of food every 4-6 hours and leave it out so that your cat can return to the food ifhe/she develops an interest in it.
It is important to discuss with your oncologist or primary care veterinarian the amount and type of food that is needed to support your cat’s daily activity. In cases where cats are not eating a balanced diet for a long period of time, vitamin and mineral supplements should eb recommended. If anorexia is going to be a persistent problem and your cat otherwise has a good quality of life, a feeding tube may be considered to provide nutritional support. Feeding tubes are generally very well tolerated and can significantly improve the nutritional management of your cat. Discussion with your oncologist and nutritionist may be helpful to make sure this would be the right decision for your cat.