Foreword – Aoife Ryan, PhD, RD

When I first qualified as a dietitian twenty years ago, I spent eight wonderful years in a large University teaching hospital in Dublin working in oncology and gastrointestinal surgery. I met many patients who struggled to eat, and many experienced swallowing difficulties. Back then, we thought that if patients simply ate more food they would gain weight and do better. They were given high-protein, high fat, high-calorie dietary advice and black-and-white leaflets of information of what to eat and what to avoid. I remember feeling frustrated and disappointed when so many patients would continue to lose weight at follow up appointments and began to question what I was doing! My PhD work led me to a greater understanding of the complexities of nutritional status in patients with cancer and the impact that poor nutrition had on outcomes.

I, and many colleagues internationally, have been inspired by the research of Professor Carla Prado at the University of Alberta. Her work has dramatically changed the way that dietitians and doctors think about weight loss in cancer. Through evaluation of CT scans, Professor Prado was the first to notice that muscle was lost in large quantities following a cancer diagnosis and that this impacted how patients tolerated chemotherapy. Much research on this topic has been done over the past 10-15 years internationally, and what we now know is that cancer-induced weight loss affects 30-80% of patients and is associated with poorer tolerance to chemotherapy, impaired quality of life, more frequent hospital admissions, and reduced survival. The research of Professor Prado and others has shown that if patients eat enough energy (calories) and aim for 25-30 grams of protein per meal, they can better their chances of maintaining their muscle mass on cancer treatment. This means they have a better chance of tolerating treatment, including chemotherapy, radiotherapy, and/or surgery. The question is: how can a patient achieve these nutritional targets?

While many cancer patients eat as well as they can, they are unfortunately dealing with a series of complex changes in their metabolism. Cancer cells, through their interaction with the immune system, cause ‘chemical messengers’ to be produced in the body, which can cause appetite loss, inflammation, and rapid loss of muscle. It is a significant challenge to get some patients to stabilize their weight and an even greater challenge to help them to regain lost weight and muscle. We urgently need simple patient resources to help patients eat better in their homes and minimize these changes in their body composition.

Having spent many years writing scientific articles (that only fellow scientists would ever read), I decided in 2012 it was time to translate what we knew about nutrition into a simple cookbook for patients with cancer and their families. I was lucky to receive funding to work on this project and, in 2013, we launched ‘Good Nutrition for Cancer Recovery’  in Ireland, which is a free high-protein high-calorie cookbook for patients who are experiencing weight loss while undergoing treatment for cancer. We went on to publish cookbooks for swallowing difficulties in cancer, and cookbooks on healthy eating for cancer survivors in the years that followed. In total, we distributed over 50,000 free cookbooks to Irish patients. The impact of this work far outweighs any scientific articles I will ever write as it directly helps cancer patients, their families, and health care professionals. While our books have won a number of awards, I was always conscious that they were only available in Ireland. I am delighted that that Professor Prado’s team at the University of Alberta has developed their own high-protein cookbook, and I congratulate them on this enormous effort. This cookbook translates what scientists know about protein and good nutrition into easy-to-prepare, nutritious meals that can help slow the loss of weight and muscle mass. I have no doubt it will be well-received and greatly appreciated by patients and their carers. I am hopeful more countries will follow suit to make evidence-based nutritional resources more accessible.