Abstract
Purpose
Many patients with cancer are interested in complementary therapies, including strategies such as reduced carbohydrate diets. Guidelines regarding the use of these diets during cancer treatment are lacking; therefore, we aimed to explore the perceptions and practices of medical oncologists in Canada regarding low-sugar and ketogenic diets.
Method
A cross-sectional, online multiple-choice survey was distributed to 206 Canadian medical oncologists. Questions explored frequency of patient interactions, oncologist perceptions of efficacy, advice given to patients, and concerns about side effects related to reduced carbohydrate diets.
Results
Responses were received from 57 medical oncologists in seven of thirteen provinces and territories, with an overall response rate of 28%. Forty-nine percent of respondents were asked at least weekly about a low-sugar diet, and 9% about the ketogenic diet. Eighty-five percent supported the use of a low–added sugar diet in patients with diabetes or hyperglycemia, while conversely 87% did not support the use of a ketogenic diet for any of their patients undergoing active cancer treatment. Respondents felt either that a ketogenic diet was not effective (31%) or that the effect on cancer outcomes was unknown (69%). Ninety-six percent of respondents had concerns about a ketogenic diet for patients receiving active cancer treatment.
Conclusion
The role of reduced carbohydrate diets during cancer treatment is topical. Canadian oncologists are particularly reluctant to support a ketogenic diet for patients on active cancer treatment, with concerns about side effects and unknown efficacy. There may be a role for continuing medical education and institutional guidelines to inform these discussions with patients.
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Acknowledgments
We would like to thank Emmy Moreno and Caitlin Woodrow, dietetic interns with the Manitoba Partnership Dietetic Education Program (2018–2019), for their assistance with analysis of the pilot survey data.
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CK, PK, and KV designed research (project conception, development of overall research plan, and study oversight). CK, PK, and BG conducted data collection. CK, PK, and PL analyzed data. PK and CK wrote the paper and had primary responsibility for final content. All authors read and approved the final manuscript.
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Informed consent was gained from all participants via the survey introduction, which stated the purpose of the study, the length of time required to complete the survey, and contact information of the study investigators. Ethical approval for the study was granted by the University of Manitoba Health Research Ethics Board and was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.
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CK has a research grant from Celgene Inc. PK, PL, KV, and BG declare that they have no conflict of interest.
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Klassen, P.N., Goldenberg, B.A., Lambert, P. et al. Ketogenic and low-sugar diets for patients with cancer: perceptions and practices of medical oncologists in Canada. Support Care Cancer 28, 5243–5249 (2020). https://doi.org/10.1007/s00520-020-05361-9
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DOI: https://doi.org/10.1007/s00520-020-05361-9